Kudziletsa: malangizo ogwiritsira ntchito, analogi
Gome 1. Kusintha kwa thupi pa insulin
| Nthawi yophunzira | Insulin kudziletsa kamodzi | Insulin detirir kawiri | Isofan insulin | Insulin glargine |
| Masabata 20 | + 0,7 kg | + 1.6 kg | ||
| 26 milungu | + 1,2 kg | + 2.8 kg | ||
| Masabata 52 | + 2.3 kg | + 3.7 kg | + 4.0 kg |
Mu maphunziro, kugwiritsa ntchito mankhwala osakanikirana ndi mankhwala a Levemir ® FlexPen ® komanso mankhwala a hypoglycemic amachepetsa chiopsezo chokhala ndi hypoglycemia yausiku ndi 61-65%, mosiyana ndi isofan-insulin.
Chiyeso chotseguka, chosasankhidwa cha odwala adachitidwa ndi odwala omwe ali ndi matenda amtundu wa 2 omwe sanakwaniritse zomwe akufuna.
Phunziroli linayamba ndi nyengo ya kukonzekera kwa masabata 12, pomwe odwala adalandira chithandizo chamankhwala a liraglutide osakanikirana ndi metformin, ndipo omwe 85% odwala adakwaniritsa HbA1c® FlexPen ® mu kumwa kamodzi tsiku lililonse, wodwala winayo anapitilizabe kulandira liraglutide kuphatikiza ndi metformin kwa milungu 52 yotsatira. Munthawi imeneyi, gulu la achire, lomwe linalandira, kuphatikiza liraglutide ndi metformin, jekeseni imodzi ya Levemir ® FlexPen ®, idawonetsa kuchepa kwa index ya HbA1c kuyambira koyamba 7.6% mpaka 7.1% kumapeto kwa masabata 52, pakalibe zigawo za hypoglycemia yayikulu. Powonjezera muyezo wa Levemir ® FlexPen ® ku liraglutide tiba, omalizawo adakhalabe ndi mwayi pokhudzana ndi kuchepa kwakukulu kwa kulemera kwa thupi mwa odwala, onani Table 2.
Gawo lachiwiri la mayesero a Clinical - mankhwala a Levemir ®, omwe adapangidwira kuwonjezera pa mankhwala ophatikizidwa ndi liraglutide ndi metformin
| Masabata a chithandizo | Odwala mwachisawawa kuti alandire chithandizo ndi Levemir ® FlexPen ® kuwonjezera pa liraglutide + metformin N = 160 | Odwala mwachisawawa kuti alandire liraglutide + metformin mankhwala N = 149 | Kudalirika kogwirizira posintha P-mtengo | |
| Kusintha kwapakati pamtengo wa chizindikiro cha HbA1c poyerekeza ndi poyambira mayeso (%) | 0–26 | - 0,51 | + 0,02 | |
| 0–52 | - 0,50 | 0,01 | ||
| Chiwerengero cha odwala omwe afikira phindu la HbA1c0–26 | 43,1 | 16,8 | ||
| 0–52 | 51,9 | 21,5 | ||
| Sinthani kulemera kwamthupi la odwala poyerekeza ndi zizindikiro poyambira mayeso (kg) | 0–26 | - 0,16 | - 0,95 | 0,0283 |
| 0–52 | - 0,05 | - 1,02 | 0,0416 | |
| Magawo a hypoglycemia wofatsa (wambiri wa zaka 0 wodwala wowonekera wa mankhwala oyeserera) | 0–26 | 0,286 | 0,029 | 0,0037 |
| 0–52 | 0,228 | 0,034 | 0,0011 |
M'maphunziro a nthawi yayitali (≥ miyezi isanu ndi umodzi) okhudzana ndi odwala omwe ali ndi vuto la matenda a shuga 1, kuthamanga kwa plasma glucose kunali bwino kuyerekeza ndi chithandizo ndi Levemir ® FlexPen ® poyerekeza ndi isofan-insulin yokhazikitsidwa pazomwe zimagwiritsidwa ntchito poyambira / bolus. Glycemic control (HbA1c) pochita mankhwala ndi Levemir ® FlexPen ® anali wofanana ndi isofan-insulin, koma ali ndi chiopsezo chocheperako cha hypoglycemia usiku komanso osachulukitsa thupi ndi Levemir ® FlexPen ®.
Zotsatira za kafukufuku wazachipatala zomwe zimawunika machitidwe a basal-bolus a insulin zimawonetsa zochitika zambiri za hypoglycemia nthawi yonse ya mankhwala a Levemir ® FlexPen ® ndi isofan-insulin. Kuwunikira kwa chitukuko cha nocturnal hypoglycemia kwa odwala omwe ali ndi vuto la matenda ashuga 1 amawonetsa kuchepa kwakukulu kwa hypctlyalemem ya nocturnal pogwiritsa ntchito Levemir ® FlexPen ® (pamene wodwalayo atha kudziyimira payekha mkhalidwe wa hypoglycemia, komanso pamene hypoglycemia imatsimikiziridwa ndikuyesa kuchuluka kwa shuga m'magazi a 2. , 8 mmol / L kapena chifukwa choyeza kuchuluka kwa shuga m'magazi osakwana 3.1 mmol / L), poyerekeza ndi omwe amagwiritsa ntchito isofan-insulin, pomwe pakati pa mankhwala aŵiri sanaulule kusiyana pakutchulidwa pafupipafupi nkhani ya nocturnal hypoglycemia m'mapapo odwala ndi mtundu 2 shuga.
Mbiri ya usiku wa glycemia ndi yosalala komanso yowonjezereka ndi Levemir ® FlexPen ® poyerekeza ndi isofan-insulin, yomwe imawoneka pachiwopsezo chochepa chokhala ndi hypoglycemia yausiku.
Mukamagwiritsa ntchito Levemir ® FlexPen ®, kupanga antibody kunawonedwa. Komabe, izi sizikhudza kuwongolera kwa glycemic.
Mimba
Mu mayeso a chipatala omwe amathandizidwa mosasamala, omwe anaphatikiza amayi 310 oyembekezera omwe ali ndi matenda amtundu wa 1, mphamvu ndi chitetezo cha Levemir ® FlexPen ® mu basement-bolus regimen (odwala 152) poyerekeza ndi isofan-insulin (odwala 158) mu kuphatikiza ndi insulin, monga prandial insulin.
Zotsatira za phunziroli zidawonetsa kuti odwala omwe amalandila mankhwalawa Levemir ® FlexPen ®, kutsika komweku kunawonedwa poyerekeza ndi gulu lomwe limalandira isofan-insulin HbA1c pa milungu 36 ya bere. Gulu la odwala omwe amalandila chithandizo ndi Levemir ® FlexPen ®, ndipo gulu lomwe limalandira mankhwala a isofan-insulin, munthawi yonse ya bere, lawonetsa zofanana mu mbiri yonse ya HbA1c.
Target HbA Level1c ≤ 6.0% pa sabata la 24 ndi la 36 la kubereka limapezeka mu 41% ya odwala omwe ali mgulu la Levemir ® FlexPen ® gulu la odwala komanso mu 32% ya odwala omwe ali mgulu la isofan-insulin.
Kusala kwa glucose kosatha pamasabata 24 ndi 36 kwa bere kunatsika kwambiri m'gulu la azimayi omwe adatenga Levemir ® FlexPen ® poyerekeza ndi gulu lomwe limathandizidwa ndi isofan-insulin.
Munthawi yonse yoyembekezera, panalibe kusiyana kwakukulu pakati pa odwala omwe adalandira Levemir ® FlexPen ® ndi isofan-insulin chifukwa cha zochitika za hypoglycemia.
Magulu awiri onse a amayi apakati omwe amathandizidwa ndi Levemir ® FlexPen ® ndi isofan-insulin adawonetsa zotsatira zofananazi pazomwe zimachitika pakachitika zovuta panthawi yonse yomwe amakhala ndi pakati, zidapezeka kuti pamachulukidwe ambiri amachitika zovuta zovuta kwa odwala nthawi yayitali msika wonse wokhudzana ndi kubadwa kwa thupi (61 (40%) motsutsana ndi 49 (31%)), mwa ana munthawi ya kukula kwa intrauterine ndipo atabadwa (36 (24%) motsutsana ndi 32 (20%) anali wamkulu pagulu lachipatala ndi Levemir ® Fle Spenny ® poyerekeza ndi gulu isophane insulin mankhwala.
Chiwerengero cha ana obadwa ndi moyo kuchokera kwa amayi omwe adakhala ndi pakati atasinthidwa mosiyanasiyana m'magulu azachipatala kuti alandire chithandizo ndi amodzi mwa omwe adayesedwa anali 50 (83%) mu gulu lachipatala la Levemir ® FlexPen ® ndi 55 (89%) pagulu lachipatala la isofan insulin. Chiwerengero cha ana omwe abadwa ndi vuto lobadwa nacho chinali 4 (5%) mu gulu la mankhwala a Levemir ® FlexPen ® ndi 11 (7%) m'gulu la mankhwala a isofan-insulin. Mwa izi, kusokonezeka kwakukulu kwa kubadwa kunadziwika mu ana 3 (4%) mu gulu lachipatala la Levemir ® FlexPen ® ndi 3 (2%) m'gulu la mankhwala a isofan-insulin.
Ana ndi achinyamata
Kuchita bwino ndi chitetezo cha kugwiritsa ntchito Levemir ® FlexPen ® mwa ana anaphunziridwa mu mayeso awiri olamulidwa omwe amakhala miyezi 12 ndi achinyamata ndi ana opitirira zaka ziwiri akudwala matenda am'modzi a matenda ashuga a matenda a shuga 1; ana 67 aliwonse omwe ali ndi matenda ashuga amtundu woyamba ali ndi zaka ziwiri mpaka zisanu. Zotsatira za kafukufukuyu zikuwonetsa kuti kuwongolera kwa glycemic (HbA1c) motsutsana ndi machitidwe azachipatala ndi Levemir ® FlexPen ® anali ofanana ndi omwe amathandizidwa ndi isofan-insulin, ndikuika kwawo pamaziko a bolus. Kuphatikiza apo, panali chiopsezo chocheperako cha nocturnal hypoglycemia (kutengera mphamvu za plasma glucose yoyesedwa ndi odwala pawokha) komanso kusowa kwa kuwonjezeka kwa kulemera kwa thupi (kupatuka kwakuthupi kwa thupi kosinthidwa molingana ndi jenda ndi zaka za wodwalayo panthawi ya chithandizo ndi Levemir ® Flexpen®, poyerekeza ndi isofan-insulin.
Chimodzi mwazofufuzira zamankhwala adawonjezeredwa kwa miyezi ina 12 (kuchuluka kwa miyezi 24 ya chidziwitso chachipatala) kuti mupeze database yonse yokwanira yopanga mapangidwe a antibodies kwa odwala motsutsana ndi chithandizo cha nthawi yayitali ndi Levemir ® FlexPen ®.
Zotsatira zomwe zimapezeka phunziroli zikuwonetsa kuti mchaka choyamba chamankhwala omwe amamwa Levemir ® FlexPen ®, panali kuchuluka kwa ma antibodies oyambitsa insulin, komabe, pofika kumapeto kwa chaka chachiwiri chamankhwala, kuchuluka kwa ma antibodies ku Levemir ® FlexPen ® kuchepa kwa odwala mpaka mulingo wocheperapo pang'ono woyambira pa nthawi yoyambitsa chithandizo ndi Levemir ® FlexPen ®. Chifukwa chake, zidatsimikizika kuti kupangika kwa ma antibodies kwa odwala omwe ali ndi matenda a shuga nthawi ya mankhwalawa ndi Levemir ® FlexPen ® sikukukhudza kwambiri kuchuluka kwa kayendetsedwe ka glycemic komanso kuchuluka kwa insulin
Pharmacokinetics
Mafuta
Kuchuluka kwa plasma ndende kumafikiridwa patatha maola 6-8 mutakhazikitsa.
Ndi regimen yolimbitsa thupi ya tsiku ndi tsiku, kuchuluka kwa mankhwala omwe amapezeka m'magazi am'magazi pambuyo pake.
Kusiyanitsa kwapakati pa intraind payekha ndikotsika kwa Levemir ® FlexPen ® poyerekeza ndi kukonzekera kwina kwa insulin. Panalibe kusiyana kwakanema pakati pa amuna ndi akazi mu pharmacokinetics of Levemir ® FlexPen ®.
Kugawa
Kugawika kwapakati pa Levemir ® FlexPen ® (pafupifupi 0.1 L / kg) kumawonetsa kuti gawo lalikulu la insulin limazungulira m'magazi.
Kupenda
Kupangika kwa mankhwala a Levemir ® FlexPen ® ndi ofanana ndi kukonzekera kwa insulin yaumunthu, metabolites yonse yopangidwayo siyothandiza. Maphunziro Omanga Mapuloteni mu vitro ndi mu vivo awonetse kusowa kwa kulumikizana kwakukulu pakati pa chiphuphu cha insulin ndi mafuta acids kapena mankhwala ena omwe amamangilira mapuloteni.
Kuswana
The terminal theka-moyo pambuyo subcutaneous jekeseni kutsimikiza ndi kuchuluka kwa mayamwidwe subcutaneous minofu ndi maola 5-7, kutengera mlingo.
Chotsogola
Ndi subcutaneous makonzedwe, plasma wozungulira anali mogwirizana ndi mlingo kutumikiridwa (pazipita ndende, kuchuluka kwa mayamwidwe).
Panalibe mankhwala a pharmacokinetic kapena pharmacodynamic pakati pa liraglutide ndi mankhwala a Levemir ® FlexPen ®, ofanana, ndi munthawi yomweyo, kwa odwala omwe ali ndi matenda a shuga a 2 a mellitus a Levemir ® FlexPen ® mu gawo limodzi la 0,5 U / kg ndi liraglutide 1.8 mg.
Magulu apadera a odwala
Mankhwala a Levemir ® FlexPen ® a pharmacokinetic anaphunziridwa mwa ana (a zaka 6 - 12) ndi achinyamata (azaka 13 mpaka 17) ndikuyerekeza ndi katundu wa pharmacokinetic mwa akulu omwe ali ndi mtundu woyamba wa matenda a shuga. Palibe kusiyana komwe kunapezeka. Palibe kusiyana kwakanthawi kachipatala mu pharmacokinetics ya Levemir ® FlexPen ® pakati pa odwala okalamba ndi achinyamata, kapena pakati pa odwala omwe ali ndi vuto la impso ndi chiwindi ntchito ndi odwala athanzi.
Maphunziro Otetezeka
Kafukufuku mu vitro, mzere wam'magazi a anthu, kuphatikiza kafukufuku wokhudza kumanga ma insulin receptors ndi IGF-1 (insulin-like grow factor), adawonetsa kuti insulini ya detemir ili ndi chiyanjano chotsika kwambiri cha ma receptor onse ndipo ilibe chidwi kwenikweni ndi kukula kwa maselo poyerekeza ndi insulin yaumunthu. Zambiri zam'mbuyomu potsatira kupenda kwatsoka kwamatendawa, kawopsedwe wa mankhwalawa, genotoxicity, mphamvu ya carcinogenic, zotsatira zoyipa pakubala, sizinawonetse vuto lililonse kwa anthu.
Kodi njira yanji?
Kugwiritsa ntchito matekinoloje amakono a DNA kumathandizanso asayansi kangapo kuwonjezera mphamvu ya othandizira omwe ali ndi insulin nthawi zonse.
Jekeseni ya Detemir imapangidwa pogwiritsa ntchito njira zama biotechnological processing a recombinant ma CD.
Ntchito ya Saccharomyces cerevisiae imagwiritsidwa ntchito - iyi ndi yoyambira ya insulin yayitali yamunthu, yomwe ilibe chochita chapamwamba pazowoneka.
Detemir ndi yankho ndi pH yopanda mbali, ndiyowonekera ndipo ilibe mtundu. Wothandiziratu wa matenda ashuga ndi wa ma insulin angapo omwe akhala akuchita zinthu kwa nthawi yayitali. Mumsika, insulin detemir imagulitsidwa pansi pa dzina la Levimir.
Kuyika ma CD kumawoneka motere: M'mafakitala, amagulitsidwa mumapangidwe a ma cartridge, mu iliyonse ya 0.142 ml yonyansa. Pafupifupi, ma phukusi amawononga ma ruble 3,000. Monga mitundu ina ya mankhwala okhala ndi insulin, mankhwalawa amagulitsidwa ndi mankhwala.
Chomwe chimachitikira Detemir
Detemir imachita zambiri kuposa insulin glargine ndi isofan. Zotsatira zazitali za wothandizirazi zimachitika chifukwa chodziyanjana ndi ma cell maselo komanso kuphatikiza kwawo ndi mafuta amafuta am'magazi a ma albumin. Poyerekeza ndi ma insulini ena, detemir imabalalika pang'onopang'ono mthupi lonse. Njira yotereyi imagwiranso ntchito kwa mankhwala, ndikuwonjezera kuyamwa.
Komanso, mosiyana ndi njira zina, insulin iyi imaneneratu, chifukwa chake zimakhala zosavuta kuyendetsa zotsatira zake.
Izi ndichifukwa cha zinthu zingapo:
- Detemir imakhalabe yamadzimadzi kuyambira pakukonzekera kufikira nthawi yomwe wothandizirayo amabweretsedwa m'thupi,
- Tinthu tating'onoting'ono timakhala ndi ma cell mamolekyulu mu seramu yamagazi ndi njira yama buffer.
Chidacho chimalumikizana ndi ma receptor akunja omwe amapezeka pa cytoplasmic cell membrane. Kapangidwe ka insulini-receptor kamapangidwa kamene kamalimbitsa njira ya mkati mwake. Pali kaphatikizidwe kakapangidwe ka glycogen synthetase, hexokinase ndi pyruvate kinase enzymes.
Kusanganikirana kwa glucose mankhwala kumachepa chifukwa cha kuchuluka kwa mayendedwe a shuga mkati mwa maselo, kumayamba kulowa bwino mu minofu. Glycogenogeneis ndi lipogeneis nawonso amakulitsidwa. Chiwindi chimayamba kutulutsa shuga pang'onopang'ono.
Wothandizirayu samakhudzidwa ndi kuchuluka kwa maselo kuposa ma insulini ena. Ilibe carcinogenic, poizoni ndi genotoxic pazochitika zonse za thupi, kuphatikiza pakugonana.
Kinetic katundu wothandizira
Pambuyo poyambitsa kununkhira m'thupi, kumalimbikitsidwa kwambiri m'madzi a plasma pambuyo maola 7. Wodwalayo akapatsidwa jakisoni kawiri pa tsiku, ndiye kuti matendawa amayamba kukhazikika patatha masiku ochepa akuchira. Pakadutsa 3 mg jekeseni m'thupi, mawu oyambira kugwira ntchito amakhala pafupifupi maola 15 ndipo kugwira ntchito bwino kumafikira maola awiri.
Popeza detemir imatha kugawidwa bwino, imazungulira m'magazi mukuyang'ana kwakukulu.
Zimapukusidwa pafupifupi kwathunthu, ndipo ma metabolites onse amakhala otetezeka kwathunthu kwa thupi. Hafu ya moyo wa mankhwalawa imasiyanasiyana malinga ndi mlingo womwe umaperekedwa kwa wodwala. Pafupifupi, ndi maola 6.
Malangizo ogwiritsira ntchito
Mlingo wofunikira kwa wodwala umasankhidwa payekha. Detemir imatha kutumikiridwa katatu patsiku. Ngati kununkhira kunayikidwa kuti kukhathamiritsa mphamvu ya glycemia, mankhwalawa amagwiritsidwa ntchito kawiri. Mlingo umodzi umaperekedwa m'mawa, ndipo 2 madzulo asanagone kapena atatha maola 12 jekeseni asanakwane.
Odwala omwe ali ndi zaka zopitilira 50 ndipo akuvutika ndi vuto la chiwindi kapena impso amafunika kusankha mosamala kwambiri. Kuphatikiza apo, amafunika kuyang'aniridwa pafupipafupi ndi shuga wamagazi.
Jakisoni wa Detemir wa insulin amayikidwa pang'onopang'ono phewa, ntchafu, kapena dera la khomo lamkati lakumbuyo. Kukula kwa zochita (mayamwidwe) a mankhwalawa zimatengera tsamba la jekeseni. Ngati jakisoni wapangidwa m'dera limodzi, malo oyika ndi singano ayenera kusinthidwa nthawi iliyonse. Izi ndichifukwa choti lipodystrophy imatha kuchitika - awa ndi ma cone achilendo, omwe amakhala ovuta kuwachotsa.
Chonde dziwani: ngati insulin idalowetsedwa m'mimba, ndiye kuti muyenera kubweza masentimita 5 kuchokera ku navel ndikugwera mozungulira.
Ndikofunikira kwambiri kubaya bwino. Pazomwe mungafunikire: insulin kutentha kwa kuchipinda (ipezeni pakati theka la ola), syringe (ngati pakufunika), antiseptic ndi swab thonje.
Komanso, zonse zimachitika molingana ndi algorithm:
- Malowa amathandizidwa ndi antiseptic, zotsalira zake zimayenera kupaka pakhungu,
- Khungu limagwidwa ndimisempha
- Singano imayikidwa pakona. Palibe kukankha mwamphamvu komwe kumapangidwa, pambuyo pake piston amatambasula pang'ono. Ngati mukugunda chotengera, ndiye muyenera kusintha tsamba la jakisoni.
- Madzimadzi amayamba pang'onopang'ono komanso moyenera. Ngati pisitoni siyikuyenda bwino, khungu pamwamba pa singano limatupa ndikuwuma - muyenera kukankhira singano mozama.
- Pambuyo pakubaya insulin, muyenera kusiya singano pansi pa khungu kwa masekondi 4-6. Zitatha izi, singano imachotsedwa ndikusunthika lakuthwa, tsamba la jakisalo limaphatikizidwanso ndi antiseptic.
Kuti jakisoni asakhale wowawa momwe mungathere, sankhani singano yofupikitsa komanso yocheperako, mukasungunuka, osafinya khungu mwamphamvu, molira ndi dzanja molimba mtima.
Zofunika! Wodwala akavulala mitundu ingapo ya mankhwala a insulin, muyenera choyamba kuyimba mwachidule, kenako.
Zoyang'ana musanalowe ndalama?
Musanagwiritse jakisoni, muyenera:
- Onaninso mtundu wa malonda
- Tetezani mankhwala kupukusira kwa zakumwa za mowa kapena zakumwa zina,
- Onjezani kukhulupirika kwa cartridge. Ngati ndiowonongeka kunja kapena gawo lowoneka bwino lomwe limaposa mulifupi wa mzerewo, silingagwiritsidwe ntchito ndipo liyenera kubwezeredwa ku pharmacy.
Chonde dziwani kuti insulini yozizira kapena yosungika bwino, makatoni okhala ndi madzi amtambo komanso achikuda, sayenera kugwiritsidwa ntchito. Detemir siyenera kugwiritsidwa ntchito kumapampu a insulin.
Mukabayidwa, muyenera kutsatira malamulowa:
- Mankhwalawa amaperekedwa pokhapokha.
- Pambuyo pa jekeseni aliyense, sinthani singano (ngati insulin imagwiritsidwa ntchito mu ampoule), chifukwa mankhwalawo amatha kutuluka chifukwa cha kutentha.
- Makatoni sangadzazidwe. Izi zimatheka pokhapokha ndi ma syrable osinthika.
Mankhwala osokoneza bongo
Mankhwala, lingaliro la insulin kwambiri silinapangidwe. Nthawi yomweyo, wodwala akamamwa mlingo waukulu kuposa womwe anamupeza, amayamba kukhala ndi chithunzi cha matenda a hypoglycemia (shuga yochepa kwambiri).
Wodwala ali ndi izi:
- Pallor
- Kutentha
- Tinnitus
- Kuwonongeka kwa ndende
- Kumva nseru
- Kutsika kowoneka bwino.
- Nkhawa ndi kusowa chidwi.
Nthawi zambiri munthu amadwala mwadzidzidzi. Mawonekedwe ofatsa amkhalidwewu amatha kutha mwa kutenga shuga pang'ono kapena china chilichonse cha shuga. Pali mapiritsi apadera omwe amathandiza kuthana osati hypoglycemia.
Muzovuta kwambiri, kuchuluka kwa shuga kumachepetsa kwambiri mpaka wodwalayo atha kufa.
Vutoli limatsatiridwa ndi zizindikiro:
- Chikumbumtima
- Chizungulire
- Kusokonekera kwa mawu
- Kugwirizana koyenera
- Mantha olimba a mantha amkati.
Hypoglycemia yayikulu imathandizidwa ndi jakisoni wamitsempha kapena subcutaneous wa 1 mg ya glucagon. Ngati thupi la munthu silikuyankha jakisoniyo mwanjira iliyonse mkati mwa mphindi 20, yankho la shuga limayendetsedwa kudzera m'mitsempha. Nthawi zambiri wodwala amatha kufa kapena kusokonezeka bongo.
Zotsatira zoyipa
Maonekedwe awo mwachindunji zimatengera mlingo wa insulin yomwe imatengedwa. Munthu akhoza kukumana ndi izi ku Detemir:
- Kuphwanya kagayidwe kachakudya njira. Wodwalayo amatha kudwala matenda am'mimba komanso amachepetsa zinthu zosiyanasiyana m'magazi.
- Zomwe zimachitika kawirikawiri komanso kwanuko. Mukhoza kuyamba kufinya, kuyabwa, ndi kutupa. Mwina kukula kwa lipodystrophy ndi edema m'malo osiyanasiyana a thupi.
- Chitetezo cha mthupi. Odwala ena amakhala ndi ziwengo, urticaria. Kuchita koopsa kwambiri kwamomwe kumapangitsa kuti edema ya Quincke ikhale ndi zotsatira zina zomwe zimabweretsa imfa.
- Refraction chisokonezo. Mphezi zowala zimasinthidwa molakwika mu mandala, chifukwa chomwe kumakhala kuphwanya kawirikawiri masomphenya ndi mawonekedwe amtundu.
- Rhinopathic matenda.
- Kuwonongeka kwa zotumphukira zamanjenje, chifukwa chomwe kumaphwanya chidwi cha khungu, minofu imafooka ndipo osamvetsera. Neuropathy imathanso kukhala yopweteka.
Ngati munthu ali ndi chidwi ndi zina mwazigawo za Detemir, izi zimachitika ngakhale mutamwa mankhwala ochepa. Amakhala olimba kwambiri kuposa odwala ena.
Monga tanena kale, kuwonda kumayambitsa hypoglycemia, komwe kumakhudza kwambiri ndende. Ndi vuto lotere, ndikulimbikitsidwa kuchepetsa kuyendetsa magalimoto, kuwongolera njira zovuta ndi mitundu ina ya ntchito, chifukwa imatha kukhala yowopsa kwa anthu.
Mwa odwala ena, hypoglycemia imatha kukula popanda zizindikiro kapena kuwonetsa kwambiri.. Ngati pali chiopsezo chakuti wodwalayo atha kudwala matendawa mosadukiza, ayenera kuchitapo kanthu kuti muchepetse kuchepa kwa shuga ndikuganiziranso za kuyendetsa bwino ndikuyendetsa ntchito yoopsa panthawi yayitali.
Kodi ndizotheka kubereka, amayi apakati ndi ana?
Palibe kusiyana kwa teratogenic kapena embryotoxic mukamagwiritsa ntchito insulin Detemir komanso munthu wamba. Pankhaniyi, amayi oyembekezera komanso omwe ali ndi nthawi yokhala ndi mkaka wa m'mawere, akamapereka mankhwala, ayenera kuyang'aniridwa ndi dokotala ndikuwonetsetsa kuchuluka kwa shuga.
Mwa amayi omwe ali ndi matenda a shuga, kuchuluka kwawo kwa glucose kumakhazikika pang'onopang'ono m'matentimenti atatu, motero kufunika kwa insulin kumachepa. Mkazi akamabereka ndikusiya kuyamwitsa, thupi limayambanso kusowa ndi insulin. Chifukwa chake simungachoke pamiyeso ya kumwa mankhwalawo chimodzimodzi, muyenera kusintha mankhwalawo.
Pali zoletsa kugwiritsa ntchito kanyenya kwa odwala ochepa. Sayenera kugwiritsidwa ntchito ndi ana osakwana zaka 6.
Kwa ana okulirapo, chithandizo cha insulin nchotheka, pomwe mwana ali ndi vuto la chiwindi, impso ndi ziwalo zina, kuyika kwa glucose komanso momwe machitidwe omwe akukhudzidwawa amayenera kuwunikira nthawi zonse.
Kugwirizana kwina ndi mankhwala ena
Mankhwala ena amatha kupititsa patsogolo zotsatira za Detemir:
- Kuchepetsa shuga pamlomo
- Monoamine oxidase ndi angiotensin amatembenuza enzyme zoletsa mankhwala,
- Osasankha b-group adrenergic blockers.
Mowa umakhudzanso insulin momwemonso. Zimathandizanso kutalika kwa nthawi ya hypoglycemic.
Zinthu zotsatirazi zimalepheretsa izi:
- Kukula kwamafuta kosiyanasiyana,
- Glucocorticoids,
- Sympathomimetics of group b,
- Madzi a chithokomiro,
- Mankhwala okhala ndi danazol.
Lancreotides ndi octreodites zimatha kukhudza zotsatira zapakati. Nthawi zina, amautsa kapena kuipitsa. Ma sulfites ndi ma thiol sangathe kugwiritsidwa ntchito ndi insulin detemir, chifukwa amawononga kapangidwe ka insulin ndipo amachepetsa mphamvu yake. Chida ichi sichingawonjezeke ku kulowetsedwa kwa otsikira.
Kusinthira ku Detemir ndi mitundu ina ya insulin
Njira zotere ziyenera kuchitika moyang'aniridwa ndi katswiri. Kusintha kwa ndende, kusintha kwa mtundu wa wothandizira (kuchokera kwa munthu kupita ku nyama / anthu a insulin analogues ndi mosemphanitsa) ndi zinthu zina zingafune kusintha kwa kayendedwe ka insulin.
Panjira
Mukapita ku Detemir, muyenera kuyang'anira kuchuluka kwa odwala omwe ali ndi shuga. Kuwongolera kotere kumachitika m'milungu ingapo yoyambirira.
Mukamathandizira odwala matenda ashuga, muyenera kupuma pakati pa mankhwala osiyanasiyana. Zitha kuthana ndi mayamwidwe ndi kuyamwa kwa wina ndi mnzake.
Zomwe zili ndi insulin
Detemir insulin ili ndi mitundu iwiri yofunika momwe mankhwala othandizira (insulin detemir) ali yemweyo.
Nawa mayina awo ndi mitengo yake:
- Levemir Flekspen mu mawonekedwe a jakisoni - mtengo phukusi lililonse pa 100 ml ndi ma ruble 4500.
- Levemir Penfil alinso mu mawonekedwe a yankho - kuchuluka komweko kumawononga ma ruble 5,000.
Gulu lomweli lamankhwala limaphatikizapo ndalama ndi insulin glargine. Mayina amalonda ndi mtengo wake:
- Yankho la jakisoni wa Aylar - ma ruble 3500,
- Latus Optiset ndi Latus Standard - ma ruble 2900,
- Latus Solostar - ma ruble 3000,
- Tozheo Solostar kuchokera ku ruble 1000 mpaka 2700.
Zofananira zina za detemir:
- Monodar Ultralong (kuyimitsidwa kwa jekeseni) - monga gawo la insulin ya nkhumba.
- Tresiba Flekstach - yankho la insuludec la insulin, limatengera ma ruble 5000.
Musanasinthe mtundu wa insulin yomwe mumagwiritsa ntchito, muyenera kufunsa dokotala, chifukwa ndalama zina zomwe zimawonetsedwa zitha kuperekedwa kwa wodwala.
Detemir ndi imodzi mwazamankhwala abwino kwambiri a insulin mogwirizana ndi magawo a thupi ndi mankhwala. Ili pafupi kwambiri ndi insulin yaumunthu. Chochita sichimasiya chilichonse chogwira ntchito mthupi chomwe chitha kukhala ndi zotsutsana ndi thupi. Mtengo wake siwokwezeka kuposa mitundu ina ya insulini.
Chifukwa chake, mtengo wapakati wa izi ndi kusinthasintha kwake kumapangitsa kuti muzitha kugwiritsa ntchito magulu osiyanasiyana a odwala.
Zoyipa:
Gwiritsani ntchito panthawi yoyembekezera komanso poyamwitsa
Mimba
Pogwiritsa ntchito Levemir ® FlexPen ® pa nthawi ya pakati, ndikofunikira kuganizira momwe phindu la kugwiritsira ntchito kwake limaposa ngozi zomwe zingachitike.
Chimodzi mwazoyesedwa zopanda mayeso zokhudzana ndi amayi apakati omwe ali ndi matenda a shuga 1, pomwe mphamvu ndi chitetezo cha mankhwala ophatikizika a Levemir ® FlexPen ® ndi insulin aspart (amayi 152 apakati) amafanizidwa ndi isofan-insulin kuphatikiza ndi insulin aspart (Azimayi 158 oyembekezera), sanawonetse kusiyana pakumvetsetsa konse panthawi ya pakati, pazotsatira za pakati, kapena thanzi la mwana wosabadwa ndi wakhanda (onani gawo "
Mlingo ndi makonzedwe:
| Madzi a m'magazi a plasma amayesedwa popanda chakudya cham'mawa | Kusintha kwa mankhwala Levemir ® FlexPen ®, ED |
| > 10.0 mmol / L (180 mg / dL) | + 8 |
| 9.1-10.0 mmol / L (163-180 mg / dl) | + 6 |
| 8.1-9.0 mmol / L (145-162 mg / dL) | + 4 |
| 7.1-8.0 mmol / L (127-144 mg / dl) | + 2 |
| 6.1-7.0 mmol / L (109-126 mg / dl) | + 2 |
| 4.1-6.0 mmol / L | Palibe kusintha (mtengo wake) |
| Ngati muli ndi shuga m'magazi amodzi: | |
| 3.1-4.0 mmol / L (56-72 mg / dl) | - 2 |
| - 4 | |
Ngati Levemir ® FlexPen ® imagwiritsidwa ntchito ngati gawo la regimen yoyambira, iyenera kuyikidwa 1 kapena 2 pa tsiku malinga ndi zosowa za wodwala. Mlingo wa Levemir ® FlexPen ® umatsimikiziridwa payekhapayekha.
Odwala omwe amafunikira kugwiritsa ntchito mankhwalawa kawiri patsiku kuti azilamulira kwambiri milingo ya glycemia amatha kumwa mlingo wa chakudya chamadzulo kapena pogona. Kusintha kwa Mlingo kumakhala kofunikira ndikulimbitsa thupi kwa wodwalayo, kusintha zakudya zake wamba kapena nthenda yolumikizana.
Mankhwala Levemir ® FlexPen ® angagwiritsidwe ntchito ngati monotherapy komanso kuphatikiza ndi bolus insulin. Itha kugwiritsidwanso ntchito limodzi ndi mankhwala amkamwa a hypoglycemic, komanso kuwonjezera pazomwe zilipo ndi liraglutide.
Kuphatikiza ndi mankhwala am'mlomo a hypoglycemic kapena kuphatikiza liraglutide, tikulimbikitsidwa kugwiritsa ntchito Levemir ® FlexPen ® kamodzi patsiku, kuyambira pa 10 PIECES kapena 0.1-0.2 PIECES / kg. Mankhwala a Levemir ® FlexPen ® amatha kutumikiridwa nthawi iliyonse yabwino kwa wodwala masana, komabe, posankha nthawi yomwe jekeseni wa tsiku ndi tsiku, muyenera kutsatira njira yokhazikitsidwa ya jekeseni.
Levemir ® FlexPen ® idapangidwa kuti ikwaniritse makina okhawo.
Levemir ® FlexPen ® sayenera kutumikiridwa kudzera m'mitseko, monga izi zimatha kuyambitsa kwambiri hypoglycemia. Mgwirizano wamankhwala mankhwala uyenera kupewedwanso. Levemir ® FlexPen ® silinapangidwe kuti mugwiritse ntchito mapampu a insulin.
Levemir ® FlexPen ® imalowetsedwa mwachangu mu ntchafu, khoma lamkati lam'mimba, phewa, dera lotetemera kapena gluteal. Masamba a jakisoni amayenera kusinthidwa pafupipafupi ngakhale atayikidwa m'dera lomwelo kuti muchepetse chiopsezo cha lipodystrophy. Monga kukonzekera kwina kwa insulin, kutalika kwa zochita zimatengera mlingo, malo oyendetsera, kutsika kwa magazi, kutentha ndi kuchuluka kwa zochitika zolimbitsa thupi.
Magulu apadera a odwala
Monga momwe amakonzera insulin ena, odwala ndi odwala omwe ali ndi vuto la impso kapena hepatic, kuyang'aniridwa kwa shuga wamagazi kuyenera kuyang'aniridwa mosamala kwambiri komanso mlingo wa kununkhira payokha.
Ana ndi achinyamata
Kuchita bwino ndi chitetezo cha Levemir ® FlexPen ® mu achinyamata ndi ana opitilira zaka 2 zatsimikiziridwa mu mayesero azachipatala mpaka miyezi 12.
Chosintha kuchokera kukonzekera kwina ka insulin:
Kusintha kuchokera kukonzekera insulin kukonzekera komanso kukonzekera insulin yayitali kupita ku Levemir ® FlexPen ® kungafune kusintha kwa mlingo ndi nthawi.
Monga momwe amakonzera insulini ina, kuyang'anitsitsa kusamala kwa shuga wamagazi pakasamutsidwa komanso m'milungu yoyamba yokhazikitsidwa ndi mankhwala ndikulimbikitsidwa.
Malangizo a concomitant hypoglycemic therapy (mlingo ndi nthawi ya makonzedwe osakhalitsa a insulin kukonzekera kapena mlingo wa pakamwa hypoglycemic mankhwala angafunike.
Zotsatira zoyipa:
Zotsatira zoyipa zomwe zimawoneka mwa odwala omwe amagwiritsidwa ntchito ndi mankhwala a Levemir ® FlexPen ® zimadalira kwenikweni mlingo wa mankhwalawa komanso zimayamba chifukwa cha kupatsirana kwa mankhwalawa. Hypoglycemia nthawi zambiri zimakhala zotsatira zoyipa kwambiri. Hypoglycemia imayamba ngati mankhwalawa kwambiri ataperekedwa pokhudzana ndi kufunika kwa insulin. Kuchokera kuzipatala zamankhwala zimadziwika kuti hypoglycemia yayikulu, yomwe ikufunika kuti anthu ena alowererepo, imapanga pafupifupi 6% ya odwala omwe amalandila Levemir ® FlexPen ®.
Zokhudza malo a jakisoni zimawonedwa nthawi zambiri ndi Levemir ® FlexPen ® kuposa poyambitsa insulin ya anthu. Izi zimaphatikizaponso redness, kutupa, kufinya, kutupa, ndi kuyunkhira pamalo a jekeseni. Zambiri zomwe zimachitika pamalo opangira jakisoni ndizochepa komanso zakanthawi, i.e. Kutha kwa mankhwala kwa masiku angapo mpaka milungu ingapo.
Gawo la odwala omwe amalandila chithandizo ndipo omwe akuyembekezeka kukulitsa zovuta zake akuyembekezeredwa ngati 12%. Zomwe zimachitika chifukwa cha zovuta, zomwe zimayesedwa kuti zimakhudzana ndi Levemir ® FlexPen ® panthawi ya mayesero azachipatala, zafotokozedwera pansipa.
Matenda a metabolism komanso zakudya
Pafupipafupi (> 1/100, 1/100, 1/1 000, 1/1 000, 1/1 000, 1/10 000, ® FlexPen ®, ikhoza kuwononga chinyengo cha insulin. Levemir ® FlexPen ® sayenera kuwonjezeredwa kulowetsedwa zothetsera.
Malo osungira:
Osasunga cholembera chogwiritsidwa ntchito mufiriji. Kugwiritsa ntchito kapena kusamutsa ngati cholembera chopanda ndi mankhwalawo kuyenera kusungidwa kwa masabata 6 pa kutentha kosaposa 30 ° C.
Mukatha kugwiritsa ntchito, tsekani cholembera ndi chipewa kuti mutetezere kuwala.
Pewani kufikira ana.
Wopanga:
Novo Nordisk A / S
Novo Alle,
DK-2880 Baggswerd, Denmark
Woimira Office "Novo Nordisk A / S"
119330, Moscow,
Lomonosovsky Prospekt 38, ofesi 11
Levemir ®, FlexPen ®, NovoFayn ®, NovoTvist ® - zizindikiro za Novo Nordisk A / S, Denmark
Malangizo a odwala pakugwiritsa ntchito Levemir ® FlexPen ®
Werengani malangizo awa mosamala musanagwiritse ntchito levemir. ® Thawani ®
Levemir ® FlexPen ® ndi cholembera chosiyana ndi insulin. Mlingo wa insulin womwe waperekedwa kuyambira 1 mpaka 60 mayunitsi, ungasinthidwe mu zowonjezera za 1 unit. Levemir ® FlexPen ® idapangidwa kuti igwiritsidwe ntchito ndi singano za NovoFine ® ndi NovoTvist ® mpaka 8 mm. Monga kusamala, nthawi zonse muzikhala ndi insulin yotumiza njira kuti muwonongeke kapena kuwononga Levemir ® FlexPen ®.
Utoto wa cholembera chosonyezedwa m'fanizoli ukhoza kusiyana ndi mtundu wa Levemir ® FlexPen ®. 
Kuyamba
Onani chizindikiro kuti Levemir ® FlexPen ® ili ndi mtundu woyenera wa insulini.
 | A
Chotsani kapu ku cholembera. Muzipetsa utoto wa mphira ndi swab thonje. |
 | B
Chotsani chomata kuchotsekera mu singano yotaya. Vulani singanoyo mokoma komanso mwamphamvu pa Levemir ® FlexPen ®. |
 | Ndi
Chotsani kapu yayikulu yakunja kuchokera singano, koma osataya. |
 | D
Chotsani ndikutaya kapu yamkati ya singano. |
 | Kuchotsa koyambirira kwa mpweya pabokosi
Ngakhale mutagwiritsidwa ntchito moyenera ndi cholembera, mpweya wochepa umatha kudziunjikira mu cartridge musanadye jekeseni iliyonse. Poletsa kulowa kwa kuwira kwa mpweya ndikuwonetsa kuyamwa kwa mtundu woyenera wa mankhwalawa: E Imbani 2 magawo a mankhwala. |
 | F
Mukadagwira Levemir ® FlexPen ® ndi singano mmwamba, ikani bokosilo kangapo ndi chala chanu kuti ma thovu amlengalenga apite pamwamba pa cartridge. |
 | G
Mukugwira cholembera ndi singano kumtunda, kanikizani batani loyambira njira yonse. Mlingo wosankha ubwerera ku zero. Dontho la insulin liyenera kuonekera kumapeto kwa singano. Ngati izi sizingachitike, sinthani singano ndikubwereza njirayi, koma osapitirira 6. Ngati insulini siyikuchokera singano, izi zikuwonetsa kuti cholembera sichili chosalongosoka ndipo sayenera kugwiritsanso ntchito. |
 | Mlingo
Onetsetsani kuti chosankha cha mankhwalawo chikhala "0". N Dinani manambala ofunikira jakisoni. Mlingo umatha kusinthidwa ndikusinthanitsa ndi mtundu wosankhidwa mwanjira iliyonse mpaka mlingo woyenera wakhazikitsidwa kutsogolo kwa chizindikiro. Mukazungulira chosankha cha mankhwala, samalani kuti musakanize mwangozi batani loyambira kuti muchepetse kutulutsa kwa insulin. Sizotheka kukhazikitsa mlingo woposa kuchuluka kwa zigawo zomwe zatsalira mu cartridge. • Musagwiritse ntchito mulingo wotsalira kuti mupeze Mlingo wa insulin. |
 | Makulidwe a insulin
Ikani singano pansi pa khungu. Gwiritsani ntchito njira jakisoni yomwe dokotala wanu wakupatsani. Kuti mupeze jakisoni, dinani batani loyambira mpaka "0" akuwonekera kutsogolo kwa chizindikiro. Samalani: mukamapereka mankhwalawo, ingokanizani batani loyambira. Mlingo wosankha ngati utasinthidwa, makonzedwe a mlingo sangachitike. |
 | J
Mukachotsa singano pansi pa khungu, gwiritsani batani loyambira ndikukhumudwa kwathunthu. |
 | Kuti
Lowetsani singano mumkono wakunja wa singano osakhudza cap. Pamene singano ilowa, valani chipewa ndikuvula singano. Kusunga ndi chisamaliro Levemir ® FlexPen ® idapangidwa kuti igwiritsidwe ntchito moyenera komanso mosatetezeka ndipo imafunikira kuisamalira mosamala. Pakakhala dontho kapena kupanikizika kwamakina mwamphamvu, cholembera cha syringe chimatha kuwonongeka ndipo insulin ikhoza kutayikira. Pamwamba pa Levemir ® FlexPen ® ikhoza kutsukidwa ndi swab thonje ikamizidwa mu mowa. Osamiza chindapusa mu mowa, osasamba kapena mafuta ikhoza kuwononga makina. Osadzazitsa Levemir ® FlexPen ®.
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