Matenda a shuga a insulin

Irina KISHKO, endocrinologist, City watoto Endocrinology Center

Insulin ndi mahomoni ofunikira kuti thupi likhalebe ndi matenda abwinobwino, koma mwa munthu wodwala matenda amtundu wa 1 samapangidwa mokwanira m'thupi. Insulin ili ndi puloteni ndipo imawonongeka m'mimba mothandizidwa ndi ma enzyme, motero singagwiritsidwe ntchito piritsi. Njira yayikulu yoyendetsera insulin ndi jakisoni wotsekemera.

Kugwiritsa ntchito mankhwala a insulin ambiri, timayesa kutsata kapangidwe kake ka kapamba. Tsoka ilo, nthawi zambiri zimakhala zovuta kukwaniritsa ngakhale mothandizidwa ndi insulin yamakono. Chifukwa chake, anthu omwe ali ndi matenda ashuga ayenera kudziwa zoyambira zamankhwala kuti muzochitika zosiyanasiyana pamoyo pakhale mwayi wosinthira mlingo wa insulin wokha.

Zikondazo zimatulutsa insulini mu njira yoyambira (pafupipafupi pang'ono) komanso m'njira ya bolus (imabisa insulini yambiri poyankha kudya). Malinga ndi izi, kukonzekera kwa insulin komwe dokotala wakupatsani kumaikidwa m'magulu awiri: osakhalitsa komanso osakhalitsa.

Mlingo wa tsiku ndi tsiku wa insulin umagawidwa mu basal mlingo ("wautali" wa insulin mmenemo mpaka 40-69%) ndi mlingo womwe umagwirizana ndi zakudya. Akuyerekezera kagawidwe ka insulin tsiku lililonse: 2/3 - masana, 1/3 - madzulo ndi usiku.

Pali njira zingapo zoyendetsera insulin, koma muyenera kudziwa kuti jakisoni imodzi ya insulin patsiku sangakupatseni thanzi labwino ndipo sangakupatseni ma metabolic ambiri abwino.

Malangizo a insulin mankhwala amasankhidwa kwa mwana ndi dokotala-endocrinologist mosasamala.

Zochizira matenda a shuga, njira zingapo zingapo za insulin zamankhwala zimagwiritsidwa ntchito.

1. Njira yodziwika bwino yokhudzana ndi insulin makonzedwe awiri a insulin yochepa komanso yayitali tsiku - asanadye chakudya cham'mawa komanso asanadye. Uwu ndi mtundu wosasintha wa insulin, umafunika kudya mosamalitsa komanso nthawi yomweyo. Ndi regimen ya chithandizo chotere, ndizosatheka kuti pakhale chiphuphu chabwino cha shuga komanso kuchepetsa chiopsezo cha zovuta.
2. Njira yolimbikitsira ya insulin pokhapokha jakisoni waifupi ndi wautali atapangidwa chakudya musanadye chakudya cham'mawa komanso musanadye chakudya chamadzulo, ndipo insulin yochepa imalowetsedwa asanadye chakudya chamadzulo. Pakadali pano, insulin yotalika nthawi yayitali imakonda kuloledwa chakudya chamadzulo kwa maola 22 mpaka 23. Chithandizo cha matenda ashuga oterowo chimayeserera katulutsidwe ka insulin, monga munthu wathanzi.

Ndondomeko ya jakisoni angapo agwiritsidwa ntchito kuyambira 1984. Kuti athandize odwala, cholembera choyamba cha syringe chinawoneka mu 1985.

Mitundu yambiri ya jakisoni imapereka ufulu wambiri m'moyo watsiku ndi tsiku, imapereka chisankho chochulukirapo ndipo chimakupangitsani kukhala olimba mtima komanso osadalira shuga.

Muyenera kukhala ndi chidziwitso chodziwika bwino cha momwe insulin imodzi kapena ina imagwirira ntchito: nthawi yayitali kuti jekeseni iyamba "kugwira ntchito", pomwe izi zimachitika ndipo ambiri amatenga nthawi yanji. Izi ndi chiyani? Mwachitsanzo, ngati magazi anu ali ocheperako (kapena, mosiyana, apamwamba), ndiye kuti zochita zanu ziyenera kukhala zosiyana pachimake cha insulin komanso kumapeto kwake.

Bulus insulin ("yofupikitsa") yomwe mumabayikira musanadye imayamba mphindi 20-30 pambuyo pobayira jakisoni ndikufika pachimake mu maola 1.5-2. Zomwe zimapangitsa kuchepetsa shuga kumatenga pafupifupi maola asanu.

Izi zikutanthauza kuti mukamagwiritsa ntchito, kupuma pakati pa zakudya zazikulu ndi jakisoni wa insulin yochepa sikuyenera kupitirira maola 5 (ngati simulowetsa insulin m'mawa).

Mafuta a insulin anthawi yochepa kwambiri amagwira ntchito pambuyo pa mphindi 10, ndipo mphamvu yake yokwanira imayamba pambuyo pa ola limodzi. Mukamagwiritsa ntchito, simungadye mosamalitsa ndi ora (bola mutangolowa insulin m'mawa).

Palinso kusiyana kwinanso pakati pa insulin ya "ifupi "ndi" ultrashort "mu njira zamankhwala zomwe tikukambirana tsopano. Ndi insulin "yayifupi", mumayenera kudya zakudya zina (zazakudya) pakati pa chakudya chachikulu kuti mupewe hypoglycemia. Ndi analogue ya "ultrashort", chosiyana ndi ichi: ngati mutadya kwambiri kadzutsa, mungafunenso jekeseni wowonjezera. Pali chosiyana ndi lamulo ili: mukatha kudya chakudya chamadzulo, munapita kukaphunzira kumasewera kapena mukupita kokayenda ndi anzanu pamsewu - simukuyenera kuwonjezera analogue ya ultrashort, zochitika zolimbitsa thupi zimachepetsa shuga m'magazi.

Mlingo wa insulin ya usiku ndizovuta kwambiri kunyamula. Ngakhale sitimadya usiku, thupi lathu limangofunika insulini yotsika kuti asinthane ndi shuga, yomwe imapangidwa ndi chiwindi. Ndi boma la jakisoni angapo, insulin ya sing'anga imakonda kuperekedwa usiku.

Ndikofunikira jekeseni wa insulin nthawi imodzi tsiku lililonse. Chofunikira kwambiri ndikuonetsetsa kuti insulini ikugwira ntchito mpaka m'mawa, choncho ndibwino kuti mupeze jakisoni mochedwa momwe mungathere, asanagone.

Kwa akuluakulu, 23.00 ndi yoyenera, pomwe ana okulirapo nthawi zambiri amakhutira ndi 22.00.

Zomwe muyenera kudziwa

Aliyense wodalira insulin ayenera kudziletsa kwathunthu shuga mkati mwa sabata. Malinga ndi zotsatira zake, endocrinologist imawerengera kuchuluka kwa matenda ashuga, amapanga dongosolo la insulin.

Ngati katswiri wodziwikiratu amalemba muyezo wapakati pa jekeseni wa 1-2 wa insulini patsiku komanso Mlingo wokhazikika, ngakhale mutakhala ndi zotsatira za kudzipenda nokha, ndikofunikira kukaonana ndi dokotala wina. Poletsa kulephera kwa impso kwa wodwala, ntchito ya dokotala ndikuwonetsa mtundu wa insulini yofunika: kusala nthawi yayitali kuti muchepetse shuga wabwinopo kapena kusala musanadye. Nthawi zina wodwala amafunikira mitundu yonse ya insulini, ndipo nthawi zina mankhwala ochepetsa shuga.

Kuphatikiza pa kujambula miyezo ya shuga wamagazi, odwala ayenera kulemba zinthu zomwe zimasintha zizindikiro monga kudya kwambiri kapena kusowa kwa chakudya, kuphatikiza zinthu zatsopano mumenyu, kuchuluka kwa zochitika zolimbitsa thupi, osayang'anira nthawi ndi mlingo wa mankhwala a shuga, matenda opatsirana, chimfine ndi matenda ena. Mlingo wa masana kapena usiku zimatengera zomwe zimawonetsa shuga asanagone komanso kusala kudya kwam'mawa, pakuwonjezeka kapena kuchepa kwa deta yausiku.

Ndikofunikira kudziwa. Kuti awonetsetse kuti kuchuluka kwa shuga m'magazi opanda kanthu kunali kwabwinobwino tsiku lonse, jakisoni wowonjezera amaperekedwa usiku. Insulin yofulumira, yaifupi kapena ya ultrashort imayendetsedwa musanadye chakudya chilichonse kuti shuga asalumphe pambuyo pa chakudya.

Magulu a insulin

Kodi kukonzekera kwa insulin kumachitika bwanji patebulo 1:

Solulle porcine insulin yozikidwa pakuwonekera pang'ono

Mankhwala osokoneza bongo monga Actrapid amalowetsedwa m'tchafu, mkati mwa minofu ya matako, onyowa kapena phewa, kukhoma lamkati kutsogolo ndi mkati mwa mtsempha. Mlingo amawerengedwa ndi dokotala, ndipo mlingo wake wa tsiku ndi tsiku ukhoza kukhala 0.5-1 IU / kg.

Mankhwala amayamba ndi kutentha firiji mphindi 30 asanadye chakudya. Kupatula lipodystrophy, mankhwala amaperekedwa nthawi iliyonse m'malo osiyana.

Ndikofunikira. Mankhwala osokoneza bongo sayenera kukhala owala mwachindunji, pakuwala, overheat ndi supercool. Musagwiritse ntchito insulin, zokutira, zachikaso, ndi ma opaque.

Kutalika kwapakatikati kwamunthu wopanga mankhwala

Mankhwalawa amalowetsedwa pansi pakhungu, sayenera kuyambitsa minyewa. Musanayikemo mankhwalawo mu syringe, vial amayenera kugwedezeka kuti isakhale yotsekemera.

Masamba a jakisoni amasinthanso kuti lipodystrophy isakhale. Masana sayenera kulowa malo osungira, sayenera kuzizira, kutentha kosungira sayenera kupitirira + 2-8 ° C, ndipo atayamba kugwiritsa ntchito sayenera kupitirira + 25 ° C, sayenera kusungidwa mufiriji.

Kuyimitsidwa kwa Ultratard NM kumakhazikitsidwa ndi biosynthetic human crystalline zinc insulin. Amabayidwa pang'onopang'ono, botolo limagwedezeka isanakwane ndipo nthawi yomweyo limadzadza mu syringe.

Pamaso pa matenda a shuga 1, imagwiritsidwa ntchito ngati mafuta oyambira komanso kuphatikiza insulin mwachangu. Mtundu 2 wa shuga, umagwiritsidwa ntchito ngati monotherapy komanso kuphatikiza ndimankhwala othamanga.

Osagwiritsa ntchito kwa nthawi yayitali pakhungu pakhungu la insulin. Sungani kutali ndi mufiriji mu gawo lamafuta mufiriji pa kutentha kwa + 2-8 ° C.

Wogwiritsa ntchito mankhwala kwa nthawi yayitali

Malangizo a insulin

Dotolo amawerengera kuchuluka kwa tsiku lililonse la insulini potengera kuchuluka kwa shuga m'magazi ndi mkodzo. Mankhwalawa amagawidwa pawiri jakisoni patsiku. Kusintha kwa mankhwalawa, odwala amapereka zolemba zawo kapena kupereka magazi mu labotale ndikupereka mkodzo kuti awunikirane, zomwe zimaphatikizapo ma servings atatu: masiku 2 (8-14 ndi 14-20 maola) ndi 1 usiku, womwe umasonkhanitsidwa pakati pa maola 20.00 ndi 8.00 m'mawa tsiku lotsatira.

Ngati dokotala atakulembani njira yolimbikitsira ya insulini yokhala ndi jakisoni 3, ndiye kuti mankhwalawa amachitika ndi insulin yayitali komanso yotalikirapo musanadye chakudya cham'mawa komanso chakudya cham'mawa, komanso musanadye nkhomaliro - pokhapokha ngati pali mankhwala ochepa, monga tafotokozera 2.

Ngati odwala matenda a shuga sagwira ntchito ndipo amadya mwamphamvu, koma amadya kunyumba ndi zakudya zama calorie ambiri, ndiye kuti mankhwala osokoneza bongo aifupi ndi apakati amaperekedwa musanadye kadzutsa, komanso musanadye chakudya chamadzulo - okhawo omwe amakhala osakhalitsa, usiku - wothandizirana pakati. Pogwiritsa ntchito njira yothandizira jekeseni wa bolus, kukonzekera kwakanthawi kumayambitsidwa musanadye chakudya cham'mawa, chakudya chamadzulo ndi chakudya chamadzulo, ndi mankhwala owonjezera usiku.

Mitundu ya mankhwala

Mitundu ya mankhwala a insulin: achikhalidwe komanso oopsa. Makina azikhalidwe zamasiku onse amaphatikizapo:

• nthawi yothandizira mankhwalawa,
• chakudya owerengeka chakudya
• zolimbitsa thupi panthawi inayake.

Kuchuluka ndi nthawi ya chakudya zimatengera mlingo wa mankhwalawa pochiza T1DM ndi T2DM.

Ulamuliro wolimbikira, m'malo mwake, umadziwika ndi mlingo wa insulin yochepa, zomwe zimatengera kuchuluka kwa chakudya. Pankhaniyi, mankhwala owonjezera amatumizidwa 1-2 nthawi / tsiku komanso lalifupi / ultrashort - chakudya chilichonse chisanachitike.

Njirayi imalola kuti pakhale zosowa, kuyenda kwa chakudya, kukonza zakudya zina zowonjezera. IIT ndikamatsanzira kapamba wamunthu wathanzi.

Mfundo zachikhalidwe

Odwala ayenera kutsatira mfundo izi:

• pafupipafupi (nthawi 4-5) komanso kudya pafupipafupi,
• Zakudya ziyenera kukhala ndi kuchuluka kwamankhwala ndi zopatsa mphamvu,
• gwiritsani ntchito mankhwala ena popanda shuga wambiri,
• sinthani 90% ya kudya tsiku lililonse shuga ndi sorbitol kapena saccharin,
• osapatula maswiti odya, chocolate, confectionery ndi muffin,
• osaphatikiza mu maphikidwe a zakudya zamwana wankhosa ndi nkhumba, zotentha ndi zokometsera, mpiru ndi tsabola, zakumwa zoledzeretsa,
• Osamadya zipatso zotsekemera, makamaka zoumba zamphesa, mphesa ndi nthochi.

Mfundo za Insulin Therapy

Pochiza matenda a shuga, mfundo zotsatirazi za insulin Therapy zimawonedwa:

• insulin yokha yamunthu imagwiritsidwa ntchito,
• glycemia mpaka katatu patsiku kapena khalani akuwunika mosalekeza,
• gwiritsani ntchito mankhwala olimbitsa kapena pampu insulin,
• sinthani mlingo wa insulin pa endocrinologist 1-2 pa sabata.

1. Mankhwala a insulin amadziwika mosaganizira kuchuluka kwa glycemia. Ikani ma insulin afupiafupi: Actrapid NM, Humulin R, Homor. Imayendetsedwa ndi kulowetsedwa kosalekeza pogwiritsa ntchito mafuta onunkhira.
2. Insulin imayendetsedwa pamlingo wa 0.1 U / kg / ola kuti athetse ketoacidosis. Chepetsani msinkhu wa glycemia pa liwiro losaposa 5 mmol / ola.
3. Ngati kuchuluka kwa shuga kumachepa pamlingo woposa 5mmol / ola - chepetsa mlingo wa mankhwalawa. Ngati mulingo wa glycemia utachepa mpaka 4 mmol / l - mlingo wa mankhwalawa umachepetsedwa 2 times. Kuchuluka kwa glycemia mu mtundu 1 wa shuga ndi 8-10 mmol / L.
4. Ndi GOK (hyperosmolar coma), ma insulin amafupikitsa (Actrapid) amagwiritsidwa ntchito, izi zisanachitike, akuwonetsa kuti kuphwanya zamadzi kumachotsedwa. Mlingo woyambira umalowa jetini, kenako ikani liwiro la 0.1 U / kg / ola (5-6 Units / ola). Nthawi zonse muziyang'anira kuchuluka kwa glycemia.
5. Ndi GOK ndi kuchepa kwa glucose, mlingo wa mankhwalawo umachepa mpaka 2 mayunitsi / ora. Pambuyo pobayira shuga (10% yankho) mu mtsempha wamafuta ndi mchere. Ngati wodwala amwa yekha, thanzi lake layenda bwino, ndiye kuti insulin yochepa (mlingo wa 6 Units) imathandizidwa mosadukiza musanadye.
6. Ngati, pambuyo pa maola 2-3, kuchuluka kwa shuga sikunachepetse ndi GOK, mlingo wa mankhwalawa ukuwonjezeka nthawi 2. Amabayidwa m'matumbo a mitsempha, ndiye kuti kulowetsedwa kumayikidwa payezo wa magawo 10 / ola. Ngati ndende ya shuga yachepa, mlingo wa mankhwalawa = 5 PIERES / ora, ndiye 2 PIECES / ora.

Malangizo a shuga

Chithandizo cha insulin chatsopano chimawoneka ngati chododometsa, koma onse odwala matenda ashuga nthawi yomweyo adamva momwe moyo wawo wasinthira.

Zomwe zidachitika pazaka makumi angapo zapitazi:

• bovine ndi nkhumba insulin inasinthidwa ndimunthu wopanga ma genetic, siziyambitsa mavuto,
• kukonzekera kwakanthawi kogwiritsa ntchito glucose komwe kumabwera ndi chakudya, basal (yowonjezera) imagwiritsa ntchito shuga, yemwe amatulutsidwa chifukwa cha kukondoweza kwa chiwindi ndi njira yochizira T1DM. Mankhwala owonjezera samalola kukula kwa hypoglycemia chifukwa cha kuyamwa,
• mitundu ya Mlingo idawoneka yomwe ikhoza kulipirira kagayidwe kazachilengedwe mu T2DM. Mankhwala a Ultrashort angalimbikitse kupanga kwa insulin ndi thupi lanu komanso kupatula zakudya zopatsa thanzi, chifukwa sipadzakhala zofunikira zoyambitsa hypoglycemia,
• ndi matenda a shuga a 2, mankhwala amathandizira kuti amasulidwe othandizira, omwe amakhala nthawi yayitali amathandizira shuga wamagazi komanso samachepetsa kuchepa kwake,
• Mankhwala ena omwe ali ndi T2DM amatha kukulitsa chidwi cha insulin yawo, ndikupangitsa kagayidwe kazakudya, makamaka mwa anthu onenepa kwambiri.
• Kwa mitundu yoyambirira ya matendawa, timapatsidwa mankhwala kuti tilepheretse kuyamwa kwa chakudya cham'mimba kuchokera ku chakudya. Mukamalandira ndalama zotere, wodwalayo sangathe kuthyola chakudyacho kapena kudya china chosaloledwa, chifukwa m'mimba mumayambitsa izi,
• panali ma cholembera a insulin omwe amathandizira kuperekera mankhwala,
• zopereka zazing'onoting'ono zapangidwa ndipo zikufunika kuti zitha kugwiritsidwa ntchito kuperekera mankhwala kudzera pacatheter yolumikizidwa khungu.
• pali glucometer kapena mawonekedwe oyeserera odzipanga okha a shuga.

Pamsika wazamankhwala ku US, insulin inhalers iyenera kuwonekera mu 2015. Fomu yatsopano ya mlingo imakupatsani mwayi wolamulira kuchuluka kwa glycemia komanso osaba jakisoni wa mahomoni tsiku ndi tsiku.

Inhaled insulin Aliexpress - mita yamagazi Mitsempha yamagazi yosasokoneza

Zomwe zidapangidwazo zinali glucometer yosasokoneza komanso mawonekedwe a wotchi.Ndiwosavuta kugwiritsa ntchito ndipo nthawi zambiri amakulolani kuwongolera kuchuluka kwa shuga osati kunyumba, komanso pantchito, mumsewu komanso zoyendera.

Pulogalamu yaifupi ndi yayitali yolemba piritsi imapezeka kuti ichiritsidwe matenda a shuga 1 ndi matenda a shuga 2. Amalowa m'malo amadzimadzi mawonekedwe a mankhwalawo, athunthu kapena pang'ono, ndipo amakonzedweratu hypoglycemic zotsatira kuti apezeke bwino boma. Pangani mapiritsi Russia ndi India.

Matenda a shuga

Ngati mukufuna kubereka moyenera, tsatirani malangizo a dokotala, ndiye kuti matenda ashuga sangasokoneze mwana ndikumubereka bwino. Mimba insulin mankhwala sichiletsedwa ngati mapiritsi ndi kudya mosamalitsa sizithandiza kuti muchepetse shuga.

Mlingo wa mankhwalawa umaperekedwa ndikuwerengedwa ndi dokotala aliyense payekha kwa mayi aliyense woyembekezera. Patsiku lobadwa komanso poyamwitsa, kuyang'anira kuchuluka kwa shuga kumachitika. Pambuyo pobadwa, mankhwala amatchulidwa ndi nthawi yayitali.

Kwambiri Zowerengeka Zachidziwitso cha Psychology

Insulinocomatous therapy (ICT) kapena insulin mantha mankhwala ndi njira yomwe hypoglycemic coma imayamba chifukwa cha makonzedwe akulu a insulin. Amagwiritsidwa ntchito ngati schizophrenia kwakanthawi kochepetsera komanso psychosis.

Zimathandizira kuchotsa pamtundu wa catatonic-oneiric, polymorphic, osapangika bwino dongosolo la delirium lokhumudwitsa paranoia ndi kuyerekezera zinthu m'maganizo. Zimathandizanso osokoneza bongo kuti aletse zizindikiro zodzipatula.

Ngati paranoid ndi paraphrenic zinthu zikuphatikizidwa ndi kulimbikira kwadongosolo kwa delirium, ndiye kuti insulin chithandizo mu zamatsenga sichimapereka zotsatira zomwe zikuyembekezeka.

Mavuto

Mavuto a insulin mankhwala amawonetsedwa:

• Matupi awo sagwirizana ndi kuyabwa, totupa, mawanga ofiira osagwira makonzedwe osayenera a mankhwalawa: kuvulala kwambiri kwa singano yakhungu kapena yowala, kuyambitsa kukonzekera kozizira, kusankha kosayenera kwa jekeseni,
• machitidwe a hypoglycemic okhala ndi shuga wochepa kwambiri: kuwoneka ngati kulimbikira kwa njala, thukuta kwambiri, kunjenjemera ndi maukwati chifukwa cha kuchuluka kwa insulin, kuperewera kwa zakudya m'thupi,
• post-insulin lipodystrophy (lipoatrophy): kusintha kwa khungu, kuzimiririka kwa minofu yamafuta pansi pa khungu pamalo a jekeseni,
• lipohypertrophy - mawonekedwe a mafuta onenepa pamalo opangira jekeseni,
• chophimba kwakanthawi pamaso pa maso ndi retinopathy - kuwonongeka kwa maso mu shuga,
• kutupa kwakanthawi kwamiyendo chifukwa chamadzi ndikukhala ndi sodium komanso kuwonjezeka kwa kuthamanga kwa magazi kumayambiriro kwa chithandizo.

Kupewa kwa mavuto ndi motere:

1. Ndi boma la hypoglycemic, muyenera kudya 100 g mkate ndi zidutswa za shuga ndi kumwa tiyi wokoma - 1 chikho.
2. Pewani chisangalalo ndi kupsinjika, kupsinjika kwamthupi.
3. Muyenera kuperekera insulin ndi malo ena obayira tsiku lililonse.
4. Onjezani Hydrocortisone pambale ndi insulin chifukwa cha matupi osakhudzika komanso kuyabwa.
5. Chitani masewera olimbitsa thupi ndikupanga mndandanda pazolimbikitsidwa ndi akatswiri kuti muchepetse kunenepa.

Mavuto a wodwala omwe amayamba ndi insulin.

Mu ana ndi achinyamata, nthawi ya matendawa imatha kusinthika ndipo kulipidwa kumatheka pokhazikitsa madongosolo a insulin ya anthu. Pampu za insulin zakunja zikuyambitsidwa mdziko muno, ngakhale kuti mtengo wake umakhala wokwera kwambiri.

FAQ

Moni. Kodi mankhwala operekera kwa ana ali ndi chilichonse? Kodi mungatchule ma insulin osiyanasiyana komanso mtundu wa tsiku lililonse la mtundu woyamba wa matenda ashuga?

Moni. Gome 2 imapereka mawonekedwe a pharmacokinetic a mankhwalawa. Gome 3 ikuwonetsa kuchuluka kwa insulin tsiku lililonse: yochepa komanso yayitali masiku ano ndi insulin.