Tresiba insulin - mankhwala atsopano a shuga

Anthu onse omwe ali ndi matenda ashuga a mtundu woyamba 1, komanso anthu ena omwe ali ndi matenda a shuga a 2, amagwiritsa ntchito mankhwalawa. Izi zikutanthauza kuti amapangira jakisoni wautali (basal) wa insulin (Lantus, Levemir, Treshiba, NPH, ndi zina), zomwe ndizofunikira kuti shuga apangidwe m'thupi mwathu pakati pa chakudya, komanso jakisoni afupifupi (Actrapid NM, Humulin R , Insuman Rapid) kapena ultrashort insulin (Humalog, Novorapid, Apidra), ndiye kuti, ma buloamu omwe amafunikira kuti achepetse kuchuluka kwa glucose omwe timapeza ndi chakudya (mkuyu. 1). M'mapampu a insulin, ntchito zonsezi zimachitika ndi ultrashort insulin.

Mkuyu. 1 Basis-bolus insulin mankhwala

Pazowerengera za tsiku ndi tsiku insulin ndi basal mlingo wa insulin wafotokozedwa mwatsatanetsatane m'nkhaniyi "Kuwerengetsa kwapansi pa insulin. " M'mawonekedwe a nkhaniyi, tizingowerengera kuwerengera kwamankhwala a insulin.

Ndikofunikira kukumbukira kuti pafupifupi 50-70% ya tsiku lililonse ya insulini imayenera kukhala pa insulin, ndi 30-50% pamtunda woyambira. Ndikuwonetsa chidwi chanu kuti ngati mlingo wanu wa insulin yayitali (yayitali) wosankhidwa molakwika, ndiye kuti kuwerengera kofotokozedwa pansipa sikungakubweretsereni phindu lina pakuwongolera shuga. Mpofunika kuti tiyambe ndi kukonza basulin insulin.

Kubwerera ku insulin.

Mlingo wa bolus insulin = insulini yochotsa glucose + insulin pa chakudya (XE)

Tiyeni tiwone chinthu chilichonse mwatsatanetsatane.

1. Insulin ya kukonza shuga

Ngati mumayezera mulingo wa glucose, ndipo zimapezeka kuti ndizokwera kuposa zomwe mukufuna kutsimikiza ndi endocrinologist yanu, ndiye kuti muyenera kuyika kuchuluka kwa insulini kuti muchepetse shuga.

Kuti muwerenge kuchuluka kwa insulini pakuwongolera shuga, muyenera kudziwa:

- shuga wamagazi pakadali pano

- zomwe mumayang'ana mu shuga (mutha kuzipeza kuchokera kwa endocrinologist wanu ndi / kapena kuwerengera kugwiritsa ntchito chowerengera)

Kukhudzika mtima akuwonetsa kuchuluka kwa mmol / L 1 unit ya insulin kutsitsa shuga. Kuwerengera coefflication (ISF), "lamulo 100" limagwiritsidwa ntchito, 100 imagawidwa mu Daily Dose of Insulin (SDI).

Sensitivity Coeffnty (CN, ISF) = 100 / LED

CHITSANZO tiyerekeze kuti SDI = 39 ED / tsiku, kenako Sensitivity Coeffnty = 100/39 = 2,5

Mwakutero, mutha kusiya zokwanira kumverera tsiku lonse. Koma nthawi zambiri, poganizira physiology yathu ndi nthawi yopanga ma mahomoni a contra-mahomoni, kumva kwa insulin m'mawa kumakhala koipa kuposa madzulo. Ndiye kuti m'mawa thupi lathu limafunikira insulini yambiri kuposa madzulo. Kutengera ndi zomwe tili ZITSANZO, kenako tifunseni:

- chepetsani zoyesererazo mpaka 2.0 m'mawa,

- siyani okwanira 2.5 masana,

- Madzulo, onjezerani ku 3.0.

Tsopano werengani mlingo wa insulin kusintha kwa shuga:

Glucose kukonza insulin = (glucose chandamale phindu) / sensitivity coeffnty

CHITSANZO munthu amene ali ndi matenda a shuga a mtundu 1, mphamvu yolumikizira 2,5 (yowerengedwa pamwambapa), amalimbikitsa kugwiritsira ntchito shuga kuchokera 6 mpaka 8 mmol / L, mulingo wamagazi pakadali pano ndi 12 mmol / L.

Choyamba, zindikirani mtengo womwe mukufuna. Tili ndi nthawi kuchokera 6 mpaka 8 mmol / L. Nanga tanthauzo la chilinganizo ndi chiyani? Nthawi zambiri, tengani njira yamasamu ya mfundo ziwiri. Ndiye kuti, mwachitsanzo chathu (6 + 8) / 2 = 7.
Insulin ya kukonza glucose = (12-7) / 2.5 = 2 PISCES

2. Insulin ya chakudya (pa XE)

Ichi ndi kuchuluka kwa insulini yomwe muyenera kulowamo kuti mumalize mafuta omwe amabwera ndi chakudya.

Kuti muwerenge kuchuluka kwa insulin pazakudya, muyenera kudziwa:

-momwe mungadye mkate wambiri kapena magalamu a chakudya, kumbukirani kuti m'dziko lathu 1XE = 12 magalamu a chakudya (mdziko 1XE limafanana ndi magalamu 10 a hydrocarbons)

- Chiwerengero cha insulin / chakudya (kapena chakudya m'thupi).

Chiwerengero cha insulin / chakudya (kapena kuchuluka kwa chakudya) ikuwonetsa kuchuluka kwa magalamu a chakudya omwe amaphatikiza 1 unit ya insulin. Powerengera, "lamulo 450" kapena "500" limagwiritsidwa ntchito. Pochita zathu, timagwiritsa ntchito "Rule 500". Mwakutero, 500 imagawidwa ndi mlingo wa insulin tsiku lililonse.

Chiwerengero cha insulin / chakudya = 500 / LED

Kubwerera kwathu CHITSANZOkomwe SDI = 39 ED / tsiku

kuchuluka kwa insulin / carbohydrate = 500/39 = 12.8

Ndiko kuti, gawo limodzi la insulin limakwirira 12,8 magalamu a chakudya, omwe amafanana ndi 1 XE. Chifukwa chake, kuchuluka kwa insulin chakudya 1ED: 1XE

Mutha kukhalanso ndi insulin / carbohydrate umodzi tsiku lonse. Koma, potengera physiology, poganiza kuti insulin yambiri imafunika m'mawa kuposa madzulo, tikulimbikitsa kuwonjezera kuchuluka kwa ins / angle m'mawa ndikuchepetsa madzulo.

Kutengera zathu ZITSANZOtikupangira:

- m'mawa kuonjezera kuchuluka kwa insulin ndi 1 XE, ndiye kuti 1.5 ZIWANDA: 1 XE

- masanawa masana 1ED: 1XE

- madzulo kusiyanso 1ED: 1XE

Tsopano tiwerenge kuchuluka kwa insulin pa chakudya

Mlingo wa insulin pa chakudya = Muyezo wa Ince / Angle * XE

CHITSANZO: Chakudya chamasana, munthu amadya 4 XE, ndipo kuchuluka kwake kwa insulin / chakudya ndi 1: 1.

Mlingo wa insulin pa chakudya = 1 × 4XE = 4ED

3. Muwerenge kuchuluka kwa insulin

Monga tafotokozera pamwambapa

DOSE YA BOLUS INSULIN = INSULIN ON CORRECTION OF GLUCOSE LEVEL + INSULIN ON FOOD (ON XE)

Kutengera zathu ZITSANZOzinapezeka

Mlingo wa bolus insulin = (12-7) / 2,5 + 1 × 4XE = 2ED + 4 ED = 6ED

Zachidziwikire, poyamba, njira yowerengera iyi ingaoneke ngati yovuta komanso yovuta kwa inu. Vutoli likuchitika, ndikofunikira kuganizira nthawi zonse kuti tibweretse kuwerengera kwa Mlingo wa bolus insulin ku automatism.

Pomaliza, ndikufuna kukumbukira kuti zomwe zili pamwambazi ndizotsatira zakuwerengera masamu chifukwa cha kuchuluka kwanu kwa insulin. Ndipo izi sizitanthauza kuti ayenera kukhala angwiro kwa inu. Mwinanso, mukamagwiritsa ntchito, mudzamvetsetsa komwe komanso zomwe ndingakwanitse kapena zochulukirapo kuti muthe kusintha shuga. Mukamawerengera izi, mudzapeza ziwerengero zake mutha kuyendayendaM'malo mosankha mtundu wa insulin modzikakamiza.

Tikukhulupirira kuti mwapeza kuti nkhaniyi ndi yothandiza. Tikufuna kuti mupambane kuwerengera Mlingo wa insulini komanso mulingo wokhazikika wa glucose!

Zambiri za Tresiba

Chithandizo chogwira mankhwalawa ndi insulin degludec (insulin degludec). Ndiye kuti, monga momwe mumaganizira, Tresiba ndi dzina lamalonda lomwe kampani idaganiza zopereka mankhwalawo.

Monga ma insulins a Lantus, Levemir kapena, titi, Novorapid ndi Apidra, mankhwalawa ndi analogue a insulin yaumunthu. Asayansi adatha kupereka mankhwalawa mwapadera pogwiritsa ntchito ma biotechnologies omwe amapanga ma DNA omwe amapanga gawo la Saccharomyces cerevisiae ndikuwongolera kapangidwe ka maselo a insulin ya munthu.

Pali chidziwitso kuti poyamba chinali chokonzekera kugwiritsa ntchito mankhwalawa kokha kwa odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga. Komabe, mpaka pano, odwala omwe ali ndi mtundu wachiwiri komanso woyamba wa shuga amatha kusinthana ndi jakisoni watsiku ndi tsiku wa insulin analogue yatsopanoyi.

Mfundo za ntchito ya Degludek ndikuphatikiza ma mamolekyulu am'mankhwala kuti akhale ma multihexamers (mamolekyulu) pambuyo pakubaya jekeseni, yomwe imapanga mtundu wa insulin depot. Pambuyo pake, Mlingo wochepa wa insulin umasiyanitsidwa ndi malo okumbikirako, omwe amathandiza kuti Treshiba ayambe kugwira ntchito.

Chofunikira! Mankhwalawa ali ndi mwayi wofanana poyerekeza ndi mankhwala ena a insulin, komanso ma analogues, chifukwa chochepa kwambiri cha hypoglycemia. Malinga ndi opanga, hypoglycemia pa nthawi ya mankhwala a Tresib insulin pa mlingo wovomerezeka siimawonedwa.

Ndipo popeza pafupipafupi hypoglycemia mwa odwala matenda ashuga ndiowopsa, ndipo imakulitsa kwambiri matendawa pawokha, iyi ndi mfundo yofunika. Mutha kuwerengera za kuopsa kwa hypoglycemia mu shuga pano.

Kwa zaka zambiri ndakhala ndikuphunzira za zovuta za DIABETES. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinology Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsiratu matenda ashuga. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 100%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipilira mtengo wonse wa mankhwalawo. Ku Russia ndi mayiko a CIS odwala matenda ashuga kale Julayi 6 alandire mankhwala - ZAULERE!

Ubwino wina wa Tresib insulin: kusinthika kochepa m'minyewa ya glycemic masana. Ndiye kuti, mukamalandira mankhwala a Degludec insulin, shuga amawonjezera tsiku lonse pamlingo wokhazikika, womwe pawokha ndi mwayi wabwino.

Inde, kulumpha mwadzidzidzi ndi kowopsa ku thanzi la odwala matenda ashuga oyamba komanso oyamba. Ubwino wachitatu womwe ukutsatira kuchokera pamwambapa ndi kukwaniritsa cholinga chabwino. Mwanjira ina, chifukwa chakuchepa kocheperako pamlingo wa glycemia, madokotala amapatsidwa mwayi wokhala ndi zolinga zabwino kwambiri.

Chenjezo: Ndiye kuti, mwachitsanzo, mwa wodwala, mitengo ya kudya shuga m'magazi ndi 9 mmol / L. Pochiza ndi kukonzekera kwina kwa insulin, poganizira za kuchuluka kwa shuga, dokotalayo sangathe kukhazikitsa cholinga chokwaniritsa 6, komanso makamaka pa 5.5 mmol / l, popeza izi zikakwaniritsidwa, nthawi ya shuga imachepa ngakhale m'munsimu 4 kapena ngakhale 3! Zosavomerezeka!

Pochiza ndi Tresib insulin, ndizotheka kukhazikitsa zolinga zoyenera kwambiri (chifukwa chakuti kusinthasintha kwa mankhwalawa ndikosafunikira), kubwezerani zabwino zokhudzana ndi matenda osokoneza bongo ndipo motero kuwonjezera nthawi yayitali ndi moyo wa odwala awo.

Ndili ndi zaka 47, ndinapezeka kuti ndili ndi matenda ashuga a 2. M'masabata angapo ndinapeza pafupifupi 15 kg. Kutopa nthawi zonse, kugona, kumva kufooka, kuwona kunayamba kukhala pansi.

Nditakwanitsa zaka 55, ndinali nditadzibaya kale ndi insulin, zonse zinali zoipa kwambiri. Matendawa adapitilirabe, kukomoka kwakanthawi kunayamba, ambulansi imandibwezera kuchokera kudziko lina. Nthawi zonse ndimaganiza kuti nthawi ino ikhala yomaliza.

Chilichonse chinasintha mwana wanga wamkazi atandilola kuti ndiwerenge nkhani imodzi pa intaneti. Simungayerekeze m'mene ndimamuyamikirira. Nkhaniyi inandithandiza kuthana ndi matenda ashuga, omwe amati ndi osachiritsika. Zaka 2 zapitazi ndidayamba kusuntha zowonjezereka, nthawi yamasika ndi chilimwe ndimapita kumayiko tsiku lililonse, ndikumalima tomato ndikugulitsa pamsika. Azakhali anga amadabwa ndimomwe ndimapangira chilichonse, komwe ndimapeza mphamvu zambiri, sakhulupirira kuti ndili ndi zaka 66.

Ndani akufuna kukhala ndi moyo wautali, wamphamvu komanso kuiwalako za matenda oyipawa kwamuyaya, tengani mphindi 5 ndikuwerenga nkhaniyi.

Tsoka ilo, Tresiba insulin imalowetsedwa kwa odwala osakwana zaka 18, komanso mwa unamwino ndi amayi apakati. Kugwiritsa ntchito mankhwalawa monga jakisoni wovomerezeka kumaletsedwanso. Njira yokhayo yoyendetsera ndikuperekera jakisoni wamkati. Kutalika kwa insulin kumatha maola 40.

Upangiri! Sizikudziwikabe kuti izi ndi zabwino kapena zoyipa, ngakhale opanga amaika izi ngati kuphatikiza mankhwalawo, ndipo amalimbikitsabe kubayira nthawi yomweyo tsiku lililonse. Katiziridwe tsiku lililonse silabwino, chifukwa, choyamba, insuliniyi sikufikira masiku onse awiri, ndipo chachiwiri, kutsata kumakulirakulira, ndipo odwala amatha kusokonezeka ngati apereka jakisoni lero kapena lero.

Mankhwalawa amapangidwa ngati ma cartridgeges omwe amagwiritsidwa ntchito mu Novopen syringe pens (Tresiba Penfill), komanso mawonekedwe a syringe penti yochita kupanga (Tresiba FlexTouch), yomwe, monga dzinali likusonyezera, liyenera kutayidwa mutatha kugwiritsa ntchito insulin yonse, ndikugula FlexTouch yatsopano.

Mlingo: 200 ndi 100 mayunitsi 3 ml. Momwe mungayendetsere insulin Tresiba? Monga tafotokozera pamwambapa, Tresiba amangopanga ma poplamu a mapulogalamu amodzi kamodzi pa maola 24 aliwonse. Ngati simunalowetse insulin kale, mukasinthira ku chithandizo cha inshuwaransi ya Tresib, muyenera kuyamba ndi mlingo wa magawo 10 nthawi 1 patsiku.

Pambuyo pake, malinga ndi zotsatira za miyeso ya kusala kwa plasma glucose, gawo lina limagwirira ntchito limodzi. Ngati muli kale pa insulin mankhwala, ndipo adotolo atasankha kuti akusamutseni ku Tresiba, ndiye kuti mlingo wa mankhwalawo udzakhala wofanana ndi mlingo wa insulin ya basal yomwe imagwiritsidwa ntchito kale (malinga kuti kuchuluka kwa hemoglobin ya glycated sikuchepera 8, ndipo insulin insulin imathandizidwa kamodzi patsiku).

Kupanda kutero, mlingo wochepetsetsa wa Degludec insulin ungafunike mukasamutsidwa kuchokera ku basal ina. Inemwini, ndili wokonzeka kugwiritsa ntchito Mlingo wocheperako pang'ono kumasulira kofananako, popeza Tresib ndi analogue ya insulin yaumunthu, ndipo mukamasulira analogues, monga mukudziwa, madontho apansi nthawi zambiri amafunikira kuti akwaniritse standardoglycemia.

Kutumizira kwa mankhwalawa kumachitika kamodzi pakadutsa masiku 7, ndipo zimatengera magawo awiri apakale a kusala kudya kwa glycemia: Insulin iyi imatha kuperekedwa limodzi ndi mapiritsi ochepetsa shuga komanso kukonzekera kwina kwa insulin.

Kodi zolakwika za Treshiba ndi ziti? Tsoka ilo, ngakhale pali zabwino zonse, mankhwalawa amakhalanso ndi zovuta. Ndipo tsopano tikulemberani inu. Choyamba, ndikulephera kugwiritsa ntchito kwa odwala ndi ana, amayi apakati komanso oyembekezera. Njira yokhayo ndiyopanikizika.

Osamapereka infravenousous a Tresiba! Chingwe chotsatira, m'malingaliro mwanga panokha, ndi kusowa kwa zochitika zofunikira. Ndi lero kuti chiyembekezo chambiri chikulandiridwa kwa iye, ndipo zaka zisanu ndi zisanu ndi zisanu ndi chimodzi zidzakhala kuti iye alibe zophophonya zowonjezera, zomwe sizikudziwika kapena sizimangokhala chete ndi opanga.

Zachidziwikire, polankhula za zofooka, sitingakukumbukireni kuti Tresib akadali pokonzekera insulini, ndipo monga kukonzekera kwina konse kwa insulin, kumatha kuyambitsa zovuta ndi zovuta za insulin.

Zofunika!

Simungathe kulandira mankhwala aulere ku Tresib Polyclinic kuti mupatsidwe mankhwala, mwina posachedwa. Kotero si aliyense angathe kuyesa kaye.

Tresiba: insulin yayitali kwambiri

Kwa zaka 1.5 ndili ndi matenda ashuga, ndidaphunzira kuti pali insulini zambiri. Koma pakati motalika kapena, monga momwe amatchulidwira molondola, oyambira, oyambira sayenera kusankha makamaka: Levemir (kuchokera ku NovoNordisk) kapena Lantus (wochokera ku Sanofi).

Chenjerani! Posachedwa, ndili ku chipatala "chakwawo", akatswiri am'masiku otsiriza adandiuza za chozizwitsa cha matenda ashuga - a Tresiba insulin wa nthawi yayitali wochokera ku NovoNordisk, yemwe wangopezeka kumene ku Russia ndipo akuwonetsa kale lonjezo. Ndinkadziona kuti ndine wosayenera, popeza kuyambika kwa mankhwala atsopano kunandidutsa.

Madotolo adatsimikizira kuti insuliniyi imatha kukhwimitsa shuga "wopanduka" kwambiri ndikuthanso nsonga zazitali kwambiri, ndikusintha mawonekedwe pazowoneka kuti zisasinthike kukhala mzere wowongoka. Zachidziwikire, ndidathamangira kukawerenga nkhaniyi pogwiritsa ntchito Google komanso madokotala omwe ndimawadziwa. Chifukwa chake nkhaniyi ikunena za inshuwaransi yayikulu kwambiri ya Treshiba.

Kuyambitsa msika

Zaka zingapo zapitazi adadziwika ndi mpikisano wamankhwala opanga ma insulin atali, okonzeka kufinya podium utsogoleri wopanda mabungwe wa wogulitsa bwino kwambiri padziko lonse kuchokera ku Sanofi. Ingoganizirani kuti kwa zaka zoposa khumi, Lantus wakhala woyamba kugulitsa m'gulu la insulin insulin.

Osewera ena pamunda samangololedwa chifukwa chotetezedwa ndi dzina la wapolisiyo. Tsiku loyambira patenti lidayamba chaka cha 2015, koma Sanofi adapeza phindu mpaka kumapeto kwa chaka cha 2016 pomaliza mgwirizano wamgwirizano ndi Eli Lilly kuti apatsidwe ufulu wokhala nawo wokha wokhala ndi mtengo wotsika mtengo wa Lantus.

Makampani ena amawerengera masiku mpaka patent itatha mphamvu zake kuyamba kupanga zochuluka zamagetsi. Akatswiri amati posachedwapa msika wa insulin yayitali udzasintha kwambiri.

Mankhwala atsopano ndi opanga adzaoneka, ndipo odwala ayenera kusankha izi. Pamenepa, kutuluka kwa Tresiba kunachitika nthawi yake. Ndipo tsopano pikhala nkhondo yeniyeni pakati pa Lantus ndi Tresiba, makamaka mukaganiza kuti chatsopanocho chidzafunika ndalama zochulukirapo.

Zogwira ntchito Treshiba - bastard. Kutalika kwakukulu kwa mankhwalawa kumatheka chifukwa cha hexadecandioic acid, yomwe ndi gawo lake, lomwe limalola kupanga mapangidwe okhazikika a ma multihexamers.

Amakhala otchedwa insulin depot mu subcutaneous wosanjikiza, ndipo kutulutsidwa kwa insulini mu kayendedwe kazinthu kumachitika mofananirako mosalekeza, popanda kutchulidwa kwakukulu, kwa mawonekedwe a de facto a insalins ena.

Kufotokozera njira yovuta yamapulogalamuyi kwa ogula wamba (kutanthauza kuti), wopanga amagwiritsa ntchito fanizo lomveka bwino. Pa tsamba lovomerezeka mutha kuwona kuyika mwaluso kwa zingwe zingapo, komwe mkanda uliwonse umakhala wamitundu yambiri, womwe, pambuyo pake, ndi nthawi yofanana imaduladula kuchokera pansi.

Ntchito ya Treshiba, yotulutsa "zigawo-mikanda" yofananira ya insulin ku depos yake, imawoneka ngati yofanana, ikupereka magazi mosalekeza komanso mofananirana. Ndi makina amenewa omwe adapereka nthaka makamaka kwa okonda kwambiri a Treshiba kuti ayerekeze ndi pampu ngakhale ndi insulin yanzeru. Inde, zonena ngati izi sizopitirira kungokopa molimba mtima.

Tresiba amayamba kuchita pambuyo pa mphindi 30-90 ndipo amagwira ntchito mpaka maola 42. Ngakhale atatalikiratu nthawi yayitali kwambiri, pochita Treshib iyenera kugwiritsidwa ntchito nthawi 1 patsiku, monga Lantus wodziwika bwino.

Chofunika: Odwala ambiri amafunsa mozama kuti mphamvu ya insulin yowonjezereka ikupita maola 24, ngati mankhwalawo amasiya "michira" yake ndi momwe izi zimakhudzira maziko onse. Zonena ngati izi sizipezeka mu zida zaku Tresib.

Koma madokotala amafotokozera kuti, monga lamulo, odwala amakhala ndi chidwi chachikulu ndi Tresib poyerekeza ndi Lantus, kotero, mlingo wake umachepetsedwa kwambiri. Ndi mlingo woyenera, mankhwalawa amagwira ntchito bwino komanso mwachidziwikire, choncho palibe chifukwa chakuwerengera "michira" iliyonse.

Mawonekedwe

Chofunikira kwambiri ku Treshiba ndi mbiri yake yotsogola. Imagwira ntchito "konkriti yolimbitsa" yomwe imapangitsa kuti malo osanja azikhala.

Pachilankhulidwe chamankhwala, kusinthasintha kosafunikira kotere kwa mankhwala kumatchedwa kusinthasintha. Chifukwa cha mayeso azachipatala adapezeka kuti kusiyanasiyana kwa Treshiba kuli kotsika kanayi kuposa kwa Lantus.

Kusamala pambuyo masiku 3-4

Kumayambiriro kwa kugwiritsidwa ntchito kwa Tciousba, ndikofunikira kusankha bwino. Izi zitha kutenga nthawi. Ndi mlingo woyenera, patatha masiku 3-4, insulin "ating kuyanika" kapena "malo okhazikika" imapangidwa, yomwe imapereka ufulu mogwirizana ndi nthawi ya Treshiba.

Wopanga akutsimikizira kuti mankhwalawa amatha kutumikiridwa panthawi zosiyanasiyana za tsiku, ndipo izi sizingakhudze momwe amagwirira ntchito komanso momwe amagwirira ntchito. Komabe, madokotala amalimbikitsa kutsatira dongosolo lokhazikika ndikuwuperekera mankhwalawo nthawi yomweyo kuti asasokonezedwe ndi zovuta za jakisoni komanso kuti asapeputse "gawo lofanana".

Tresiba kapena Lantus?

Nditadziwa za zodabwitsa zaku Treshiba, nthawi yomweyo ndidawafunsa mafunso omwe ndimawadziwa. Ndinali ndi chidwi ndi chinthu chachikulu: ngati mankhwalawa ali abwino kwambiri, bwanji aliyense samatembenukira kwa iwo? Ndipo ngati ndikunena zoona, ndi ndani wina amene amafunika Levemir?

Upangiri! Koma zonse, sizikhala zophweka. Palibe chodabwitsa kunena kuti aliyense ali ndi matenda awo a shuga. Mwanjira yabwino kwambiri ya mawu. Chilichonse ndichokhazokha mwakuti palibenso njira zoyenera zopangira. Choyimira chachikulu pakuwunika bwino kwa "insulin coating" ndicho chipukuta misozi. Kwa ana ena, jakisoni imodzi ya Levemir patsiku imakhala yokwanira kulipira bwino (inde! Pali ena).

Iwo omwe samalimbana ndi Levemire iwiri nthawi zambiri amakhutira ndi Lantus. Ndipo wina waku Lantus akumva bwino kuyambira chaka chimodzi. Pazonse, lingaliro la kupereka izi kapena kuti insulini imapangidwa ndi adotolo, omwe amafufuza zosowa zanu ndi mawonekedwe anu ndi cholinga chokha chokwaniritsa zolinga zabwino za shuga.

Mkangano wa insulin pakati pa Sanofi ndi Novo Nordisk. Mtunda wautali. Wampikisano waukulu wa Treshiba anali, ndipo adzakhala Lantus. Zimafunikanso kasamalidwe kamodzi ndipo amadziwika kuti amagwira ntchito kwanthawi yayitali.

Kafukufuku wofananirana pakati pa Lantus ndi Tresiba adawonetsa kuti mankhwalawa onse amagwira bwino ntchito yolimbana ndi glycemic control.

Komabe, zosiyana ziwiri zazikulu zidadziwika. Choyamba, mlingo wa insulin ku Tresib umatsimikiziridwa kuti utachepetsedwa ndi 20-30%. Ndiye kuti, mtsogolomo, maubwino ena azachuma amayembekezedwa, koma pamtengo waposachedwa wa insulin, izi sizofunikira.

Kachiwiri, kuchuluka kwa hypoglycemia nocturnal kumachepa ndi 30%. Izi zakhala mwayi waukulu wotsatsa ku Treshiba. Nkhani yakumasamba a shuga usiku ndizosokoneza munthu wodwala matenda ashuga, makamaka pakakhala kuti palibe njira yowunikira. Chifukwa chake, lonjezano loonetsetsa kuti tulo ta matenda ashuga limawoneka modabwitsa.

Kuopsa

Kuphatikiza pa kutsimikizika kogwira ntchito, mankhwala aliwonse atsopano ali ndi njira yayitali yopangira mbiri yabwino potengera kuyambitsa kwake. Zambiri pazakugwiritsa ntchito Treshiba m'maiko osiyanasiyana ziyenera kusungidwa pang'onopang'ono: madokotala mwachizolowezi amamwa mankhwala omwe sanaphunziridwe pang'ono ndipo sathamangira kukawapereka mankhwala kwa odwala awo.

Zofunika! Ku Germany, mwachitsanzo, kudana ndi Tresib kwakhazikitsidwa. Bungwe lodziyimira lokha ku Germany Institute for Quality and ufanisi mu Health Care lidachita kafukufuku wawo, likufanizira zotsatira za Treshiba ndi omwe akupikisana nawo, ndipo adazindikira kuti insulini yatsopanoyi singadzitamandire pazabwino zina zilizonse ( "Palibe mtengo wowonjezera").

Mwachidule, bwanji kulipira kangapo kwa mankhwala omwe siabwino kwambiri kuposa Lantus wakale wakale? Koma si zokhazo. Akatswiri aku Germany adapezanso zotsatilapo chifukwa chogwiritsa ntchito mankhwalawa, komabe, mwa atsikana okha. Adawonekera mwa atsikana 15 mwa 100 omwe amatenga Treshiba milungu 52. Ndi mankhwala ena, chiwopsezo cha zovuta zinali zochepa nthawi 5.

Mwambiri, m'moyo wathu wa matenda ashuga, nkhani ya kusintha basulin insulin yakhwima. Mwana akamakula komanso kukhala ndi matenda ashuga ndi Levemir, ubale wathu umayamba kuchepa. Chifukwa chake, chiyembekezo chathu chikugwirizana ndi Lantus kapena Tresiba. Ndikuganiza kuti tizingoyenda pang'onopang'ono: tiyambira ndi zakale, ndipo tiona.

Zambiri za mankhwalawa

Wopanga: Novo Nordisk (Denmark), Novo Nordisk (Denmark)

Dzina: Tresiba®, Tresiba®

Machitidwe
Owonjezera akuchita insulin kukonzekera.
Ndi analogue ya insulin yamunthu.

Tip! Kuchita kwa Degludek ndikuti kumawonjezera kugwiritsidwa ntchito kwa glucose ndi mafuta ndi minyewa yam'maselo, minofu itatha, insulin imamangiriza kwa ma cell a seli. Kuchita kwachiwiri ndikufuna kuchepetsa kuchuluka kwa shuga ndi chiwindi.

Kutalika kwa mankhwalawa ndi maola opitilira 42. The kuchuluka kwa insulin mu plasma kumachitika patatha maola 24-36 pambuyo pa insulin. Insulin imadalira mlingo.

Zisonyezero zogwiritsira ntchito: lembani matenda ashuga a shuga kuphatikiza ma insulin amfupi komanso owonjezera-osakhalitsa, mtundu II shuga mellitus (onse monga monotherapy komanso kuphatikiza othandizira a hypoglycemic othandizira). Kugwiritsa ntchito insulin kumatheka mwa akulu okha.

Njira yogwiritsira ntchito:
S / c, kamodzi patsiku. Ndikofunika kuperekera insulin nthawi yomweyo tsiku lililonse. Mlingo umatsimikiziridwa payekhapayekha.

Zotsatira zoyipa:
Hypoglycemic zinthu, thupi lawo siligwirizana, lipodystrophy (ntchito kwa nthawi yayitali).

Zoyipa:
Ana ochepera zaka 18, pakati ndi mkaka wa m`mawere, hypoglycemia, tsankho lililonse.

Zochita Zamankhwala:
Acetylsalicylic acid, mowa, kulera kwa mahomoni, ma anabolic steroid, sulfonamides amalimbikitsa zotsatira za hypoglycemic.

Mphamvu ya hypoglycemic imakhala yofooka - mphamvu zakulera za mahomoni, glucocorticoids, beta-blockers, mahomoni a chithokomiro, ma antidepressants a tricyclic.

Mimba ndi kuyamwa:
Kugwiritsidwa ntchito kwa Tresib insulin panthawi yapakati komanso pakamayamwa kumatsutsana, chifukwa palibe chidziwitso chachipatala pazomwe zimagwiritsidwa ntchito nthawi izi.

Malo osungira:
Pamalo amdima pakutentha kwa 2-8 ° C (musamazizire). Osayatsira dzuwa. Botolo lomwe limagwiritsidwa ntchito litha kusungidwa kutentha (osati kupitirira 25 ° C) kwa milungu 6.

Zopangidwa:
1 ml ya mankhwala a jakisoni ali ndi insulin degludec 100 IU.
Katoni imodzi ili ndi mayunitsi 300 (3 ml).

Momwe mungagwiritsire ntchito Tresiba insulin?

Munkhaniyi, mutha kuphunzira malangizo a insulini, kusankha payekha mlingo, mupeze zomwe zikuwonetsa ndi contraindication, komanso za mankhwala a Tresib, wowerenga wowerenga. Monga aliyense amadziwa, thupi la munthu limatha kugwira ntchito popanda insulini.

Malangizo: Mankhwala amathandiza popanga shuga, omwe amadzazidwa ndi chakudya. Zimachitika kuti pazifukwa zina kusapeza bwino m'thupi ndipo mahomoni sikokwanira. Pankhaniyi, Tresib adzawathandiza, achitapo kanthu kwa nthawi yayitali.

Treshiba insulin ndi mankhwala omwe ali ndi chinthu chotchedwa Degludec, ndiko kuti, ali ngati insulin ya munthu. Popanga chida ichi, asayansi adatha kugwiritsa ntchito biotechnology kukonzanso DNA pogwiritsa ntchito mtundu wa Saccharomyces cerevisiae ndikusintha kapangidwe ka insulin pamaselo a mamolekyulu. Mpaka posachedwapa, panali malingaliro akuti mankhwalawo amangopezeka kwa anthu omwe ali ndi mtundu wachiwiri wa matenda ashuga.

Koma asayansi atsimikizira kuti anthu omwe ali ndi mtundu woyamba komanso wachiwiri wa shuga amaloledwa kugwiritsa ntchito kasamalidwe kake tsiku lililonse popanda ngozi. Ngati mukuyang'ana mozama, ndiye kuti mumvetsetsa momwe thupi lonse limakhudzira: pambuyo popereka mankhwalawo, ma macromolecules amaphatikizana ndikupanga insulin depot.

Pambuyo pophatikiza, pamabwera nthawi yolekanitsa milingo yaying'ono ya insulin kuchokera ku depot ndikugawa thupi lonse, zomwe zimathandiza kuti mankhwala azikhala nthawi yayitali. Ubwino wa Trecib umapangitsa kuchepa pang'ono kwa insulin m'magazi.

Komanso, mukamagwiritsa ntchito insulini iyi molingana ndi malangizo omwe adokotala akupatsirani, ndizotheka kupewa zolephera m'magazi a shuga kapena kuti asayang'anitsidwe. Zinthu zitatu za Tresib: ZIWEREWERE - OSATI SENTI! "Nthenda ya shuga ndi matenda opha, anthu 2 miliyoni amafa pachaka!" Ungadzipulumutse bwanji? ”- Endocrinologist pankhani ya kusintha kwa matenda a shuga.

Contraindication

Wodwala wosakwana zaka 18. Nthawi ya mimba yonse. Nthawi yoyamwitsa. Kusagwirizana ndi insulin yokha kapena zina zowonjezera zamankhwala a Tresib. Pambuyo pa kukhazikitsidwa kwa mankhwalawa, imayamba kuchita mphindi 30-60.

Chofunika: Mankhwalawa amatha maola 40, ndipo sizikudziwika ngati izi ndi zabwino kapena zoipa, ngakhale opanga amati izi ndi zabwino. Ndikulimbikitsidwa kulowa tsiku lililonse nthawi yomweyo.

Koma ngati, komabe, wodwalayo amamwa tsiku lina lililonse, ayenera kudziwa kuti mankhwalawa omwe adapereka satha masiku awiri, ndipo akhoza kuiwalanso kapena kusokonezeka ngati adabaya jakisoni panthawi yoikika. Insulin imapezeka mu zolembera zotayika komanso makatiriji omwe amaikidwa mu cholembera. Mlingo wa mankhwalawa ndi magawo a 150 ndi 250 mu 3 ml, koma amatha kusiyanasiyana kutengera dziko ndi dera.

Choyamba, kugwiritsa ntchito insulin, muyenera kusankha mlingo wofanana. Izi zitha kutenga nthawi. Tresiba ndi insulin. Ngati dotolo asankha mlingo woyenera, ndiye kuti m'masiku 5 ayende bwino, zomwe zimapatsanso ufulu wogwiritsa ntchito Tresib.

Tip: Opanga amati mankhwalawa amatha kugwiritsidwa ntchito nthawi iliyonse ya tsiku. Koma madotolo amalimbikitsabe kutsatira mtundu wa mankhwalawo, kuti asapeputse "bwino". Tresiba ikhoza kugwiritsidwa ntchito mosazindikira, koma ndizoletsedwa kulowa m'mitsempha, chifukwa cha izi kutsika kwamphamvu m'magazi kumayamba.

Sizoletsedwa kulowa mu minofu, chifukwa nthawi ndi kuchuluka kwa zochulukirapo zimasiyana. Ndikofunikira kulowa kamodzi patsiku nthawi imodzi, makamaka m'mawa. Mlingo woyamba wa insulin: mtundu wachiwiri wa matenda ashuga - mtundu woyamba ndi magawo 15 ndipo kenako kusankha kwake.

Mtundu umodzi wa matenda osokoneza bongo umaperekedwa kamodzi patsiku ndi insulin yochepa, yomwe ndimatenga ndikudya kenako ndimasankha. Malo oyambira: ntchafu ya m'mbali, pamapewa. Onetsetsani kuti mwasintha jakisoni, monga chifukwa cha kukulira kwa milomo.

Wodwala yemwe sanamwe insulin m'mbuyomu, mogwirizana ndi malangizo ogwiritsira ntchito Tresib, ayenera kutumikiridwa kamodzi patsiku m'magawo 10. Ngati munthu wasamutsidwa kuchokera ku mankhwala ena kupita ku Teshiba, ndiye kuti ndimasanthula kuchuluka kwa shuga m'magazi ndikusintha komanso masabata oyambilira kumwa mankhwala atsopano.

Pangakhale kofunikira kusintha nthawi ya makonzedwe, muyeso wa kukonzekera kwa insulin. Mukasinthira ku Tresiba, ndikofunikira kuzindikira kuti insulin yomwe wodwalayo anali ndi njira yoyambira yoyendetsera, ndiye posankha kuchuluka kwa mulingo, lingaliro la "unit to unit" liyenera kuonedwa ndikusankhidwa koyimira pawokha.

Mukasinthira ku insulin yokhala ndi matenda a shuga 1, mfundo ya "unit to unit" imagwiritsidwanso ntchito. Ngati wodwalayo ali ndi makina awiri, ndiye kuti insulini imasankhidwa palokha, mwina akhoza kuchepetsa mlingo ndi zotsatirazi za shuga.

Chenjezo: Dongosolo lakagwiritsidwe ntchito. Ngati wodwalayo nthawi zonse amaiwala kupereka mankhwalawo, ndiye kuti ayenera kuyika ma geninestone monga momwe amakumbukirira, ndikubwerera ku regimen.

Kugwiritsa ntchito kwa Tresib kwa magulu omwe ali pachiwopsezo chachikulu: anthu azaka za senile (zopitilira zaka 60) - mankhwalawa amatha kuthandizidwa motsogozedwa ndi shuga m'magazi ndikusintha Mlingo wa insulin, anthu omwe ali ndi vuto la impso kapena chiwindi - Treshiba imatha kuperekedwa pokhapokha pakuwongolera shuga m'magazi ndikusintha Mlingo insulin

Anthu omwe ali ndi zaka zosakwana 18 - zokolola sizinaphunzirepo; Zotsatira zoyipa Kusagwirizana kwa chitetezo cha m'thupi - mukamagwiritsa ntchito mankhwalawa, thupi limadwala kapena hypersensitivity imatha kukhala ndi mseru, kutopa, kusanza, kutulutsa lilime ndi milomo, kuyabwa kwa khungu).

Chofunikira! Hypoglycemia - imapangidwa chifukwa cha makina ambiri osokoneza bongo, ndipo izi zimapangitsa kuti munthu asamadziwe, agwidwe, azisokonezeka bongo, azingokhala pansi kwambiri komanso ngakhale kufa. Itha kupangidwanso pambuyo podumpha chakudya, kuchita masewera olimbitsa thupi, komanso kusakhazikika mu kagayidwe kazakudya.

Matenda ena aliwonse amathandizira kukula kwa hypoglycemia, kuti mupewe izi muyenera kuwonjezera kuchuluka kwa mankhwalawa. Lipodystrophy - imayamba chifukwa cha kupitiliza kwa mankhwalawa pamalo omwewo (zimachitika chifukwa cha kuchuluka kwa insulini m'mafuta am'magazi ndikuwonongeratu), ndipo zizindikiro zotsatirazi zimadziwika: kupweteka, kutupa, kutupa, hematoma.

Ngati mankhwala osokoneza bongo apezeka, muyenera kumalirira china chake chokoma, monga msuzi wa zipatso, tiyi wokoma, ndi chokoleti chosakhala ndi matenda ashuga. Pambuyo pakusintha, muyenera kulumikizana ndi dokotala kuti muthandizenso kusintha kwa mlingo. Mukamagwiritsa ntchito mankhwalawa, ma antibodies amatha kupezeka kwa nthawi yambiri, momwe mungasinthire kusintha kwa mankhwalawa kuti mupewe zovuta.

Mlingo ndi kasamalidwe (malangizo)

Tciousba Penfill ndi analogue ya insulin yayitali kwambiri. Mankhwalawa amathandizidwa mosavuta kamodzi patsiku nthawi iliyonse, koma ndikofunikira kuperekera mankhwalawa nthawi yomweyo tsiku lililonse.

Odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, mankhwalawa amatha kugwiritsidwa ntchito ngati monotherapy, kapena kuphatikiza ndi PHGP, GLP-1 receptor agonists, kapena bolus insulin. Odwala omwe ali ndi vuto la matenda a shuga 1 amadziwika kuti ndi Tenshiba Penfill osakanikirana ndi insulin yochepa / yochepa-yochepa yothandizira kufunika kwa prandial insulin.

Mlingo wa Treshiba Penfill uyenera kutsimikiziridwa payekha malinga ndi zosowa za wodwala. Kuti muwonetsetsetse kutsata kwa glycemic, ndikulimbikitsidwa kuti kusintha kwa mlingo kuchitike pamaziko a kusala kwa plasma glucose.

Monga momwe amakonzera insulin iliyonse, kusintha kwa Treshiba Penfill kungafunikenso kukulitsa zolimbitsa thupi kwa wodwalayo, kusintha kwa zakudya zake zabwinobwino, kapena kudwala.

Mlingo woyambirira wa mankhwalawa

Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, mlingo woyenera wa tsiku lililonse wa Tciousba Penfill ndi magawo 10, kenako nkusankhidwa ndi mtundu wa mankhwalawo.

Zofunika! Odwala omwe ali ndi vuto la matenda a shuga 1, amapatsidwa mankhwala kamodzi patsiku limodzi ndi prandial insulin, yomwe imaperekedwa pamodzi ndi chakudya, kenako ndikusankhidwa kwa mtundu wa mankhwalawa.

Kusintha kuchokera kukonzekera kwina kwa insulini; kuwunika mosamala kuchuluka kwa shuga wamagazi pakasamu komanso mu masabata oyamba a mankhwala atsopano ndikulimbikitsidwa. Malangizo a concomitant hypoglycemic therapy (muyezo komanso nthawi yotsatirira kukonzekera kwa insulin kapenanso njira zina zomwe munthawi yomweyo mumagwiritsa ntchito mankhwala a hypoglycemic) zingakhale zofunikira.

Odwala a shuga a 2

Mukasamukira ku Treshiba Penfill odwala omwe ali ndi mtundu wachiwiri wa shuga omwe ali pa basal kapena basal-bolus regulen of insulin, kapena pa regimen yothandizira ndi zosakaniza zakupanga za insulin / insulin.

Mlingo wa Treshiba Penfill uyenera kuwerengedwa potengera mtundu wa insulin ya basal yomwe wodwalayo adalandira asanasamuke ku mtundu watsopano wa insulin, malinga ndi mfundo ya ца pa unit 'iliyonse, ndikusinthidwa pazosowa za wodwala payekha.

Odwala Awa Matenda A shuga Aakulu

Odwala ambiri omwe ali ndi vuto la matenda ashuga a mtundu woyamba, akamasintha kuchokera ku inshuwaransi iliyonse kupita ku Treshiba Penfill, amagwiritsa ntchito mfundo ya 'one per unit' potengera mlingo wa insal insulin yomwe wodwala adalandira asanasanduke, ndiye kuti mlingo umasintha malinga ndi zofunikira zake payekha.

Odwala omwe ali ndi matenda a shuga 1 a mtundu wa mellitus, omwe panthawi yosamutsidwa kupita ku Tresiba Penfill amathandizira pa insulin mankhwala omwe amapezeka ndi insal insulin panthawi yoperekera kawiri tsiku lililonse, kapena odwala a index ya HLALC 1/10, nthawi zambiri (1/100 mpaka 1 / 1.000 mpaka 1/1 10,000 mpaka 1 / 1,000), kawirikawiri (1 / 10,000) komanso osadziwika (zosatheka kuyerekezera kutengera deta yomwe ikupezeka).

Matenda owononga chitetezo chamthupi:

Nthawi zambiri, hypersensitivity zimachitika, urticaria. Matenda a Metabolic ndi zakudya: nthawi zambiri - hypoglycemia. Kusokonezeka kwa khungu ndi minyewa yodutsa: pafupipafupi - lipodystrophy. Mavuto ndi zovuta zina pamalo a jakisoni: pafupipafupi - zimachitika pamalo a jakisoni, nthawi zambiri - zotumphukira edema.