Momwe mungasinthire (kuperekera) insulin kwa odwala matenda ashuga

Insulini ndi chinthu chamafuta chomwe chimapangidwa ndi kapamba, maselo ake a beta. Ndikulingalira kuchuluka kwa magwiridwe antchito a chiwalochi komanso kuchuluka kwa mahomoni m'thupi omwe mungadziwe ngati munthu akudwala matenda a shuga kapena ayi.

Pali mitundu ingapo ya matenda:

1. Mtundu woyamba wa shuga. Pathology ili ndi mawonekedwe a autoimmune. Pankhaniyi, motsutsana ndi kuwonongeka kwa maselo a gland, kupanga kwa insulin yawo, komwe kuli kofunikira pakuwongolera kuchuluka kwa shuga m'magazi, kumachepera kapena kupangika kwa mahomoni kwathunthu.
2. Type 2 shuga. Mwa odwala, kuchuluka kwa insulin komwe kumapangidwanso kumachepetsedwa kapena kumatulutsa wamba, koma thupi silimazindikira, kukana ngati chinthu chakunja.

Mwa kubaya bwino insulini m'thupi ndi jakisoni, ndikotheka kubwezeretsanso kuchuluka kwake komwe kumathandizira, zomwe zimathandizira kusintha zomwe zimachitika komanso kupewa zomwe zingachitike chifukwa cha matendawa.

Chifukwa chiyani makonzedwe oyenera a insulin amafunikira

Njira yanzeru ya insulin yovomerezeka imakupatsani mwayi woperekera:

• pazokwanira (pafupifupi 90%) ndi kulowetsedwa kwakanthawi kwa mankhwalawo m'magazi.
• kuchepa kwamphamvu kwa hypoglycemia.
• kusowa kwa zowawa.
• ochepa kuvulala khungu ndi subcutaneous mafuta.
• Popeza hematomas pambuyo jakisoni.
• kuchepa kwa chiwopsezo cha lipohypertrophy - kukula kwa minofu yamafuta m'malo owonongeka pafupipafupi.
• Kuchepetsa mantha a jakisoni, mantha kapena kupsinjika kwa malingaliro musanalowe jekeseni aliyense.

Njira yayikulu yokhazikitsira insulin ndi shuga wabwinobwino pambuyo podzuka komanso masana maola angapo mutatha kudya.

Zoyenera, odwala matenda ashuga omwe ali ndi mitundu yonse yamatenda amayenera kupereka jakisoni wa insulin, mosasamala kanthu za cholinga cha mankhwala a insulin, komanso abale ndi abale awo. Ndi matenda a 2 a shuga, kulumpha mwadzidzidzi mu shuga ndikotheka chifukwa chovulala, kupsinjika kwakukulu, matenda omwe amayenda ndi kutupa. Nthawi zina, hyperglycemia imatha kusokoneza kwambiri kagayidwe kachakudya, mpaka kufika pa chikomokere (werengani za hyperglycemic coma). Pankhaniyi, jakisoni wa insulin ndiye njira yabwino kwambiri yosungitsira thanzi la wodwalayo.

Palibe chifukwa chomwe mungagwiritsire ntchito insulin yomwe yatha, chifukwa mphamvu zake sizikulosera. Itha kutaya gawo limodzi ndi katundu wake, ndikuwalimbikitsa kwambiri.

Zachikhalidwe

Njira yodziwira mankhwala a insulin ndiyosavuta kwambiri. Muyenera kupangira jakisoni katatu kokha patsiku, kuyeza shuga komanso kangapo. Kuphweka kwa regimen iyi ya insulin mankhwala, mwatsoka, kumasintha kukhala kotsika kwake. Shuga mwa odwala imasungidwa kwambiri pa 8 mmol / L, kotero pazaka zambiri apeza zovuta za matenda ashuga - mavuto amitsempha ndi samanjenje. Chakudya chilichonse chomwe chimakhala ndi mafuta ambiri patebulopo chimasandukanso chiphuphu china. Kuti achepetse shuga, odwala matenda ashuga pachikhalidwe amachepetsa kwambiri zakudya zawo, kuwonetsetsa kuti azikhala ndi chakudya chambiri, monga momwe odwala omwe ali ndi matenda a shuga amathandizira.

Zambiri

Regimen yolimba kwambiri imapereka jekeseni osachepera asanu patsiku. Awiri mwa iwo ndi a insulin yayitali, 3 ndi yochepa. Shuga amayenera kuyezedwa m'mawa, asanadye komanso pokonzekera kugona. Nthawi iliyonse yomwe mukufunikira kuwerengetsanso kuchuluka kwa magawo a tsiku ndi tsiku, insulini yachangu imafunikira kubayidwa. Koma palibe zoletsa zilizonse mu pulogalamu iyi ya insulin. Mutha kuchita chilichonse, chinthu chachikulu ndikuwerengera zomwe zimapezeka m'mbale ndi kupangira jakisoni wa kuchuluka kwa insulini.

Zosankha: Werengani zambiri zamankhwala othandizira insulin pano.

Palibe maluso apadera a masamu ofunikira pa izi, pakuwerengera kuchuluka kwa insulini, chidziwitso pamlingo woyambira sukulu ndikokwanira. Kuti mupeze jakisoni molondola, sabata la maphunziro ndilokwanira. Tsopano chiwembuchi chimaonedwa kuti ndi chotsogola kwambiri komanso chothandiza, kugwiritsa ntchito kwake kumapereka zovuta zochepa komanso nthawi yayitali ya moyo wa odwala omwe ali ndi matenda ashuga.

>> Momwe mungadziwerengere pawokha mulingo wa insulin (ndikofunikira kwambiri kuti muphunzire, mupeza matebulo ndi malangizo ambiri)

Kodi ndingalowetsereni insulin kwa odwala matenda ashuga?

Muyenera kubaya insulin pansi pakhungu, m'matumbo a adipose. Chifukwa chake, malo omwe jakisoni amayenera kuchitidwa bwino azikhala ndi mafuta oyambira:

1. Mimba ndi malo kuchokera ku nthiti zotsika kupita kumapazi, kuphatikiza mbali ndi njira yocheperako kumbuyo, komwe nthawi zambiri mafamu amapanga. Simungathe kubayira insulini mumchombo ndi kuyandikira kuposa 3 cm.
2. Matako - quadrant pansi pamunsi kumbuyo pang'ono pafupi ndi mbali.
3. Mchiuno - Kutsogolo kwa mwendo kuyambira poyambira mpaka pakati pa ntchafu.
4. Mbali yakunja ya phewa imachokera pachiwuno mpaka kumapeto. M'deralo majekesedwe amaloledwa pokhapokha ngati pali mafuta okwanira pamenepo.

Kuthamanga ndi kukwanira kwa kuyamwa kwa insulin kuchokera m'malo osiyanasiyana amthupi ndi kosiyana. Mwachangu komanso chokwanira kwambiri, timadzi timalo timalowa m'magazi kuchokera m'matumbo am'mimba. Pang'onopang'ono - kuchokera phewa, matako, makamaka kutsogolo kwa ntchafu. Chifukwa chake, kubayirira insulin m'mimba ndizabwino kwambiri. Ngati wodwala amangopatsidwa insulin yayitali, ndibwino kuti muibayetsere m'derali. Koma ndi regimen yochizira kwambiri, ndibwino kupulumutsa m'mimba chifukwa cha insulini yochepa, chifukwa pamenepa shuga amapititsidwira kumisempha yomweyo, chifukwa amalowa m'magazi. Ngati jakisoni wa insulin yayitali pamenepa, ndikofunika kugwiritsa ntchito m'chiuno ndi matako. Ultrashort insulini imatha kubayidwa m'malo aliwonse awa, chifukwa ilibe kusiyana pakumwedwa kwa malo osiyanasiyana. Ngati kubaya insulin panthawi yoyembekezera m'mimba ndikovuta m'maganizo, mogwirizana ndi adotolo, mutha kugwiritsa ntchito mkono kapena ntchafu.

Mlingo wa kulowa kwa insulini m'magazi umachulukitsa ngati malo a jakisoni amamuwonjezera m'madzi otentha kapena amangomizidwa. Komanso, kulowa kwa timadzi timeneti kumachitika mwachangu m'malo omwe minofu imagwira ntchito. Malo omwe insulin ingalowetsedwe posachedwa sayenera kupitilira ndi kusuntha mwachangu. Mwachitsanzo, ngati mukukonzekera kuyenda mtunda wautali, ndibwino kuti mupeze mankhwalawo m'mimba, ndipo ngati mukufuna kupukutira - kulowa mu ntchafu. Mwa mitundu yonse ya insulini, chowopsa kwambiri ndi kuyamwa mwachangu kwa ma analogi omwe amagwira ntchito nthawi yayitali; kuwotcha malo a jekeseni pamenepa kumathandizira kwambiri ngozi ya hypoglycemia.

Masamba obayira ayenera kusinthidwa pafupipafupi. Mutha kumudula mankhwalawo mtunda wa 2 cm kuchokera pamalo omwe adabayira kale. Jekeseni wachiwiri pamalo omwewo pakatha masiku atatu ngati palibe pakhungu.

Kuphunzira kubaya insulin molondola

Kukula kwa insulin sikufunika, chifukwa pamenepa zochita za timadzi timene zimakulirakulira mosakayikira, chifukwa chake, kutsika kwamphamvu kwa shuga kumakhala kwakukulu. Ndikotheka kuchepetsa chiopsezo cha insulini kulowa mu minofu, m'malo mwa adipose minofu, posankha syringe yolondola, malo ndi njira ya jakisoni.

Ngati singano ya syringe ndi yayitali kwambiri kapena mafuta osakwanira, jakisoni amapangidwa pakhungu: pofinya khungu ndi zala ziwiri, jekeseni insulini pamwamba pa khola, tengani syringe ndikuchotsa zala zokha. Kuchepetsa kuzama kwa gawo la syringe ndikotheka ndikuwonetsa pa 45% pakhungu.

Kutalika kwakuku kwa singano ndi mawonekedwe a jekeseni:

Zidzachitika ndi chiyani ngati odwala matenda ashuga sangabayire insulin

Ngati kuchuluka kwa shuga m'thupi sikungayende bwino kwakanthawi, mikhalidwe yoopsa imabuka pokhudzana ndi ziwalo zamkati ndi machitidwe. Izi zimagwira ntchito pazovuta za insulin chithandizo kapena mayendedwe ake osayenera.

Popeza chitukuko cha matenda osokoneza bongo chimadziwika ndi zoyipa kuzungulira, mtima, mantha dongosolo, zovuta zoyambirira zimachokera kwa iwo. Kuphatikiza apo, makina owonera ndi owerengera, magwiridwe antchito a ziwalo zoberekera, mwa akazi ndi amuna, amasokonezeka.

Mavuto omwe angakhalepo mwa matenda ashuga ndi awa:

• kuphwanya kwamtima (arrhythmia, kupweteka kwa sternum, tachycardia, etc.),
• sitiroko
• wolakalaka pakufunika kuti aziduladula (nthawi zambiri m'munsi miyendo),
• kuwonongeka kwakanthawi
• kukula kwa matenda opatsirana pachikhodzodzo ndi impso,
• kupezeka kwa erectile kukanika, kusabala.

Mutha kupewa zovuta izi pokhalabe ndi shuga m'magazi, kuwona moyo wathanzi komanso wokangalika. Kuphatikiza apo, ndikofunikira kutsatira malangizo otsatirawa:

• Chotsani kunenepa kwambiri, kuchiritsa kunenepa,
• kukhala ndi chakudya choyenera komanso chopatsa thanzi
• osatulutsa zakudya zokhala ndi shuga,
• Lekani kusiya zizolowezi zoipa: kusuta, kumwa mowa, kugwiritsa ntchito mankhwala osokoneza bongo,
• khalani moyo wokangalika.

Chithandizo cha matenda a shuga chimaperekedwa ndi dokotala, poganizira mtundu wa matenda, makamaka thanzi.

Kodi zimapweteka kubaya insulin

Nthawi zambiri, pakukhazikitsa mankhwala a mahomoni, zizindikiro za ululu sizipezeka. Zovuta zimachitika nthawi zambiri pogwiritsanso ntchito singano yotaya. Pambuyo pa jakisoni woyamba, kutha kwa singano kumatha kupunduka, komwe kumatha kuwoneka mukagwiritsa ntchito zida zokulitsa.

Kugwiritsanso ntchito singano ya insulin makonzedwe kumayambitsa kuvulala kwa minofu m'dera la jakisoni, komwe kumayambitsa kupweteka kwamitsempha, kukha magazi. Chifukwa chake, ndikofunikira kugwiritsa ntchito singano yatsopano pa jakisoni aliyense wa mahomoni.

Zomwe zimachitika mukaphonya jakisoni

Ngati regimen yotsogola ikuphwanyidwa, ndiye kuti, ngati mutatha kudumpha kuwombera kwa insulin yayitali, simukufunika kubayitsa maola owonjezera. Pankhaniyi, kulipira kuchotsedwa kwa chinthu ndi njira yowonjezera yolimbitsa thupi kukuwonetsedwa. Mwanjira ina, muyenera kusunthira zina, nthawi ndi nthawi tsiku lonse kuti mumachita masewera olimbitsa thupi.

Ngati jakisoni wa insulin wa nthawi yayitali atasowa, pomwe makonzedwe a mahomoni amafunikira kawiri pa tsiku, 0,5% ya omwe wasowa akuwonjezeredwa kumodzi mwa jakisoni.

Ngati mwaphonya jakisoni wa insulin yochepa, muyenera kupereka jakisoni, koma pokhapokha patakhala kukumbukira kukumbukira kuphwanya kwa boma mukangomaliza kudya kapena m'maora awiri oyamba.

Ngati mwaphonya jakisoni wa inshuwaransi, timalimbikitsidwa kuperekera jakisoni, koma kugwiritsa ntchito mlingo wochepetsetsa wa mahomoni, womwe umakulolani kuti muchepetse hyperkalemia.

Kodi muyenera kubayira insulin kangati?

Nthawi pakati pa kasamalidwe ka insulin zimatengera mtundu wa mankhwalawa omwe amagwiritsidwa ntchito. Chifukwa chake, insulin yayifupi komanso yayitali imabisidwa.

Insulin yofulumira iyenera kumwedwa musanadye, chifukwa zimatenga mphindi 25-30 kulowa m'magazi. Zambiri za insulin yochepa:

• nyama kapena insulin ya anthu ilipo
• pazipita achire zotsatira kumatenga maola 2-4,
• m'magazi mulipo kwa maola 8, osatinso.

Insulin yomwe imatenga nthawi yayitali imadziwika ndi izi:

• zochokera nyama
• Nthawi zambiri, jakisoni imodzi imafunikira tsiku lonse,
• kuchuluka kwa mahomoni m'magazi kumawonedwa pambuyo mphindi 30,
• mahomoni m'thupi amapezeka kwa maola 24, osatinso.

Ndikulimbikitsidwa kuperekera mahomoni nthawi yomweyo tsiku lililonse. Izi zimabweretsa kupewera kuchepetsedwa kwa zinthu zomwe zingachitike pakukula kwa zinthu komanso kukulitsa zotsatira zoyipa.

Mlingo wa tsiku lililonse wa insulin yochepa komanso yayitali amawerengedwa motere:

• m'mawa - 35%,
• nthawi ya nkhomaliro - 25%,
• musanadye - 30%,
• musanagone - 10 peresenti ya tsiku ndi tsiku.

Sitikulimbikitsidwa kuti muphatikize zigawo zoposa 14-16 mu syringe imodzi. Ngati kuli kofunikira kukhazikitsa mlingo waukulu, kuchuluka kwa jakisoni kumachulukitsidwa ndikuchepetsa kwakanthawi pakati pawo.

Sringe ndi kusankha kwa singano

Pazithandizo za matenda ashuga komanso kuyambitsa mahomoni, ndikofunikira kusankha singano yoyenera ya syringe. Makulidwe ake amatsimikizika mogwirizana ndi kukula kwa gage (G): chokulirapo chizindikiro, ndi singano yopingasa. Kwa ana omwe ali ndi matenda ashuga amagwiritsa ntchito singano zopyapyala, kwa akulu - poganizira mawonekedwe.

Kukhazikitsidwa kwa singano zopyapyala kumakhala bwino komanso sikumayambitsa chisangalalo chilichonse, popeza kulibe kukakamizidwa kwa ma epermermis pakuboola. Pali singano zolembedwa "makoma owonda", omwe amamasulira ngati "makoma owonda". Ngakhale khungu limapweteka popanda kupweteka, insulin imasunthika yowoneka bwino ndi singano zotere, zomwe zitha kufotokozedwa ndi gawo lochepa.

Njira ya Insulin In injion

Njira yoyendetsera timadzi ta matenda ashuga ndi motere:

• kumasulidwa kwa malo omwe singano iyenera kuyikidwako (chithandizo cha m'deralo ndi mowa kapena njira zina sizofunikira),
• kutenga khungu lanu ndi chala chachikulu ndi chofiyira, chomwe chimachepetsa chiopsezo cholowa minofu,
• kuyikiridwa ndi singano pamphepete mwa khungu lanu pakadutsa madigiri 45 kapena perpendicular mpaka pakhungu.
• kuyambitsa kwa mankhwala mumasekondi ochepa,
• kuchotsa singano.

Kutsatira malamulowa pamwambapa, mutha kuchepetsa chiopsezo chotsatira zoyipa chifukwa cha insulin.

Kodi ndiyenera kupukuta khungu langa ndi mowa ndisanapange insulin

Zopangira mowa zimathandizira kuti insulin iwonongeke. Pachifukwa ichi, chisanachitike chithandizo cha malo ofunikira ndi chida choyenera sichofunikira. Izi zitha kufotokozedwanso ndi kusowa kwa chiopsezo cha matenda olowa ndi jakisoni wa singano pogwiritsa ntchito mankhwala ndi syringe yamakono.

Momwe mungabayitsire insulin

Kukhazikitsidwa kwa insulin popanda mapangidwe a khola la epidermal ndikothekanso, mankhwalawa onse odwala ndi ana. Komabe, izi ndizovomerezeka pokhapokha ngati minofu yamkati yolimba ndiyakuda. Poterepa, sankhani singano yopyapyala kwambiri ya syringe ndi yaying'ono.

Odwala ena amalimbikitsidwa kuti asankhe singano yotalika 8 ndi 127 mm, kuti alowe mu khola lopakika la khungu.

Pomwe kuli bwino kupereka insulin

Ndikulimbikitsidwa kupaka insulin mu umodzi mwamagawo ali mthupi awa:

Ndikofunikira kupewa kuti mahomoni asalowe mu khungu lakuya, ndiye kuti, amapanga minofu. Kupanda kutero, imachitika mwachangu, zomwe zimayambitsa chiopsezo cha dontho lakuthwa la shuga. Ndi singano yokwanira ya singano, ndiye kuti, kulowetsedwa kwa insulin kumachepetsa, komwe kumachotsa mphamvu yofunikira yotsitsa shuga.

Kuthira mwachangu kwa mankhwalawa kumawonedwa ndikulowetsedwa m'mimba, pang'onopang'ono - m'malo okongola ndi achikazi.

Kodi ndifunika kubaya insulin ndi shuga wochepa

Ndizosatheka kuyankha motsimikiza funso ili. Insulin yochepa kapena ya ultrashort, yomwe imaperekedwa musanadye, imaphatikizapo chakudya ndi kukonza. Choyamba ndi chofunikira kuti zakudya zama protein komanso mapuloteni azitha kuzamwa, chachiwiri - kusintha shuga wambiri.

Ndi shuga wochepetsedwa mthupi, kukhazikitsidwa kwa bolus yokonzekera sikofunikira. Poterepa, botolo la chakudya limachepetsedwa.

Kodi ndingagwiritse ntchito insulin yomwe yatha

Palibe chifukwa muyenera kugwiritsa ntchito mankhwalawa ndi atatha nthawi alumali. Izi zikugwiranso ntchito ku mankhwala owonongeka omwe samabweretsa chithandizo chofunikira. Kuphatikiza apo, zidzayipitsanso thanzi. Mankhwalawa amalimbikitsidwa kuti atayidwe kuchokera ku khabati yamankhwala kunyumba, ndiye kuti, kutayidwa.

Kangati mutha kubayira insulin ndi syringe yomweyo

Syringe imangokhala yogwiritsidwa ntchito kamodzi osagwiritsa ntchito mankhwalawo ndikulowetsa thupi la munthu.Singano iliyonse ili ndi chizindikiro choletsa kugwiritsa ntchito kawiri. Wopangayo alibe kuyang'anira thanzi lakugwiritsa ntchito singano mobwerezabwereza.

Chifukwa china choletsa kugwiritsanso ntchito kwa singano ndikuti pambuyo pokhazikitsa mahomoni, inshuwaransi ya insulin imakhalabe mu lumen yake, yomwe, itayanika, imalimbikitsa kupangika kwa makhiristo. Mukamagwiritsanso ntchito syringe, yotsirizirayi imakulitsa kupitiliza kwa mankhwalawa mu lumen, zomwe zimapangitsa kuti syrinji isweke.

Momwe mungabayire insulin panthawi yapakati

Insulin ndi mankhwala otetezeka m'mimba omwe amathandizira kuti shuga azikhala bwino. Mlingo, makamaka kugwiritsa ntchito mankhwalawa, umatsimikiziridwa ndi adotolo. Mlingo wa tsiku ndi tsiku umatha kuchepetsedwa, mwachitsanzo, pamaso pa toxosis, kapena kuchuluka (munthawi zina).

Kufunika kwa thupi lamahomoni kumachulukirachulukira m'zaka za 2 ndi 3, pomwe mwana wosabadwayo akukula komanso kukula. Jakisoni wachiwiri wamahomoni amagwiritsidwa ntchito, kugwiritsa ntchito ma syringes ndi zolembera, komanso pampu ya insulin.

Mankhwala osokoneza bongo komanso osiyanasiyana

Ngati mwangozi mwadzidzidzi woposa mlingo wa insulin yolimbikitsidwa ndi adokotala, mwachangu hypoglycemic syndrome imachitika. Izi zitha kufotokozedwa ndikumanga kwa glucose onse omwe amapezeka, omwe amachititsa kuchepa kwa mahomoni.

Khalidwe lomwe limawonetsa kukhudzana kwa mankhwala osokoneza bongo atchulidwa motere:

• chikumbumtima
• kusanza ndi kusanza matenda
• ana opukusidwa
• kukomoka
• mutu
• zolimbitsa thukuta,
• kusakhazikika.

Subcutaneous makonzedwe a insulin amachititsa lipodystrophy (kuchepa kwa kuchuluka kwa adipose minofu yaying'ono) pambali ya mankhwala. Kukonzekera kwatsopano kwamankhwala amtundu wa insulin m'njira zapadera kumadzetsa mkwiyo.

Chithandizo cha zizindikiro zoyipa ndichizindikiro. Chithandizo chofuna kukakamiza nthawi yomweyo chimachitika, ndipo mankhwalawo amaloŵedwa m'malo ndi analogue.

Contraindication

Ngakhale kufunika kwa insulin kwa odwala omwe ali ndi matenda osokoneza bongo, mankhwalawa atha kuphatikizidwa kuti agwiritsidwe ntchito nthawi zina. Zoletsazo zikuphatikiza:

• matenda, chizindikiro chomwe ndi hypoglycemia,
• chitukuko cha chiwindi hepatitis,
• kukula kwa matenda a chiwindi,
• kukulitsa kwa hemolytic jaundice, komwe kumachitika motsutsana ndi maziko a kuthowoka kwa maselo ofiira amwazi.
• chitukuko cha kapamba - chotupa mu kapamba,
• Kukula kwa yade - yotupa mu impso,
• kukula kwa impso amyloidosis - matenda omwe amayamba chifukwa cha kuperewera kwa kagayidwe kachakudya ka michere mokhudzana ndi mapuloteni,
• chitukuko cha urolithiasis,
• kukhalapo kwa zilonda zam'mimba m'mimba kapena duodenum,
• matenda a mtima owonongeka.

Ndi chisamaliro chapadera, kukonzekera kwa insulin kumagwiritsidwa ntchito pa matenda a shuga ndi matenda ophatikizika ngati kukokoloka kwa coronary. M'malo omaliza, pali kusalinganika pakati pa kufunikira kwa okosijeni m'matumbo a mtima ndi kukhudzidwa kwa okosijeni mkati mwake.

Kuphatikiza apo, ndikofunikira kuyang'anira momwe zinthu zimaperekera mankhwala a insulin motsutsana ndi maziko a:

• pachimake ubongo
• endocrine pathologies,
• Matenda a Addison (adrenal gland kuchepa),
• kulephera kwa aimpso.

Kuti insulin ibweretse phindu lambiri la mankhwalawa, ndikofunikira kutsatira malamulo ogwiritsira ntchito, mlingo woyenera womwe madokotala amapereka. Kudzichitira nokha shuga ndikosavomerezeka. Pankhaniyi, sikuti kuchira kumangoyenda pang'onopang'ono, koma kuwonongeka kwakenso kwaumoyo kumachitika, kumafuna chithandizo chamankhwala.

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