Limagwirira ntchito a insulin "Detemir", dzina lamalonda, mogwirizana ndi mankhwala, mankhwala, mitengo, ndemanga

Kukonzekera kwa insulin kumasiyana. Izi ndichifukwa chakufunika kugwiritsa ntchito mankhwala omwe ali oyenera kwa anthu omwe ali ndi mawonekedwe osiyanasiyana.

Ngati mukutsutsana ndi zigawo za mankhwala amodzi, muyenera kugwiritsa ntchito ina, ndichifukwa chake akatswiri azamankhwala akupanga zinthu zatsopano ndi mankhwala omwe angagwiritsidwe ntchito kupondereza zizindikiro za matenda ashuga. Chimodzi mwa izo ndi Detemir insulin.

Zambiri ndi mankhwala a pharmacological

Mankhwala ndi a gulu la insulin. Imakhala ndi chochitika chachitali. Dongosolo la malonda la mankhwalawa ndi Levemir, ngakhale kuli mankhwala omwe amadziwika kuti Insulin Detemir.

Fomu yomwe wothandizirayo amagawidwira ndi yankho la kayendetsedwe ka subcutaneous. Maziko ake ndi chinthu chomwe chimapezeka pogwiritsa ntchito ukadaulo wa maumboni a DNA - Detemir.

Izi ndi imodzi mwazinthu zosungunuka za insulin yaumunthu. Cholinga cha machitidwe ake ndikuchepetsa kuchuluka kwa shuga m'thupi la odwala matenda ashuga.

Gwiritsani ntchito mankhwalawa molingana ndi malangizo. Mlingo ndi mawonekedwe a jekeseni amasankhidwa ndi dokotala. Kudzisintha mlingo kapena kusatsatira malangizo kumatha kuyambitsa bongo, komwe kumayambitsa hypoglycemia. Komanso, simuyenera kusiya kumwa mankhwala osadziwa dokotala, chifukwa izi ndizowopsa ndi zovuta za matendawa.

Chithandizo chogwira ntchito cha mankhwala ndi analogue ya insulin ya anthu. Zochita zake ndizosiyana kutalika kwa nthawi. Chidacho chimakumana ndi ma receptor a membrane wam'maselo, kotero kuti kuyamwa kwake kuthamanga.

Kuwongolera kuchuluka kwa shuga ndi chithandizo chake kumakwaniritsidwa pakuwonjezera kuchuluka kwa kudya kwake ndi minofu minofu. Mankhwala amathandizanso kupanga shuga m'magazi. Mothandizidwa ndi iye, ntchito ya lipolysis ndi mapuloteni imachepa, pomwe mitundu yambiri yama protein imagwira.

Kuchulukitsa kwakukulu kwa Detemir m'magazi ndi maola 6-8 atatha kupanga jakisoni. Kutsimikiziridwa kwa chinthuchi kumachitika pafupifupi muzochitika zonse odwala (ndikusinthasintha pang'ono), kumagawidwa mokwanira 0,5 l / kg.

Zikalowa m'mapuloteni a plasma, metabolites omwe sanapangidwe amapangidwa. Kuchiritsa kumadalira kuchuluka kwa mankhwalawo omwe amaperekedwa kwa wodwala komanso momwe mayamwidwe amachitikira mwachangu. Hafu ya zinthu zomwe zimaperekedwa zimachotsedwa m'thupi pambuyo pa maola 5-7.

Zizindikiro, njira ya makonzedwe

Pokhudzana ndi kukonzekera kwa insulin, malangizo ogwiritsira ntchito akuyenera kuwonedwa bwino. Iyenera kuphunziridwa mosamala, koma ndikofunikanso kuganizira malingaliro a dokotala.

Kuchita bwino kwa mankhwala ndi mankhwalawa zimatengera momwe chithunzi cha matendawa chawunikira. Pokhudzana ndi izi, mlingo wa mankhwalawa komanso ndandanda ya jekeseni imatsimikiziridwa.

Kugwiritsa ntchito chida ichi kukuwonetsedwa pakupeza matenda ashuga. Matendawa atha kukhala a mtundu woyamba ndi wachiwiri. Kusiyanako ndikuti ndi matenda amtundu woyamba, Detemir amagwiritsidwa ntchito ngati monotherapy, ndipo mu mtundu wachiwiri wa matendawa, mankhwalawo amaphatikizidwa ndi njira zina. Koma zitha kupezeka zina chifukwa cha zomwe munthu ali nazo payekha.

Mlingowo umatsimikiziridwa ndi adotolo, poganizira zovuta zamatenda, moyo wa wodwalayo, mfundo zake za zakudya komanso kuchuluka kwa zochita zolimbitsa thupi. Kusintha kwazinthu zonsezi kumafuna kusintha masinthidwewo ndi maperekedwe ake.

Zilonda zitha kuchitika nthawi iliyonse, ngati zili zoyenera kwa wodwalayo. Koma ndikofunikira kuti jakisoni wobwereza umachitika nthawi yomweyo yomwe yoyamba idamalizidwa. Amaloledwa kulowa mu ntchafu, phewa, khomo lamkati, matako. Saloledwa kupereka jakisoni m'dera lomwelo - izi zimayambitsa lipodystrophy. Chifukwa chake, akuyenera kusuntha mkati mwa malo ovomerezeka.

Phunziro la kanema pa njira yothandizira kuperekera insulin pogwiritsa ntchito cholembera:

Contraindators ndi malire

Muyenera kudziwa komwe nthawi zina kugwiritsa ntchito mankhwalawa kumatsutsana. Ngati sizingaganiziridwe, wodwala amatha kukhudzidwa kwambiri.

Malinga ndi malangizo, insulin ili ndi zotsutsana zochepa.

Izi zikuphatikiza:

1. Hypersensitivity pamagawo a mankhwala. Chifukwa chaichi, odwala ali ndi zovuta zonse pamankhwala awa. Zina mwazomwezi zimadzetsa chiwopsezo chachikulu pamoyo.
2. Zaka za ana (osakwana zaka 6). Onani kuyenera kwa mankhwalawa kwa ana a m'badwo uno kwalephera. Kuphatikiza apo, palibe deta pa chitetezo chogwiritsidwa ntchito pakadali pano.

Palinso mikhalidwe yomwe kugwiritsa ntchito mankhwalawa kumaloledwa, koma amafunika kuwongolera mwapadera.

Zina mwa izo ndi:

1. Matenda a chiwindi. Ngati alipo, momwe gawo lawogwiritsa ntchito lingasokonekera, chifukwa chake, mlingo uyenera kusintha.
2. Kusokonekera mu ntchito ya impso. Pankhaniyi, kusintha kwa machitidwe a mankhwalawa ndizothekanso - kumatha kuwonjezeka kapena kuchepa. Kuwongolera okhazikika pamachitidwe othandizira kumathandizira kuthetsa vutoli.
3. Ukalamba. Thupi la anthu opitilira zaka 65 likukusintha kwambiri. Kuphatikiza pa matenda ashuga, odwala oterewa ali ndi matenda ena, kuphatikizapo matenda a chiwindi ndi impso. Koma ngakhale atasowa, ziwalozi sizigwira ntchito komanso ngati mwa achinyamata. Chifukwa chake, kwa odwala awa, mlingo woyenera wa mankhwalawa ndiwofunikanso.

Zinthu zonsezi zikamaganiziridwa, chiwopsezo cha zotsatira zoyipa kuchokera ku Detemir insulin chitha kuchepetsedwa.

Malinga ndi kafukufuku woyenera pamutuwu, mankhwalawa sakhala ndi vuto lililonse pa nthawi ya mimba komanso kukula kwa mluza. Koma izi sizimamupangitsa kukhala wotetezeka kwathunthu, chifukwa chake madokotala amayesa zoopsa asanasankhe amayi ake amtsogolo.

Mukamagwiritsa ntchito mankhwalawa, muyenera kuyang'anitsitsa mosamala momwe mankhwalawo alili, onani kuchuluka kwa shuga. Munthawi yamatumbo, zizindikiro za shuga zimatha kusintha, motero, kuwongolera ndikuwongolera kwakanthawi Mlingo wa insulin ndikofunikira.

Palibe chidziwitso chokwanira pokhudzana ndi kulowa kwa chinthucho pakaka mkaka wa m'mawere. Koma amakhulupirira kuti ngakhale zikafika kwa mwana, zotsatira zoyipa siziyenera kuchitika.

Dululir ya Detemir imachokera ku mapuloteni, motero imatha kuyamwa. Izi zikusonyeza kuti kuthandizira mayi pogwiritsa ntchito mankhwalawa sikungavulaze mwana. Komabe, azimayi pakadali pano ayenera kutsatira zakudya, komanso kuyang'ana kuchuluka kwa shuga.

Zotsatira zoyipa ndi bongo

Mankhwala aliwonse, kuphatikiza insulin, amatha kuyambitsa mavuto. Nthawi zina zimawonekera kwakanthawi kochepa, mpaka thupi lizolowera zomwe zimagwira.

Nthawi zina, mawonetseredwe a pathological amachitika chifukwa cha contraindication osadziwika kapena kuchuluka kwa mlingo. Izi zimabweretsa zovuta zazikulu, zomwe nthawi zina zimatha kupangitsa kuti wodwalayo afe. Chifukwa chake, zovuta zilizonse zokhudzana ndi mankhwalawa ziyenera kudziwitsidwa kwa dokotala.

Zina mwazotsatira zake ndi izi:

1. Hypoglycemia. Vutoli limaphatikizidwa ndi kuchepa kwakukulu kwa shuga m'magazi, amenenso limakhudza thanzi la munthu wodwala matenda ashuga. Odwala amakumana ndi mavuto monga kupweteka mutu, kunjenjemera, mseru, tachycardia, kusazindikira. Mu hypoglycemia yayikulu, wodwalayo amafunika kuthandizidwa mwachangu, popeza pakakhala kusintha kosintha mu ubongo, zimachitika.
2. Zowonongeka. Chodziwika kwambiri ndi matenda ashuga retinopathy.
3. Ziwengo. Imatha kudziwoneka ngati mitundu yaying'ono (zotupa, kufupika kwa khungu), komanso ndi zizindikiro zotchulidwa (anaphylactic shock). Chifukwa chake, popewa zochitika zotere, kuyesa kumvetsetsa kumachitika musanayambe kugwiritsa ntchito Detemir.
4. Mawonetsero apafupi. Amakhala chifukwa cha zomwe khungu limayendetsa pakumwa mankhwala. Amapezeka m'malo a jakisoni - malowa amathanso kukhala ofiira, nthawi zina pamakhala kutupa pang'ono. Maganizo ofananawa nthawi zambiri amapezeka koyamba kwa mankhwalawa.

Ndizosatheka kunena kuti ndi gawo liti la mankhwalawa lomwe lingayambitse bongo wambiri, chifukwa izi zimatengera umunthu wake. Chifukwa chake, wodwala aliyense ayenera kutsatira malangizo omwe adalandira kuchokera kwa dokotala.

Chiwerengero cha odwala omwe adakumana ndi gawo limodzi la hypoglycemia panthawi ya mankhwala ndi Detemir insulin kapena Glargin insulin

Malangizo apadera ndi kugwiritsa ntchito mankhwala osokoneza bongo

Kugwiritsa ntchito mankhwalawa kumafuna kusamala.

Kuti mankhwalawa akhale othandiza komanso otetezeka, malamulo awa akuyenera kuonedwa:

1. Osagwiritsa ntchito mankhwalawa a shuga ana osakwana zaka 6.
2. Osadumpha chakudya (pamakhala chiopsezo cha hypoglycemia).
3. Osachulukitsa ndi zochitika zolimbitsa thupi (izi zimabweretsa kuchitika kwa hypoglycemic state).
4. Kumbukirani kuti chifukwa cha matenda opatsirana, kufunikira kwa insulin kumakulirakulira.
5. Osamapereka mankhwalawa kudzera m'mitsempha, pamenepa, hypoglycemia imayamba).
6. Kumbukirani kuthekera kwa kusokonezeka kwa chidwi ndi momwe angapangire hypo- ndi hyperglycemia.

Wodwala ayenera kudziwa za zonsezi kuti achite bwino mankhwalawo.

Chifukwa chogwiritsa ntchito mankhwala ochokera m'magulu ena, zovuta za Detemir insulin zimasokonekera.

Nthawi zambiri, madokotala amakonda kusiya kuphatikiza koteroko, koma nthawi zina izi sizingatheke. Zikatero, muyezo wa mankhwalawo umaperekedwa.

Ndikofunika kuwonjezera mlingo pamene mukumwa mankhwala monga:

• amphanomachul
• glucocorticosteroids,
• okodzetsa
• mankhwala opangira uchembere,
• gawo la antidepressants, etc.

Mankhwalawa amachepetsa mphamvu ya chinthu chomwe chili ndi insulin.

Kuchepetsa Mlingo umakonda kugwiritsidwa ntchito limodzi ndi mankhwala otsatirawa:

• manzeru
• kaboni anhydrase inhibitors, ACE, MAO,
• othandizira a hypoglycemic
• anabolic steroids
• beta blockers,
• mankhwala okhala ndi mowa.

Ngati simukusintha muyeso wa insulin, kumwa mankhwalawa kungayambitse hypoglycemia.

Nthawi zina wodwala amakakamizika kuwona dokotala kuti athetse wina ndi mnzake. Zifukwa za izi zimatha kukhala zosiyana (kupezeka kwa zovuta, mtengo wokwera, zovuta zosagwiritsidwa ntchito, ndi zina). Pali mankhwala ambiri omwe ali ndi fanizo la Detemir insulin.

Izi zikuphatikiza:

Mankhwalawa ali ndi vuto lofananalo, nthawi zambiri amagwiritsidwa ntchito ngati m'malo. Koma munthu amene ali ndi chidziwitso chofunikira komanso chidziwitso ayenera kusankha kuchokera pamndandandawu kuti mankhwalawo asavulaze.

Mtengo wa Levemir Flexpen (dzina la malonda a Detemir) wopanga Danish kuchokera ku 1 390 mpaka 2 950 rubles.

Pharmacology

"Detemir" imawonedwa ngati choyambira cha insulin yaumunthu, yodziwika ndi zotsatira zazitali, mbiri yosalala. Thupi limangirira ku ma receptor ena, ndikulola kubereka kwachilengedwe. Insulin imakhudza kagayidwe kazakudya, imayendetsa. Mankhwala amachepetsa shuga, glucose amatha kulowa mu minofu.

Ngati mankhwalawa amaperekedwa kawiri m'maola 24, ndiye kuti ndikotheka kukwaniritsa yunifolomu imodzi m'magazi pafupifupi pafupifupi jekeseni awiri. Thupi la munthu aliyense limadziwika ndi machitidwe amodzi a mayamwidwe "Detemir, koma, mwambiri, ndi yotsika poyerekeza ndi ena omwe amaphatikizidwa, osawonetsa zochitika.

"Detemir" sigwirizana ndi mafuta acids, mankhwala omwe amaphatikiza ndi mapuloteni. Nthawi yotsiriza yomaliza imatengera mlingo wa mankhwalawa, kuchuluka kwa kuyamwa kwa minofu yolowerera. Ndipafupifupi maola 5-7.

"Detemir" ili ndi zinthu zotsatirazi:

• kukondoweza kwa mayamwidwe a shuga m'maselo, zotumphukira zimakhala,
• shuga kagayidwe kachakudya,
• kuphatikiza mapuloteni ophatikizidwa
• kuletsa kwa glucogeneis.

Mwa kuwongolera njirazi, shuga amachepetsa. Pambuyo pochoka, chinthu chachikulu chidzayamba pokhapokha maola 6.

Pokhudzana ndi mankhwala aliwonse a insulin, kutsatira mosamalitsa malangizo kumafunika. Ndikofunikira kuphunzira malangizo mosamala, ndikofunikira kukwaniritsa kuikidwa kwa dokotala. Zotsatira za kukonza kwa mkhalidwe zimadalira molondola pakuwunika kwa chipatala cha matenda. Pankhaniyi, mlingo wa mankhwalawa, nthawi ya bungwe la jakisoni yotsimikizika.

Kugwiritsa ntchito "Detemir" ndikolembera matenda ashuga. Matenda a shuga ndi amtundu woyamba kapena wachiwiri. Kusiyanako ndikuti koyamba, mankhwalawa amawonetsedwa kuti ali ndi monotherapy, lachiwiri - amaphatikizidwa ndi ena. Pali kusiyanasiyana chifukwa cha wodwalayo ndi matenda ake.

Kugwiritsa ntchito mlingo "Detemir"

Mankhwalawa angagwiritsidwe ntchito mwanjira imodzi yokha - uwu ndi jekeseni wa subcutaneous. Jakisoni wamkati ndiowopsa chifukwa chakuchulukitsa kambiri kangapo. Panthawi iyi, hypoglycemia imapita patsogolo.

Dosing imatsimikiziridwa ndi dokotala, poganizira mawonekedwe a thupi la wodwalayo. Kusintha kwa Mlingo wosankhidwa ndikofunikira mukamadwala matenda a matenda ashuga, zolimbitsa thupi zimawonjezeka, ndipo matenda ofanana amawonekera. "Detemir" imagwiritsidwa ntchito ngati mankhwala a monotherapy, pamodzi ndi othandizira a hypoglycemic pothandizira pakamwa.

"Detemir" imayambitsidwa panthawi yabwino ndi munthu, koma mutakhazikitsa nthawi, muyenera kutsatira dongosolo tsiku lililonse. Jakisoni amawathandizira pang'onopang'ono mu gawo lakunja la peritoneum, ntchafu, phewa, matako, ndi malo otetemera a minofu.

Malo olowetsera amafunika kusintha nthawi ndi nthawi kuti ateteze lipodystrophy. Monga nthawi ya chithandizo ndi mankhwala ena a insulin okalamba, anthu omwe ali ndi vuto la impso ndi chiwindi, ndikofunikira kuyang'anira shuga m'magazi. Ndikofunikira kusintha mlingo aliyense payekha. Nthawi yoyamba pambuyo poika "Detemir" ndikofunikira kuti muchepetse shuga makamaka mosamala. Kuchiza sikuthandizira kulemera.

Zofooka

Kwa odwala ena, Detemir amangoikidwa poyang'aniridwa ndi achipatala mosamala, mosamala. Izi zimayikidwa mu malangizo. "Detemir" ikhoza kugwiritsidwa ntchito mosamala ndipo pambuyo poti mlingo wa mankhwala upite kwa odwala omwe ali ndi zovuta zina mthupi:

• zovuta pakumagwira ntchito kwa chiwindi, chifukwa zimatha kupotoza ntchito ya gawo lalikulu la Detemir,
• maliseche a impso - lingaliro la momwe mankhwalawo akusinthira,
• ukalamba - pambuyo pa zaka 65 m'thupi, kusintha kosiyanasiyana komwe kumachitika chifukwa cha ukalamba kumayamba, ziwalo sizigwira ntchito mwachangu, kotero, mankhwalawa amatha kuchepetsedwa kuti asavulaze.

Zotsatira zoyipa

Insulin iliyonse, kuphatikiza Detemir, imatha kuyambitsa zovuta pakudya. Nthawi zina amakula kwakanthawi, pomwe thupi silikhala ndi nthawi yoti lizolowere zovuta za mankhwalawa. Nthawi zina, mbali yonseyi imagwirizanitsidwa ndi zolakwika zosadziwika komanso vuto la bongo.

Zochita zoyipa zimatha kubweretsa zotsatira zowopsa, zomwe sizipha nthawi zambiri.

Ndikofunikira kufotokozera dotolo munthawi yake. Zotsatira zoyipa zimaphatikizapo:

• hypoglycemia - kutsika kwa shuga m'magazi, komwe kumakhala ndi zotsatira zoyipa,
• mutu
• miyendo yanjenjemera
• nseru
• kugunda kwa mtima
• kukomoka.

Ndi vuto lalikulu la vuto la hypoglycemic, chisamaliro chofunikira chimafunika, mwanjira ina kusintha kwa ubongo.

Zovuta zake, ziwalo zowoneka nthawi zambiri zimavutika. Nthawi zambiri matenda a shuga amakhala ndi retinopathy.

Allergies imagwiranso ntchito pazotsatira zoyipa - redness of the khungu, totupa, mpaka kuwukira kwa anaphylactic. Kuyeserera koyeserera kumathandiza kupewa zoyipa.

Zotsatira zoyipa zimaphatikizapo mawonekedwe pakhungu pa malo a jakisoni - imasandulika yofiira, nthawi zina kutupa pang'ono. Izi zimachitika pafupipafupi magawo oyambira.

Kuchita

Mankhwala ena amakhudza kufunika kwanu kwa insulin. Mphamvu ya hypoglycemic imafooka ndi:

• njira zakulera zakugwiritsira ntchito mkati,
• glucocorticosteroids,
• mahomoni a chithokomiro ndi ayodini,
• calcium blockers,
• diuretics a group la thiazide,
• heparin
• kukula kwamafuta,
• amphanomachul
• morphine
• antidepressants
• chikonga.

Mphamvu ya hypoglycemic ya jekeseni wa Detemir imatheka chifukwa cha kuyanjana ndi:

• othandizira pakamwa
• michere
• osasankha beta-blockers,
• anabolic steroids
• manzeru
• pyridoxine
• Kukonzekera kwa lifiyamu
• kukonzekera ndi Mowa mu zikuchokera.

Zakumwa zoledzeretsa zimatha, kumawonjezera kufunika kwa insulin. Mankhwala ochokera ku thiol, magulu a sulfite amawononga insulin. Mankhwala sioyenera kulowetsedwa.

Bongo

Kuchuluka kwina kwa insulin komwe kumapangitsa bongo kukhala kosakhazikika sikunakhazikitsidwe, mlingo wake ndi payekha. Hypoglycemia nthawi zambiri sizichitika mwachangu, koma motsatana ndi kuyambitsa milingo yayikulu kwa wodwala wina.

Hypoflycemia yofatsa imatha kuyima yokha. Kuti muchite izi, ingomwa glucose, idyani chidutswa cha shuga, china chokoma, mafuta ochulukirapo. Pazifukwa izi, anthu odwala matenda ashuga ali ndi maswiti omwe ali pafupi - shuga wazakudya, maswiti, makeke.

Pakuwukira kwambiri, ngati munthu wataya chikumbumtima, kulowetsedwa kwa shuga kwa 0,5-1 mg wofunikira, kulowetsedwa kwa shuga ndi koyenera. Wovutikayo akapanda kuzindikira kotala la ola limodzi pambuyo pa glucagon, pamafunika shuga.

Kuti mupewe kuwonongeka pafupipafupi, muyenera kudya china chake chopatsa thanzi.

Kusankha kwa analogi

Nthawi zina wodwala matenda ashuga amakakamizidwa kufunsa dokotala kuti athetse insulin ndi analogue. Zomwe zimasiyana zimasiyana: zoyipa, kukwera mtengo, zosokoneza pakugwiritsa ntchito. Zambiri m'malo mwake zimadziwika ndi Detemir. Zotchuka kwambiri zikuwonetsedwa pagome.

Mankhwala ndi ofanana pakuchitikira, motero nthawi zambiri amasinthana. Koma akatswiri okhawo ayenera kusankha, kuti asavulaze.

Ndine wodwala matenda ashuga"Detemir" imandithandiza kuchepetsa shuga m'magazi, pomwe siyimayambitsa zovuta, mosiyana ndi mitundu yapitayi ya insulin. Chinthu chachikulu chomwe adotolo adakambirana nthawi zonse ndikutsatira nthawi yovomerezeka, osapitirira kapena kuchepetsa mlingo.

Ndili ndi matenda ashuga amtundu woyamba kuyambira ndili ndi zaka 22, ndimagwiritsa ntchito mitundu ina ya insulin kale, koma posachedwapa adokotala adalemba"Detemir." Mankhwalawa amathandizanso chimodzimodzi, mphamvu yake imangokhala kwa maola 24 okha. Zowoneka bwino za mankhwalawa ndi zabwino, ndakhala ndikugwiritsa ntchito kwa milungu yopitilira 3.

Mtengo wa "Detemir" umachokera ku 1300 mpaka 3000 rubles, koma m'makiriniki ena amatha kupezeka kwaulere, ngati pali mankhwala omwe adalembedwa ndi iye kwa endocrinologist ku Latin. "Detemir" imagwira ntchito ngati mutsatira malangizo onse pazokondweretsa, kuikidwa kwa katswiri.

Pomaliza

"Detemir" ndi analogue yosungunuka ya insulin yamunthu, imakhala ndi zochita nthawi yayitali, mbiri yosalala. M'moyo wamakono, shuga si sentensi. Pambuyo pakupanga insulin yopanga, anthu amakhala ndi moyo wokhazikika. Ndikofunikira kuti aziyang'anira kuchuluka kwa shuga awo, kugwiritsa ntchito mankhwala apadera mongaalangidwa ndi madokotala.

Zolemba

1. Antsiferov M. B., Dorofeeva L. G., Petraneva E. V. Kugwiritsa ntchito insulin glargine (Lantus) pa matenda a shuga mellitus (zomwe zinachitikira ku Moscow endocrinological service) // Farmateka. 2005.V. 107. Ayi. 12 P. 24-29.
2. Cryer P. E., Davies S. N., Shamoon H. Hypoglycemia mu shuga // Diabetes Care. 2003, vol. 26: 1902-1912.
3. DeWitt D. E., Hirsch I. B. Outpatient insulin mankhwala a mtundu 1 ndi mtundu 2 matenda a shuga. Ndemanga yasayansi // JAMA. 2003, 289: 2254-2264.
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20. Vague P., Selam J. L., Skeie S. et al. Kuzindikira kwa insulin kumalumikizidwa ndikuwongolera kwambiri kwa glycemic ndikuchepetsa chiopsezo cha hypoglycaemia kuposa NPH insulin mwa odwala omwe ali ndi matenda a shuga 1 pamaboma oyambira a basal-bolus omwe ali ndi premeal insulin aspart // Matenda a shuga. 2003, 26: 590-596.

A. M. Mkrtumyan, Doctor wa Medical Science, Pulofesa
A. N. Oranskaya, woimira mayunivesite azachipatala
MGMSU, Moscow

Pharmacological zochita za chinthu

Detemir insulin imapangidwa pogwiritsa ntchito michere ya michere yotchedwa recombinant deoxyribonucleic acid (DNA) pogwiritsa ntchito mtundu wina wotchedwa Saccharomyces cerevisiae.

Insulin ndiye chinthu chachikulu cha mankhwala a Levemir flekspen, omwe amatulutsidwa monga njira yankho mu zolembera 3 za syringe (300 PIECES).

Ma analogue amtundu wa anthu amamangiriridwa ndi zotumphukira zomwe zimagwira mu cell ndipo zimayambitsa zochitika zachilengedwe.

Mndandanda wa insulin wa anthu umalimbikitsa kutsegulira kwa zotsatirazi mthupi:

• kukondoweza kwa glucose komwe kumachitika ndi zotumphukira maselo ndi minofu,
• shuga kagayidwe kachakudya,
• kuletsa kwa gluconeogenesis,
• kuchuluka mapuloteni kaphatikizidwe
• kupewa lipolysis ndi proteinolysis mu mafuta maselo.

Chifukwa cha njirazi zonse, pali kuchepa kwa ndende yamagazi. Pambuyo pa jakisoni wa insulin, Detemir amayamba kuchita bwino kwambiri atatha maola 6-8.

Ngati mumalowetsa yankho kawiri patsiku, ndiye kuti insulini yofanana ndi insulin imatheka pambuyo pobayidwa kawiri kapena atatu. Kusintha kwamkati kwamkati mwa Detemir insulin kumakhala kotsika kwambiri poyerekeza ndi mankhwala ena a basal insulin.

Hormone iyi imakhudzanso zomwe zimagonana ndi amuna ndi akazi. Voliyumu yake yogawa pafupifupi ndi 0,1 l / kg.

Kutalika kwa theka la moyo wa insulin yovomerezeka pakhungu limatengera mlingo wa mankhwalawa ndipo pafupifupi maola 5-7.

Malangizo ogwiritsira ntchito mankhwalawa

Dokotala amawerengera kuchuluka kwa mankhwalawa, poganizira kuchuluka kwa shuga kwa odwala matenda ashuga.

Mlingo uyenera kusinthidwa ngati kuphwanya zakudya za wodwala, kuchuluka kwa zochitika zolimbitsa thupi kapena kuwoneka kwa ma pathologies ena. Insulin Detemir ikhoza kugwiritsidwa ntchito ngati mankhwala akuluakulu, kuphatikiza ndi insulin kapena mankhwala ochepetsa shuga.

Jakisoni amatha kuchitika mkati mwa maola 24 nthawi iliyonse, chinthu chachikulu ndikuwonetsetsa nthawi yomweyo tsiku lililonse. Malamulo oyambira kuperekera mahomoni:

1. Jakisoni amapangidwa pansi pa khungu kulowa m'mimba, mapewa, matako kapena ntchafu.
2. Kuti muchepetse kuthekera kwa lipodystrophy (matenda am'mafuta am'mimba), malo a jekeseni ayenera kusinthidwa pafupipafupi.
3. Anthu opitilira zaka zopitilira 60 ndipo odwala omwe ali ndi vuto la impso kapena chiwindi amafunika kuyang'anitsitsa shuga ndi kusintha kwamankhwala osokoneza bongo.
4. Mukasamutsidwa kuchokera ku mankhwala ena kapena koyambirira kwa mankhwalawa, ndikofunikira kuyang'anitsitsa kuchuluka kwa glycemia.

Tiyenera kudziwa kuti mankhwalawa a insulini Detemir samatengera kuwonjezeka kwa wodwala. Asanapite maulendo ataliatali, wodwalayo ayenera kufunsa katswiri wothandizirana ndi mankhwalawa chifukwa chogwiritsa ntchito mankhwalawa.

Kuchepetsa kwakanema kwa zamankhwala kumatha kubweretsa mkhalidwe wa hyperglycemia - kuchuluka kwambiri kwa shuga, kapena ngakhale matenda ashuga a ketoacidosis - kuphwanya kwa kagayidwe kazakudya chifukwa chosowa insulin. Ngati dokotala sakulumikizidwa mwachangu, zotsatira zake zingachitike.

Hypoglycemia imapangidwa pamene thupi limatha kapena silikhuta mokwanira ndi chakudya, ndipo mlingo wa insulin, nawonso umakhala wokwera kwambiri. Kuti muwonjezere kuchuluka kwa shuga m'magazi, muyenera kudya chidutswa cha shuga, kapu ya chokoleti, china chokoma.

kutentha thupi kapena matenda osiyanasiyana nthawi zambiri kumakulitsa kufunikira kwa mahomoni. Kusintha kwa mlingo wa yankho kungakhale kofunikira pakukula kwa matenda a impso, chiwindi, chithokomiro, tiziwalo tamatumbo ndi ma thumbu a adrenal.

Mukaphatikiza insulin ndi thiazolidinediones, ndikofunikira kuganizira kuti akhoza kuthandiza kukulitsa matenda a mtima ndi kulephera kosalekeza.

Mukamagwiritsa ntchito mankhwalawa, kusintha kwa ndende ndi psychomotor kumatha.

Contraindication ndi zotheka kuvulaza

Mwakutero, palibe zotsutsana pakugwiritsa ntchito insulin Detemir. Zolepheretsa zimangokhudzana ndi kukhudzidwa kwapazinthu zina ndi zaka ziwiri zokha chifukwa choti kafukufuku wazokhudza ana a insulin sanachitepo kanthu.

Panthawi yobala mwana, mankhwalawa amatha kugwiritsidwa ntchito, koma moyang'aniridwa ndi dokotala.

Kafukufuku wambiri sanawone zotsatira zoyipa mwa mayi ndi mwana wake wakhanda pomayambitsa jakisoni wa insulin panthawi yomwe anali ndi bere.

Amakhulupirira kuti mankhwalawa amatha kugwiritsidwa ntchito poyamwitsa, koma palibe maphunziro omwe adachitika. Chifukwa chake, kwa amayi omwe ali ndi pakati komanso kuyamwitsa, adokotala amasintha muyeso wa insulin, kulemera pamaso pake phindu la mayi ndi chiwopsezo cha mwana wawo.

Zokhudza momwe thupi limakhudzira, malangizo omwe angagwiritsidwe ntchito ali ndi mndandanda woyenera:

1. Mkhalidwe wa hypoglycemia wodziwika ndi zizindikiro monga kugona, kukwiya, kutsekeka kwa khungu, kunjenjemera, kupweteka mutu, chisokonezo, kukhumudwa, kukomoka, tachycardia. Vutoli limatchulidwanso kuti insulin.
2. Hypersensitivity yapafupi - kutupa ndi kufupika kwa jekeseni, kuyabwa, komanso mawonekedwe a lipid dystrophy.
3. Thupi lawo siligwirizana, angioedema, urticaria, zotupa pakhungu ndi thukuta kwambiri.
4. Kuphwanya kwam'mimba thirakiti - nseru, kusanza, kupweteka m'mimba, kutsegula m'mimba.
5. Kufupika, kunachepetsa kuthamanga kwa magazi.
6. Zowonongeka - kusintha kwa kukonzanso komwe kumatsogolera ku retinopathy (kutupa kwa retina).
7. Kukula kwa zotumphukira neuropathy.

Mankhwala osokoneza bongo amachititsa kuti shuga ayambe kugwa mofulumira. Ndi hypoglycemia wofatsa, munthu ayenera kudya mankhwala omwe amakhala ndi chakudya chamagulu ambiri.

Wodwalayo akavulala kwambiri, makamaka ngati sakudziwa, kufunikira kuchipatala mwachangu ndikofunikira. Dokotala amapaka jakisoni wa shuga kapena glucagon pansi pa khungu kapena pansi pa minofu.

Wodwalayo akachira, amapatsidwa shuga kapena chokoleti kuti asafooketse shuga kangapo.

Mtengo, ndemanga, njira zofananira

Mankhwala a Levemir flekspen, omwe amagwira ntchito omwe ndi insulin Detemir, amagulitsidwa m'malo ogulitsa mankhwala osokoneza bongo ndi malo ogulitsa pa intaneti.

Mutha kugula mankhwalawa pokhapokha ngati mukupatsidwa mankhwala ndi dokotala.

Mankhwalawa ndiokwera mtengo kwambiri, mtengo wake umasiyana kuchokera ku 2560 mpaka 2900 rubles aku Russia. Pankhaniyi, si wodwala aliyense amene angakwanitse.

Komabe, ndemanga za Detemir insulin ndizabwino. Anthu ambiri odwala matenda ashuga omwe adalumikizidwa ndi mahomoni ofanana ndi anthu adazindikira izi:

• kutsika kwapang'onopang'ono kwa shuga m'magazi,
• kusungidwa kwa machitidwe a mankhwala pafupifupi tsiku limodzi,
• kugwiritsa ntchito zolembera,
• kawirikawiri zimachitika zovuta.
• kukhalabe kulemera kwa odwala matenda ashuga chimodzimodzi.

Kuti mukwaniritse shuga wabwinobwino mungathe kutsatira malamulo onse a matenda a shuga. Uku sikuti ndi jakisoni wa insulin kokha, komanso masewera olimbitsa thupi, zovuta zina zokhudzana ndi zakudya komanso kudziletsa pakukhazikika kwa ndende yamagazi. Kuthana ndi ma dosages olondola ndikofunikira kwambiri, popeza kuyambika kwa hypoglycemia, komanso zotsatirapo zake zazikulu, siziyikidwa pambali.

Ngati mankhwalawa pazifukwa zina sizigwirizana ndi wodwalayo, adokotala amatha kukupatsirani mankhwala ena. Mwachitsanzo, insulin Isofan, yomwe ndi analogue ya mahomoni amunthu, omwe amapangidwa ndi mainjiniine. Isofan imagwiritsidwa ntchito osati mu shuga mellitus woyamba komanso wachiwiri, komanso mawonekedwe ake (mwa amayi apakati), pathways, komanso othandizira opaleshoni.

Kutalika kwa nthawi yake kumakhala kocheperako kuposa Detemir insulin, komabe, Isofan ilinso ndi hypoglycemic kwambiri. Ili ndi zovuta ngati zomwezi, mankhwala ena angakhudze kugwira ntchito kwake. Gawo la Isofan limapezeka m'mankhwala ambiri, mwachitsanzo, Humulin, Rinsulin, Pensulin, Gansulin N, Biosulin N, Insuran, Protafan ndi ena.

Kugwiritsa ntchito moyenera insulin ya Detemir, mutha kuchotsa zizindikilo za matenda ashuga. Zofananira zake, kukonzekera komwe kumakhala ndi insulin Isofan, kudzakuthandizani pamene kugwiritsa ntchito mankhwalawo ndikoletsedwa. Momwe imagwirira ntchito komanso chifukwa chomwe mukufunira insulini - mu kanema munkhaniyi.

Analogs popanga ndi chisonyezo chogwiritsidwa ntchito

Mndandanda womwe uli pamwambapa wa analogies ya mankhwala, omwe akuwonetsa insulin, ndizabwino kwambiri chifukwa zimakhala ndi zinthu zomwe zimagwirizana ndipo zimagwirana molingana ndi chisonyezo chogwiritsidwa ntchito

Insulin "Detemir": malongosoledwe a mankhwala

Mankhwalawa amapezeka mu mawonekedwe a mtundu wopanda mawonekedwe. Mu 1 ml yake mumakhala chinthu chachikulu - insulin detemir 100 PESCES. Kuphatikiza apo pali zinthu zina zowonjezera: glycerol, phenol, metacresol, zinc acetate, sodium hydrogen phosphate dihydrate, sodium chloride, hydrochloric acid q.s. kapena sodium hydroxide q.s., madzi a jakisoni mpaka 1 ml.

Mankhwalawa amapezeka mu cholembera, momwe muli 3 ml yankho, kufanana kwa 300 PIECES. 1 unit ya insulin imakhala ndi 0,142 mg ya insulin determir yopanda mchere.

Kodi Detemir amagwira ntchito bwanji?

Detemir insulin (dzina lamalonda Levemir) imapangidwa pogwiritsa ntchito biotechnology of recombinant deoxyribonucleic acid (DNA) pogwiritsa ntchito mtundu wina wotchedwa Saccharomyces cerevisiae. Insulin ndiye gawo lalikulu la Levemir flekspen ndipo ndi chithunzi cha mahomoni aumunthu omwe amamangilira zotumphukira maselo a cell ndikupanga njira zonse zachilengedwe. Zili ndi zovuta zingapo mthupi:

• imalimbikitsa kugwiritsa ntchito shuga ndi zotumphukira zimakhala ndi ma cell,
• amalamulira kagayidwe kazakudya,
• timaletsa gluconeogenesis,
• kumawonjezera kaphatikizidwe kazakudya,
• imalepheretsa lipolysis ndi proteinolysis m'maselo a mafuta.

Ndili othokoza chifukwa chowongolera machitidwe onsewa omwe magazi a magazi amachepa. Pambuyo pakukhazikitsa mankhwala, zotsatira zake zazikulu zimayamba pambuyo pa maola 6-8.

Ngati mumalowetsa kawiri patsiku, ndiye kuti kuchuluka kwa shuga kokwanira kumatha kupezeka pambuyo pakubayidwa kawiri mpaka katatu. Mankhwalawa ali ndi zotsatira zofananira kwa amayi ndi abambo. Voliyumu yake yogawa pakati ili mkati mwa 0,1 l / kg.

Hafu ya moyo wa insulin, yomwe idalowetsedwa pansi pa khungu, imatengera mlingo komanso pafupifupi maola 5-7.

Zomwe zikuchitika za mankhwala "Detemir"

Detemir insulin (Levemir) imakhala yothandiza kwambiri kuposa zinthu za insulin monga Glargin ndi Isofan. Kukula kwake kwakutali kwa thupi kumachitika chifukwa cha mayanjano odziwika bwino opanga ma cell maselo akafika ndi mbali yamafuta amafuta am'magazi a ma albumin a albumin. Poyerekeza ndi ma insulini ena, amamwazika pang'onopang'ono mthupi lonse, koma chifukwa cha izi, mayamwidwe ake amalimbikitsidwa kwambiri. Komanso, poyerekeza ndi ma analogi ena, Detemir insulin ndiwodziwikiratu, chifukwa chake ndizosavuta kuyang'anira momwe zimakhalira. Ndipo izi ndichifukwa zingapo:

• chinthucho chimakhalabe chamadzi kuyambira pomwe chimakhala chokhala ngati cholembera mpaka kufikira thupi.
• tinthu tating'onoting'ono timalumikizana ndi ma cellcule a albumin mu seramu yamagazi ndi njira yotsatsira.

Mankhwalawa amakhudza kukula kwa maselo ocheperako, zomwe sizinganenedwe za insulini zina. Zilibe ma genotoxic komanso poizoni m'thupi.

Momwe mungagwiritsire "Detemir"?

Mlingo wa mankhwalawa amasankhidwa payekhapayekha kwa wodwala aliyense yemwe ali ndi matenda ashuga. Mutha kulowa kamodzi kapena kawiri pa tsiku, izi zikuwonetsedwa ndi malangizowo. Umboni wogwiritsika ntchito kwa Detemir insulin ntchito umati kuti ukwaniritse kuongolera kwa glycemia, jakisoni amayenera kuperekedwa kawiri pa tsiku: m'mawa ndi madzulo, osachepera maola 12 ayenera kutha pakadutsa.

Kwa okalamba omwe ali ndi matenda a shuga komanso omwe akuvutika ndi vuto la chiwindi ndi impso, mankhwalawa amasankhidwa mosamala kwambiri.

Insulin imalowetsedwa pang'onopang'ono m'khosi, ntchafu ndi dera lanu. Kukula kwa zochita zimatengera komwe mankhwalawo amaperekedwa. Ngati jakisoni wapangidwa m'dera limodzi, ndiye kuti malo opumira amatha kusinthidwa, mwachitsanzo, ngati insulin ingalowetsedwa pakhungu la pamimba, ndiye kuti izi ziyenera kuchitidwa 5 cm kuchokera ku navel komanso mozungulira.

Ndikofunikira kupeza jakisoni moyenera. Kuti muchite izi, muyenera kutenga cholembera ndi kutentha kwa chipinda, antiseptic ndi ubweya wa thonje.

Ndipo tsatirani njirayi motere:

• gwiritsani ntchito malo opumira pogwiritsa ntchito mankhwala osokoneza bongo ndipo lolani kuti khungu liume,
• Khungu limagwidwa ndimisempha
• singano iyenera kuyikidwira pakona, kenako mbayo ikakoka pang'ono, ngati magazi abwera, chotengera chiwonongeka, malo a jekeseni ayenera kusinthidwa,
• mankhwalawa ayenera kuthandizidwa pang'onopang'ono komanso moyenera, pomwe piston imayenda movutikira, ndipo pamalo opumira khungu limatupa, singano iyenera kuyikiridwa kwambiri,
• pambuyo mankhwala kukonzekera, ndikofunikira kukhala kwa masekondi ena 5, kenako syringe imachotsedwa ndikuyenda kokhazikika, ndipo tsamba la jakisoni limachiritsidwa ndi antiseptic.

Kuti jakisoni asapweteke, singano iyenera kukhala yochepa thupi momwe mungathere, khungu siliyenera kufinyidwa mwamphamvu, ndipo jekeseni iyenera kuchitidwa ndi dzanja lolimba popanda mantha ndi kukayikira.

Ngati wodwala wavulala mitundu ingapo ya insulini, ndiye kuti yoyamba imayimiriridwa mwachidule, kenako.

Kodi muyenera kuyang'ana musanalowe mu Detemir?

Musanapange jakisoni, muyenera:

• onaninso mtundu wa ndalama
• disinction wa nembanemba ndi antiseptic,
• yang'anirani bwino kukhulupirika kwa katoni, ngati mwadzidzidzi wawonongeka kapena kukayikira kukonzekera kwake, ndiye kuti simukufunika kuti mugwiritse ntchito, muyenera kuubwezera ku pharmacy.

Ndikofunika kukumbukira kuti ndizoletsedwa kugwiritsa ntchito Detemir insulin kapena imodzi yomwe idasungidwa molakwika. M'mapampu a insulin, mankhwalawa sagwiritsidwa ntchito, poyambitsa ndikofunikira kusunga malamulo angapo:

• kutumikiridwa kokha pakhungu,
• singano isintha pambuyo jekeseni aliyense,
• katoni sikukhutira.

Kodi mankhwalawa amasemphana ndi milandu iti?

Musanagwiritse ntchito Detemir, ndikofunikira kudziwa ngati chatsimikizika mosamala:

• ngati wodwala akumva chidwi ndi zigawo zina za mankhwalawo, amatha kuyambitsidwa, zotsatira zina zimatha kupha.
• Kwa ana ochepera zaka 6, mankhwalawa samalimbikitsidwa, sizotheka kuyang'ana momwe zimawakhudzira ana, chifukwa chake ndizosatheka kuneneratu momwe zidzawakhudzire.

Kuphatikiza apo, pali magulu amtundu wotere wa odwala omwe amaloledwa kugwiritsa ntchito mankhwalawa pochiza, koma ndi chisamaliro chapadera komanso kuyang'aniridwa mosalekeza. Izi zikuwonetsedwa ndi malangizo ogwiritsira ntchito. Insulin "Detemir» mwa odwala omwe ali ndi ma pathologies, kusintha kwa mankhwalawa kumafunikira:

• Kuphwanya chiwindi. Ngati zomwe zalembedwazi zikuchitika m'mbiri ya wodwalayo, ndiye kuti zomwe wachita zikuluzikulu zingasokonekera, ndiye kuti mankhwalawo ayenera kusintha.
• Kulephera mu impso. Ndi ma pathologies oterowo, mfundo za momwe mankhwalawo amatha kusinthidwira, koma vutoli litha kuthetsedwera ngati mumayang'anira wodwalayo pafupipafupi.
• Anthu okalamba. Pambuyo pazaka 65, zosintha zingapo zambiri zimachitika mthupi, zomwe zimakhala zovuta kwambiri kuti zitsatire. Pakukalamba, ziwalo sizigwira ntchito mwachangu ngati achinyamata, chifukwa chake, ndikofunikira kuti asankhe mlingo woyenera kuti uthandizenso kuchuluka kwa shuga, osavulaza.

Ngati mungaganizire malingaliro onsewa, ndiye kuti chiwopsezo cha zotsatira zoyipa chitha kuchepetsedwa.

"Detemir" pa nthawi yoyembekezera komanso poyamwitsa

Chifukwa cha maphunziro a kugwiritsa ntchito insulin "Detemira» mayi woyembekezera komanso mwana wake wosabadwa, zinatsimikiziridwa kuti chida sichikhudza kukula kwa mwana. Koma kunena kuti ndizotetezeka kwathunthu, ndizosatheka, chifukwa panthawi yomwe kusintha kwa mahomoni kumachitika mthupi la mzimayi, komanso momwe mankhwalawo angachitire mosiyanasiyana sizingatheke. Ichi ndichifukwa chake madokotala, asanapange mankhwala panthawi yoyembekezera, onetsetsani kuopsa kwake.

Pa chithandizo, muyenera kuyang'anira kuchuluka kwa shuga. Zizindikiro zimatha kusintha kwambiri, kotero kuwunikira kwakanthawi ndi kusintha kwa mankhwalawa ndikofunikira.

Ndizosatheka kunena ndendende ngati mankhwalawa alowa mkaka wa m'mawere, koma ngakhale atapeza, akukhulupirira kuti sizingavulaze.

Malangizo apadera ogwiritsa ntchito

Malangizo a insulin "Detemir" amachenjeza kuti kugwiritsa ntchito mankhwalawa kumafunikira kusamala kwapadera. Kuti mankhwalawa apereke zotsatira zomwe zili zofunikira ndikukhala otetezeka, muyenera kutsatira malamulo awa:

• osagwiritsa ntchito mankhwalawa ana osaposa zaka 6,
• osadumpha chakudya, pamakhala chiopsezo cha hypoglycemia,
• osazunza
• Onetsetsani kuti mukukumbukira kuti chifukwa cha chitukuko, thupi lifunika insulini yambiri,
• osagwiritsa ntchito mankhwalawa mwachangu,
• kumbukirani kuti kuchuluka kwa zochita ndi chidwi chamaonedwe zimatha kusintha ngati Hyper- ndi hypoglycemia zachitika.

Kuti mankhwalawa apitirire molondola, aliyense wodwala matenda ashuga ayenera kudziwa malamulowo. Dokotala wopezekapo amayenera kukambirana, osangodziwa jakisoni ndi muyezo wamagazi, komanso kulankhula za kusintha kwa moyo wawo komanso kadyedwe.

Mitu ya mankhwalawa

Odwala ena amayenera kuyang'ana mayendedwe a Detemir a insulin omwe amapangidwa ndi zinthu zina. Mwachitsanzo, odwala matenda ashuga omwe ali ndi chidwi chokhudzana ndi zigawo za mankhwalawa. Pali zithunzi zambiri za Detemir, kuphatikizapo Insuran, Rinsulin, Protafan ndi ena.

Koma ndikofunikira kukumbukira kuti analogue yokha ndi mlingo wake uyenera kusankhidwa ndi dokotala aliyense payekha. Izi zikugwirira ntchito ku mankhwala aliwonse, makamaka okhala ndi matendawa.

Mtengo wa mankhwala

Mtengo wa insulin Detemir Danish kupanga umachokera ku 1300-3000 rubles. Koma ndikofunikira kukumbukira kuti mutha kuzipeza zaulere, koma pankhaniyi, muyenera kukhala ndi chilangizo cha Chilatini cholembedwa ndi endocrinologist. Detemir insulin ndi mankhwala othandiza kuchiza matenda a shuga 1 ndi mtundu 2, chinthu chachikulu ndikutsatira malingaliro onse, ndipo zimangopindulitsa odwala matenda ashuga.

Ndemanga za Insulin

Anthu odwala matenda ashuga komanso madotolo amayankha bwino Detemir. Zimathandizira kuchepetsa shuga yamwazi, imakhala ndi zotsutsana pang'ono komanso mawonekedwe osafunikira. Chokhacho choyenera kuganizira ndikulondola kwa kayendetsedwe kake ndikutsatira malingaliro onse ngati, kupatula insulin, mankhwala ena amalimbikitsidwa kwa wodwala.

Matenda a shuga masiku ano si chiganizo, ngakhale kuti matendawa amayesedwa ngati amwalira mpaka atapangidwa insulin. Kutsatira malingaliro a dokotala ndikuwonetsetsa kuchuluka kwa shuga m'magazi, mutha kukhalabe ndi moyo wabwino.

Kodi mungapeze bwanji analogue yotsika mtengo ya mankhwala okwera mtengo?

Kuti mupeze chiwonetsero chotsika mtengo cha mankhwala, chofananira kapena chofanana, choyambirira timalimbikitsa kulabadira kapangidwe kake, zomwe ndi zinthu zomwezo zomwe zikugwira komanso zomwe zikugwiritsidwa ntchito. Zomwe zimagwiritsidwanso mosiyanasiyana ndi mankhwalawa zimawonetsa kuti mankhwalawo ndi ofanana ndi mankhwalawo, monga mankhwala ena kapena mitundu ina. Komabe, musaiwale za zovuta zomwe zimagwiritsidwa ntchito ndi mankhwala ofanana, omwe angakhudze chitetezo ndi kugwiranso ntchito. Musaiwale za malangizo a madotolo, kudzipereka nokha kungawononge thanzi lanu, chifukwa chake onani dokotala wanu musanagwiritse ntchito mankhwala.

Malangizo a insulin

Machitidwe
Insulin ndi mankhwala ena ochepetsa shuga;
Kuphatikiza pa zotsatira za hypoglycemic (kutsitsa shuga), insulin imakhala ndi zotsatirapo zingapo: imachulukitsa masitolo a minofu ya glycogen, imalimbikitsa kaphatikizidwe ka peptide, imachepetsa kumwa kwa mapuloteni, ndi zina zambiri.
Kuwonetsedwa kwa insulini kumayendetsedwa ndi kukondoweza kapena kuletsa (kuponderezana) kwa michere ina, glycogen synthetase, pyruvate dehydrogenase, hexokinase imakhudzidwa, lipase ikuyambitsa mafuta acids a minofu ya adipose, lipoprotein lipase, kuchepetsa magazi ndikudya chifukwa chokhala ndi mafuta ambiri.
Mlingo wa biosynthesis ndi secretion (secretion) wa insulin zimatengera kuchuluka kwa shuga m'magazi. Ndi kuwonjezeka kwa zomwe zili mkati mwake, katulutsidwe ka insulin ndi kapamba kumawonjezera, m'malo mwake, kutsika kwa kuchuluka kwa shuga m'magazi kumachepetsa kubisalira kwa insulin.
Pakukhazikitsa zotsatira za insulini, gawo lotsogolera limaseweredwa ndi kulumikizana kwina ndi cholandilira chapadera pamadzi a cell ya cell, ndikupanga insulin receptor zovuta. Zomwe zimapangira insulini limodzi ndi insulin zimalowa mu cell, momwe zimakhudzira kuphatikizana kwa mapuloteni am'magazi, kuwonjezereka kwina kosamveka sikumveka bwino.
Insulin ndiye chithandizo chenicheni cha matenda a shuga; chifukwa amachepetsa hyperglycemia (kuchuluka kwa shuga m'magazi) ndi glycosuria (kukhalapo kwa shuga mumkodzo), amabwezeretsanso kuchuluka kwa glycogen mu chiwindi ndi minofu, amachepetsa kupanga shuga, ndikuchepetsa matenda a shuga m'magazi (kukhalapo kwamafuta m'magazi) Amathandizira wodwalayo.
Insulin yogwiritsira ntchito kuchipatala imapezeka kuchokera ku zikondamoyo za ng'ombe ndi nkhumba. Pali njira yothandizira kuphatikizira mankhwala a insulin, koma ndi osatheka. Posachedwa apanga njira za biotechnological zopangira insulin yaumunthu. Insulin yomwe idapangidwa ndi mainjiniering genetic imagwirizana kwathunthu ndi mndandanda wa amino acid wa insulin yamunthu.
Milandu yomwe insulin imapezeka kuchokera ku zikondamoyo za nyama, zodetsa zosiyanasiyana (ma proinsulin, glucagon, kudzipereka, mapuloteni, ma polypeptides, ndi zina zotere) zitha kupezeka pokonzekera chifukwa chosakwanira kuyeretsa. Kukonzekera bwino kwambiri kwa insulin kumatha kuyambitsa mavuto osiyanasiyana.
Njira zamakono zimapangitsa kuti zitheke (monopic - chromatographic oyeretsedwa ndikutulutsa "nsonga" ya insulin), yoyeretsedwa kwambiri (monocomponent) ndikukonzekera insulin. Pakadali pano, mafuta a insulin a insulin amagwiritsidwa ntchito kwambiri. Pazokonzekera za insulin, nyama zimakonda kusankha insulin chifukwa cha nkhumba.
Ntchito ya insulin imatsimikizika kuti ikubadwa (mwa kuthekera kutsika shuga m'magulu a akalulu athanzi) komanso ndi imodzi mwazinthu zachilengedwe (electrophoresis pamapepala kapena chromatography papepala). Pa gawo limodzi la ntchito (UNIT), kapena unit yapadziko lonse lapansi (IE), chitani zochitika za 0404082 mg wa crystalline insulin.

Zisonyezero zogwiritsidwa ntchito:
Chizindikiro chachikulu chogwiritsa ntchito insulin ndi mtundu I shuga mellitus (wodwala insulin), koma m'malo ena umalembedwanso mtundu II wa matenda a shuga (osagwirizana ndi insulin).

Njira yogwiritsira ntchito:
Pochiza matenda a shuga, insulin yokonzekera zosiyanasiyana zimagwiritsidwa ntchito (onani pansipa).
Insulin yogwira ntchito yayifupi imagwiritsidwanso ntchito munjira zina za pathological: kuyambitsa matenda a hypoglycemic (kutsitsa shuga m'magazi) m'njira zina za schizophrenia, monga mankhwala a anabolic (olimbitsa kaphatikizidwe ka protein) ndi kutopa konse, kusowa kwa zakudya, furunculosis , thyrotoxicosis (matenda a chithokomiro), omwe ali ndi matenda am'mimba (atony / kuchepera kwa toni /, gastroptosis / prolfall m'mimba /), hepatitis yayitali (kutupa kwa minyewa ya chiwindi), nyh mitundu ndi matenda enaake chiwindi, komanso chigawo chimodzi "polarizing" zothetsera ntchito azichitira pachimake inatsekeratu insufficiency (mismatch pakati kufunika mtima mpweya ndi yobereka ake).
Kusankhidwa kwa insulin pochiza matenda ashuga kumadalira kuopsa kwa matendawa, momwe wodwalayo alili, komanso kuthamanga kwa nthawi komanso nthawi yayitali ya Hypoglycemic. Cholinga chachikulu cha insulin komanso kukhazikitsa mlingo wa mankhwala imachitika mu chipatala (chipatala).
Kukonzekera kwa insulin kochepa ndi njira zothetsera subcutaneous kapena mu mnofu makonzedwe. Ngati ndi kotheka, amaperekedwanso kudzera m'mitsetse yamkati. Ali ndi mphamvu yochepetsera shuga yochepa komanso yochepa. Nthawi zambiri amathandizidwa kupakidwa mphindi 15 mpaka 15 musanadye chakudya kangapo patsiku. Zotsatira pambuyo pobayira jakisoni wapakati pa mphindi 15 mpaka 20, kufika pazowonjezereka pambuyo pa maola awiri, nthawi yonse yovutikira sichikupita maola 6. Amagwiritsidwa ntchito makamaka kuchipatala kukhazikitsa kuchuluka kwa insulin kwa wodwala, komanso ngati pakufunika kukwaniritsa mwachangu Kusintha kwa ntchito ya insulin mthupi - ndi matenda a shuga komanso precom (kutaya kwathunthu kapena pang'ono pang'ono chifukwa cha kuchuluka kwakukula kwa shuga).
Kuphatikiza pa tog 9, kukonzekera mwachangu insulini kumagwiritsidwa ntchito ngati anabolic othandizira ndipo amalembera, monga lamulo, mumiyeso yaying'ono (4-8 mayunitsi 1-2 patsiku.
Kukonzekera kwa insulin kwa nthawi yayitali (kwa nthawi yayitali) kumapezeka m'mitundu mitundu yosiyanasiyana yokhala ndi kuchepetsa shuga (semylong, yayitali, ultralong). Mankhwala osiyanasiyana, zotsatira zake zimakhala maola 10 mpaka 36. Chifukwa cha mankhwalawa, kuchuluka kwa jakisoni tsiku ndi tsiku kumatha kuchepetsedwa. Nthawi zambiri amapangidwa mu mawonekedwe a kuyimitsidwa (kuyimitsidwa kwa ma tinthu tosagwirizana ndimadzi), kumayendetsedwa kokha kapena intramuscularly, mtsempha wamkati samaloledwa. Pazakudya zokhala ndi matenda ashuga komanso mikhalidwe yoyipa, mankhwalawa amakhala osagwiritsidwa ntchito.
Mukamasankha kukonzekera kwa insulin, ndikofunikira kuonetsetsa kuti nthawi ya kutsika kwambiri kwa shuga ikugwirizana ndi nthawi yomwe mumamwa. Ngati ndi kotheka, mankhwala 2 a nthawi yayitali amatha kuperekedwa mu syringe imodzi. Odwala ena amafunika osati motalika, komanso mwachangu kuchuluka kwa shuga m'magazi. Ayenera kupatsidwa mankhwala okhala ndi insulin.
Nthawi zambiri, mankhwala omwe amagwiritsidwa ntchito kwa nthawi yayitali amathandizidwa musanadye chakudya cham'mawa, koma ngati kuli koyenera, jakisoni ikhoza kuchitika maola ena.
Zokonzekera zonse za insulin zimagwiritsidwa ntchito potsatira zakudya. Tanthauzo la kuchuluka kwa mphamvu (kuyambira 1700 mpaka 3000 khal) kuyenera kutsimikiziridwa ndi kulemera kwamthupi la wodwalayo panthawi yamankhwala, ndi mtundu wa zochita. Chifukwa chake, ndi kuchepa kwa zakudya komanso kugwira ntchito zolimbitsa thupi, kuchuluka kwa zopatsa mphamvu patsiku kwa wodwala kuli osachepera 3000, wokhala ndi zakudya zokwanira komanso kukhala ndi moyo wokhazikika, sayenera kupitilira 2000.
Kuyambitsa Mlingo wambiri, komanso kusowa kwa chakudya ndi zakudya, kumayambitsa matenda a hypoglycemic (kutsitsa shuga), kumayendetsedwa ndi kumva njala, kufooka, thukuta, kugwedezeka kwa thupi, kupweteka mutu, chizungulire, kukwiya, chisangalalo . Pambuyo pake, hypoglycemic coma ikhoza kukhala (kuiwalika kwa chikumbumtima, chodziwika ndi kuperewera konse kwa thupi pakukhudzidwa kwakunja chifukwa chakuchepa kwambiri kwa shuga m'magazi) ndikutaya chikumbumtima, kugwidwa, komanso kutsika kwamphamvu kwa mtima. Pofuna kupewa matenda a hypoglycemic, odwala ayenera kumwa tiyi wokoma kapena kudya shuga pang'ono.
Ndi chifuwa cha hypoglycemic (chokhudzana ndi kuchepa kwa shuga m'magazi), yankho la glucose 40% limalowetsedwa m'mitsempha mu 10 ml ml, nthawi zina mpaka 100 ml, koma osatinso.
Malangizo a hypoglycemia (kutsitsa shuga wamagazi) mu mawonekedwe owopsa amatha kuchitika pogwiritsa ntchito minyewa kapena subcutaneous makonzedwe a glucagon.

Zotsatira zoyipa:
Ndi subcutaneous makonzedwe a insulini, lipodystrophy (kuchepa kwa kuchuluka kwa adipose minofu yaying'ono) imatha kupezeka malo a jekeseni.
Kukonzekera kwamakono kwambiri kwa insulin komwe kumayambitsa zovuta zomwe sizigwirizana, komabe, milandu yotereyi siyikusiyidwa. Kukula kwa matenda oopsa sayanjana pafupipafupi kumafunanso kufooka (kuletsa kapena kuletsa ziwopsezo) kugwiritsira ntchito mankhwalawa.

Zoyipa:
Zotsatira zakugwiritsira ntchito insulin ndi matenda omwe amapezeka ndi hypoglycemia, hepatitis yacute, cirrhosis, hemolytic jaundice (chikasu cha pakhungu ndi zotupa za m'maso zimayambitsa kupindika kwa maselo ofiira am'magazi), kapamba (kutupa kwa impso), nephritis (kutupa kwa impso) matenda a impso ogwirizana ndi kuphwanya mapuloteni / amyloid metabolism, urolithiasis, m'mimba ndi zilonda zam'mimba, zotupa za mtima (mtima kulephera chifukwa chakomoka mtima matenda a mavavu ake).
Kusamala kwakukulu kumafunikira pochiza odwala omwe ali ndi matenda osokoneza bongo, omwe akudwala matenda a coronary insufficiency (cholakwika pakati pa kufunikira kwa mpweya ndi kubereka kwake) ndi ubongo wopanda vuto | magazi. Kusamala ndikofunikira pakugwiritsa ntchito insulin! odwala omwe ali ndi matenda a chithokomiro, matenda a Addison (osakwanira ntchito ya adrenal), kulephera kwa impso.
Njira yovomerezeka ya insulini iyenera kuyang'aniridwa mosamala. Pa trimester yoyamba ya mimba, kufunika kwa insulin nthawi zambiri kumacheperachepera ndikuwonjezeka mu trimesters yachiwiri ndi yachitatu.
Alfa-adrenergic blockers ndi beta-adrenostimulants, ma tetracyclines, salicylates amawonjezera katulutsidwe ka insulin (excretion ya thupi yopangika) insulin. Thiazide diupetics (diuretics), beta-blockers, mowa ungayambitse hypoglycemia.

Kutulutsa Fomu:
Syringe insulin imapezeka mu | mabotolo agalasi osindikizidwa ndi zotsekera mphira ndi aluminiyumu yopuma.

Malo osungira:
Sungani pa kutentha kuchokera +2 mpaka + 10 * C. Kuzizira kwa mankhwala sikuloledwa.

Zopangidwa:
1 ml ya yankho kapena kuyimitsidwa nthawi zambiri kumakhala magawo 40.
Kutengera ndi zomwe zimapangidwa, insulini imadzipatula ku zikondamoyo zanyama ndipo imapangidwa pogwiritsa ntchito njira zopangira ma genetic. Malinga ndi kuchuluka kwa kuyeretsedwa, kukonzekera kwa insulini kuchokera ku minofu yanyama kumagawidwa kukhala monopic (MP) ndi monocomponent (MK). Pakadali pano omwe amapezeka kuchokera ku zikondamoyo za nkhumba, zimawonetsedwa ndi cholembera C (SMP - nkhumba monopic, SMK - monocomponent ya nkhumba), ng'ombe - kalata G (ng'ombe: GMP - ng'ombe monopod, GMK - ng'ombe monocompitute). Kukonzekera kwa insulin yaumunthu kumasonyezedwa ndi kalata C.
Kutengera kutalika kwa kuchitapo kanthu, ma insulins amagawidwa:
a) pokonzekera insulin kukonzekera: kuyamba kwa mphindi 15-30, kuchuluka kwa pambuyo 1 / 2-2 maola, nthawi yonse ya maola 4-6,
b) Kukonzekera insulin kukonzekera nthawi yayitali kumakhala ndi mankhwala a nthawi yayitali (kuyambira pambuyo pa maola 1 / 2-2, kuchuluka pambuyo pa maola 3 mpaka 12, kutalika kwa maola 8 mpaka 12) Pambuyo pa maola 8-18, kutalika konse kwa maola 20-30).

Gulu lamagulu:
Mahormone, analogues awo ndi antihormonal mankhwala
Mankhwala okhala ndi pancreatic mahomoni ndi mankhwala opangira hypoglycemic
Mankhwala a Gulu la Insulin