Kugwiritsa ntchito ma insulin analogu mankhwalawa matenda a shuga mellitus Zolemba zasayansi mwapadera

Kupambana kofunika kwambiri kwapazaka zaposachedwa kukonza mankhwala a insulin kwakhala kukuwunikira muzochitika zamankhwala zamakonzedwe atsopano a insulin m'badwo - insulin analogues. Pakadali pano, insulin analogues ya ultrashort ndi kuchitapo kanthu yayitali imagwiritsidwa ntchito bwino mu matenda ashuga, amapatsidwa chidwi poyerekeza ndi chibadwa cha insulin. Mankhwala a pharmacodynamic ndi pharmacokinetic a insulin analogu amapereka kutsata kwathunthu kwa zotsatira za insulin, kuphatikizapo basal insulinemia ndi insulinemia poyankha chakudya, kuthandiza kukwaniritsa zabwino zomwe zili ndi odwala omwe ali ndi matenda osokoneza bongo komanso kupititsa patsogolo matendawa. Kuwunika kwa kafukufuku waposachedwa kuwunika kukuwonetsa kukhathamira komanso kulonjeza kwa kugwiritsa ntchito njira ya insulin kwa nthawi yayitali pochiza matenda amtundu wa 2 komanso mtundu wa 2 matenda a shuga.

MALANGIZO OTHANDIZA MU CHIPANGIZO CHA DIABETES MELLITUS

Kukhazikitsidwa kwa ma insulin analogos - m'badwo wachitatu wa kukonzekera kwatsopano kwa insulin - muzochita zamankhwala akhala akutukuka kwambiri pothandizira mankhwalawa a shuga mellitus m'zaka zaposachedwa. Pakalipano insulin analog yomwe ikugwira ntchito mwachangu ikugwiritsidwa ntchito bwino mu matenda ashuga, ndikupanga zotsatira zabwino poyerekeza ndi kugwiritsa ntchito insulin. Pharmacodynamic ndi pharmacokinetic machitidwe a insulin analog amapereka mokwanira kwathunthu pazotsatira za insulin ya amkati, kuphatikizapo basal insulini komanso kuyankha kwa insulin pakulowetsa chakudya, kukwaniritsa kuyamwa kokhutiritsa kwa glycemic kwa odwala omwe ali ndi mtundu 1 ndi 2 matenda osokoneza bongo komanso kusintha matendawo nthendayo. Kuwunika kwa kafukufuku komwe kwaperekedwa posachedwa kuwunika kukuwonetsa kukhathamira ndi ziyembekezo pakugwiritsa ntchito njira yolimbira yolimbirana ndi matenda a shuga

Kodi m'malo insulin?

Anthu odwala matenda a shuga amafunikira mankhwala omwe amachepetsa shuga ya magazi awo. Chifukwa chaichi, mapangidwe a insulin aumwini amapangidwa. Amayesetsa kukhalabe ndi thanzi labwino ndikuwongolera zomwe zimachitika. Insulin imagawidwa kukhala munthu ndi nyama. Zinthu zosiyanasiyana zimatha kupereka zotsatira zomwezo, ngakhale mawonekedwe ake ndi osiyana.

Mitundu ya insulin

Siyanitsani mitundu yayikulu ya mankhwala kutengera nthawi yomwe akuchitapo kanthu komanso mogwira ntchito. Ndikofunika kudziwa kuti pali mitundu yosiyanasiyana ya mankhwala omwe amatha kusintha m'malo mwa mankhwala ena posankha mlingo woyenera. Zinthu zotsitsa shuga zimagawidwa m'mitundu iyi:

zochita zazifupi
nthawi yayitali
kuthamanga
kuchitapo kanthu kwanthawi yayitali
kuphatikiza (kusakanikirana) kumatanthauza.

Zinthu zomwe zimagwirizana kwambiri ndi insulin ya anthu zidapangidwa. Amatha kuyamba zochita zawo mphindi 5 zokha atalowetsedwa m'magazi.

M'malo mwake mungathe kugwiritsa ntchito mitundu yopanda tanthauzo popanda kuthandizira kuti musakhale wowoneka ngati hypoglycemia. Kukonzekera kwa insulin kumapangidwa pokhapokha pazomera.

Njira zimasiyanitsidwa ndi kusintha kwawo kuchoka ku acidic kupita ku zinthu wamba, kusungunuka kwathunthu.

Asayansi adagwiritsa ntchito DNA yophatikizanso kuti apange mankhwala atsopano. Ma analogi a insulin adapezeka pogwiritsa ntchito matekinoloje ena ophatikizira, kuphatikizapo ma DNA a recombinant.

Mobwerezabwereza amapanga mawonekedwe apamwamba kwambiri a insulin yochepa ndi zochitika zina, zomwe zimakhazikitsidwa chifukwa cha mankhwala aposachedwa kwambiri.

Mankhwalawa amakupatsani mwayi wabwino pakati pa chiwopsezo cha dontho la shuga ndi glycemia yomwe mukufuna. Kuperewera kwa mahomoni kumatha kupangitsa wodwala kukhala ndi vuto la matenda ashuga.

Mafuta a insulin zinthu

M'malo mankhwalawa ndikofunikira kuti musatenge kuperewera kwa mankhwala. Insulin yochepa-pang'ono idayamba kupanga mankhwala ambiri, monga mankhwala osavuta kwambiri ochepetsa shuga. Insulin analogues imatha kusintha nthawi kuti achitike zinthu zonse zabwino kwa anthu omwe akudwala matenda ashuga.

Mankhwala othandizira mafuta amkati, opangidwa kuti apititse shuga, komanso katundu wofanana ndi insulin ya anthu. Mankhwalawa adapangidwa kuti azitha kuwongolera zochita za hypoglycemic. Pamodzi ndi ntchito zazikulu, mankhwalawo amagwira kusefera kwa shuga m'chiwindi.

Chochitikacho chimayamba nthawi yomweyo chinthucho chikaperekedwa. Mankhwalawa akuyenera kugwiritsidwa ntchito ndi anthu omwe ali ndi vuto la matenda a shuga a mtundu woyamba 1, komanso kuchepetsa kunenepa kwambiri, kupewa matenda oopsa a hyperglycemic.

Muyenera kusinthira ku mankhwala ena ngati mukusowa chinthu chimodzi kapena ngati muli ndi hypoglycemia.

Kutsitsa Mwazi

Humalog imayamba kutsika magazi m'mphindi 5 pambuyo pa kuperekedwa.

Mankhwala amapangidwa chifukwa cha insulin ya anthu. Zotsatira zake zimayamba mphindi 5 mankhwala atalowa m'magazi.

Humalog ndi analogue ya ultrashort insulin, yomwe cholinga chake ndicho kuti abweze kuchuluka kwa shuga mthupi. Mwina kugwiritsa ntchito mankhwala tsiku lililonse pofuna kupewa. Nthawi zambiri, insulin imatengedwa pamimba yopanda chakudya asanadye.

Anthu omwe ali ndi matenda amtundu wa 2 komanso amtundu wa 2 amatha kubaya insulin pomwe akukweza shuga. Ndikwabwino kugwiritsa ntchito mankhwalawa milandu:

onjezani shuga mu shuga,
kusalolera kwa mankhwala ena,
kukhalapo kwa hypoglycemia yopanda kuchitapo kanthu,
kukhalapo kwa shuga wosadalira insulini, momwe mumakhala kuphwanya kwa solulility ya insulin zina,
opareshoni, pambuyo pake pakhoza kukhala zovuta.

Insulin

Analogue ya insulin ultrashort zochita za anthu. Ikugwiritsa ntchito limodzi ndi ma membala am'mimba a cytoplasm mu cell. Zotsatira zake, ma insulin receptor complexes amapangidwa.

Izi zimathandizira kapangidwe ka michere, kuphatikizapo hexokinase, pyruvate kinase ndi glycogen synthetics. Zotsatira za insulin yochepa zimatengera kuwonjezeka kwa mayendedwe amkati ndikuwonjezera kuyamwa kwa glucose mu subcutaneous mafuta.

Mankhwalawa amayamba kugwira ntchito yake mankhwala akangofika pansi pakhungu. Kutsika kwa shuga m'magazi kumachitika panthawi yopuma kwa maola 3.5 mutatha kudya.

Aspart akhoza kubayidwa mu ntchafu.

Kutheka kwa usiku hypoglycemia kumachepetsedwa. Katundu wa aspart amayenera kudulidwira m'mimba, ntchafu, phewa kapena matako, ndipo nthawi iliyonse mukafunikira kusintha tsamba la jakisoni. Kukumana kwa kukhudzika kwaumunthu payekha kapena pazinthu zina zowonjezereka kungawoneke pa mankhwala.

"Aspartame" kapena chakudya chowonjezera E951

Izi ndizopangira shuga kapena zoziziritsa kukhosi zopangira zinthu. Kapangidwe ndi kapangidwe ka mankhwalawo ndizosiyana ndi shuga. Mulinso phenylalanine ndi ampartic amino acid.

E951 yowonjezera sikuwonetsa kukana kutentha; kutentha kwambiri, chinthucho chimatha kuwola komanso kutaya mawonekedwe ake akale. Chifukwa cha khalidweli, Aspartame amagwiritsidwa ntchito ngati zowonjezera pazakudya zomwe sizimathandizidwa ndi kutentha.

Vutoli likhoza kukhala ndi zotsatirapo zake, motero kugwiritsa ntchito kuyenera kukhala kocheperako komanso kukaonana ndi dokotala.

Ndi chisamaliro chapadera, ndikofunikira kumwa mankhwala kwa amayi apakati, monga mwana wosabadwayo angavutike.

Novomiks ndi ena

Novomix imayendetsedwa kudzera syringe.

Mankhwala apadziko lonse omwe adapangidwa kuti akhazikitse chinthu chosungunuka ndi cholembera chapadera.

Mlingo woyenera nthawi zambiri amawerengedwa ndi dokotala, koma chizolowezi chimakhala pafupifupi 50 mayunitsi. Mlingo uyenera kusinthidwa nthawi ndi nthawi. Gwiritsani ntchito singano 8mm zokha. Ndikwabwino kuti mutenge nanu zolembera.

Chidacho ndi kuyimitsidwa koyera kwa mtundu woyera, wopanda mapampu.

Njira yowonjezera mayendedwe amkati limodzi ndi kutsika kwa kuchuluka kwa shuga komwe kumatulutsidwa m'chiwindi ndi magazi. Kuwonjezeka kwa chidwi cha munthu pazinthu zomwe zili mu cholembera kumayang'aniridwa nthawi zonse. Ana ochepera zaka zisanu ndi chimodzi amakhala bwino osayendetsa Novomix, chifukwa pakhoza kukhala zolakwika mu thupi chifukwa chakuti mayeso azachipatala a ana sanachititsidwe.

Pomaliza

Pali zinthu zochulukirapo zingapo kupewera zovuta za matenda ashuga. Dokotala amayenera kupatsa insulin, chifukwa mtsogolomu mutha kupeza hypoglycemia. Zotsatira zonse za matenda a shuga zimakhudzana ndi shuga wamagazi. Chifukwa chake, osazengereza kusankha mankhwala oyenera, ndibwino kutsatira upangiri ndi kukakamira kwa dokotala.

Mapiritsi a insulin

Insulin ndi timadzi tomwe timagwira ntchito zingapo nthawi imodzi - timaphwanya shuga m'magazi ndikuwapereka kwa maselo ndi minyewa yathupi, potero imawakhutiritsa ndi mphamvu yofunikira kuti ichitike bwino.

Hormoneyi ikakhala yoperewera m'thupi, maselo amaleka kulandira mphamvu zochuluka mulingo woyenera, ngakhale kuti kuchuluka kwa shuga m'magazi kumakhala kwakukulu kwambiri kuposa kwazonse.

Ndipo vuto lotere likapezeka mwa munthu, amalamulidwa kukonzekera insulin.

Amakhala ndi mitundu ingapo, ndipo kuti mumvetsetse bwino kuti insulini ndiyabwino, ndikofunikira kulingalira mwatsatanetsatane mitundu yake ndi madigiri akuwonekera kwa thupi.

Zambiri

Insulin imagwira ntchito yofunika kwambiri m'thupi. Tili othokoza kuti maselo ndi minyewa ya ziwalo zamkati zimalandira mphamvu, chifukwa chomwe zimatha kugwira bwino ntchito ndikugwira ntchito yawo. Zikondwererozi zimaphatikizidwanso pakupanga insulin.

Ndipo ndikukula kwa matenda aliwonse omwe amachititsa kuti maselo ake awonongeke, amayamba chifukwa chakuchepa kwa kapangidwe ka timadzi tambiri timeneti. Zotsatira zake, shuga yemwe amalowa mthupi mwachindunji ndi chakudya sakhala m'magazi ndipo amakhala m'magazi momwe amapangira michere.

Ndipo chimayamba matenda a shuga.

Koma ndi zamitundu iwiri - yoyamba ndi yachiwiri. Ndipo ngati ndi matenda a shuga 1 pakakhala kuperewera kwina kapena kokwanira, ndiye kuti ndi matenda amtundu wa 2, vuto losiyanako pang'ono limachitika mthupi.

Zikondazo zimapitilizabe kupanga insulini, koma maselo amthupi amasiya kuzimva, chifukwa amasiya kuyamwa mphamvu zonse.

Potengera maziko awa, shuga samatha mpaka kumapeto komanso amakhazikika m'magazi.

Koma nthawi zina, ngakhale ndi matenda a shuga a mtundu wachiwiri, kutsatira zakudya sikumabweretsa zotsatira zabwino, chifukwa pancreas "imatopa" komanso amasiya kutulutsa timadzi tambiri tambiri. Pankhaniyi, kukonzekera kwa insulin kumagwiritsidwanso ntchito.

Amapezeka m'mitundu iwiri - mapiritsi ndi mayankho a intradermal management (jekeseni).

Ndipo polankhula za zomwe zili bwino, insulini kapena mapiritsi, ziyenera kudziwidwa kuti majekeseni ali ndi chiwonetsero chachikulu kwambiri mthupi, chifukwa zomwe zimagwira zimathandizira kulowa mu kayendedwe kazinthu ndikuyamba kuchita. Ndipo mapiritsi a insulin amayambira kulowa m'mimba, pambuyo pake amapezeka kuti amapanga timitsempha ndipo kenako amalowa m'magazi.

Kugwiritsira ntchito kukonzekera kwa insulin kuyenera kuchitika pokhapokha atakambilana ndi katswiri

Koma izi sizitanthauza kuti insulini m'mapiritsi ilibe ntchito zochepa. Zimathandizanso kuchepetsa magazi a m'magazi komanso zimathandizira kukonza zomwe zimachitika wodwalayo. Komabe, chifukwa chochepa pang'onopang'ono, sioyenera kugwiritsidwa ntchito mwadzidzidzi, mwachitsanzo, poyambika kwa hyperglycemic coma.

Mwachidule kuchita insulin

Insulin yochepa-yankho ndi yankho la crystalline zinc-insulin. Chowonjezera chawo ndichakuti amachita mthupi la munthu mwachangu kwambiri kuposa mitundu ina ya kukonzekera kwa insulin. Koma nthawi yomweyo, nthawi yawo yochita umatha mwachangu momwe zimayambira.

Mankhwalawa amalowetsedwa subcutaneous theka la ola musanadye njira ziwiri - intracutaneous kapena intramuscular. Kuchuluka kwa kugwiritsidwa ntchito kwawo kumatheka pambuyo pa maola 2-3 mutatha kutsata. Monga lamulo, mankhwala osokoneza bongo omwe amagwiritsidwa ntchito posachedwa amagwiritsidwa ntchito limodzi ndi mitundu ina ya insulin.

Insulin Yapakatikati

Mankhwalawa amasungunuka pang'ono pang'onopang'ono m'matumbo amkati ndipo amatengeka ndi kayendedwe kazinthu, chifukwa chomwe zimakhala ndi mphamvu kwambiri kuposa ma insulin omwe amangokhala osachita kanthu.

Nthawi zambiri pochita zamankhwala, insulin NPH kapena tepi ya insulin imagwiritsidwa ntchito.

Yoyamba ndi yankho la makristasi a zinc-insulin ndi protamine, ndipo chachiwiri ndi chosakanikirana chomwe chimakhala ndi kristalo ndi amorphous zinc-insulin.

Limagwirira zake zochita insulin

Insulini yapakatikati ndiyachinyama ndi anthu. Ali ndi ma pharmacokinetics osiyanasiyana. Kusiyana pakati pawo ndikuti insulin yakuchokera kwa anthu imakhala ndi hydrophobicity yayikulu kwambiri ndipo imagwirizana bwino ndi protamine ndi zinc.

Pofuna kupewa zoyipa zomwe zimagwiritsidwa ntchito ndi insulin ya nthawi yayitali, iyenera kugwiritsidwa ntchito mosamalitsa malinga ndi chiwembu - 1 kapena 2 kawiri pa tsiku.

Ndipo monga tanenera pamwambapa, mankhwalawa nthawi zambiri amaphatikizidwa ndi ma insulin achidule.

Izi ndichifukwa choti kuphatikiza kwawo kumapangitsa kuti mapuloteni azisakanikirana bwino ndi zinc, chifukwa chomwe kunyowa kwa insulin yocheperako kumachepetsedwa.

Kuchita insulini kwa nthawi yayitali

Gulu la mankhwala omwe ali ndi mankhwala ali ndi kuyamwa pang'ono pang'onopang'ono m'magazi, motero amachitapo kanthu kwa nthawi yayitali.

Izi amachititsa kuti magazi azikhala ndi shuga tsiku lililonse. Amayambitsidwa 1-2 pa tsiku, mlingo wake umasankhidwa payekhapayekha.

Zitha kuphatikizidwa ndi insulin zazifupi komanso zapakati.

Njira zogwiritsira ntchito

Mtundu wa insulini yotani ndi kuchuluka kwake, ndi dokotala yekhayo amene amasankha, potengera zomwe wodwalayo ali nazo, kuchuluka kwa kuchuluka kwa matenda komanso kupezeka kwa zovuta ndi matenda ena. Kuti mudziwe kuchuluka kwake kwa insulin, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi pambuyo pa kayendetsedwe kake.

Malo abwino kwambiri a insulin ndi khola lam'madzi pamimba.

Ponena za mahomoni omwe amayenera kupangidwa ndi kapamba, kuchuluka kwake kuyenera kukhala pafupifupi ED patsiku. Zomwezo zimafunikira kwa odwala matenda ashuga. Ngati ali ndi vuto losakwanira pancreatic, ndiye kuti kuchuluka kwa insulin kumatha kufika pa ED patsiku.Nthawi yomweyo, 2/3 yake iyenera kugwiritsidwa ntchito m'mawa, ndi nthawi yonse yamadzulo, chakudya chisanachitike.

Malangizo abwino kwambiri omwera mankhwalawa amadziwika kuti amaphatikiza insulin yochepa komanso yapakati. Mwachilengedwe, njira yogwiritsira ntchito mankhwalawa imadaliranso izi. Nthawi zambiri pamachitidwe otere, njira zotsatirazi zimagwiritsidwa ntchito:

kugwiritsa ntchito nthawi imodzimodziyo insulini yochepa komanso yaying'ono pamimba yopanda kanthu m'mawa asanadye chakudya cham'mawa, ndipo madzulo kumangokhala mankhwala osakhalitsa (musanadye chakudya chamadzulo) amawayika ndikatha maola ochepa - ochita masewera olimbitsa thupi,
Mankhwala okhala ndi kanthu kwakanthawi amagwiritsidwa ntchito tsiku lonse (mpaka kanayi pa tsiku), ndipo asanagone, jakisoni wa mankhwala a nthawi yayitali kapena yayifupi amatumizidwa,
pa 5-6 a.m. insulin ya sing'anga kapena nthawi yayitali imayendetsedwa, ndipo musanadye chakudya cham'mawa komanso chakudya chilichonse chotsatira - chochepa.

Ngati dotolo adapereka mankhwala amodzi kwa wodwala, ndiye kuti ayenera kugwiritsidwa ntchito mosamalitsa. Chifukwa, mwachitsanzo, insulin yochepa imayikidwa katatu patsiku masana (omaliza asanagone), pakati - kawiri pa tsiku.

Zotsatira zoyipa

Mankhwala osankhidwa moyenera ndi mlingo wake pafupifupi sizipangitsa kukhalapo kwa mavuto. Komabe, pali zochitika zina pamene insulin yokha siyili yoyenera kwa munthu, ndipo pamenepa mavuto ena angabuke.

Kupezeka kwa zotsatira zoyipa mukamagwiritsa ntchito insulin nthawi zambiri kumayenderana ndi kupezeka kwa mankhwala osokoneza bongo, kosayenera pakukonzekera kapena kusungidwa kwa mankhwalawa

Nthawi zambiri, anthu amasintha okha pawokha, ndikuwonjezera kapena kuchepetsa kuchuluka kwa insulini, zomwe zimapangitsa kuti ziwonetsero zomwe sizingachitike.

Kuchulukitsa kapena kutsika kwa mankhwalawa kumabweretsa kusinthasintha kwa shuga wamagazi mbali imodzi kapena imodzi, mwakutero kukulitsa kukula kwa hypoglycemic kapena hyperglycemic coma, yomwe imatha kubweretsa mwadzidzidzi.

Vuto lina lomwe odwala matenda ashuga nthawi zambiri amakumana nalo ndi zovuta zomwe zimachitika, zomwe zimachitika kawirikawiri chifukwa cha insulini yoyambira nyama.

Zizindikiro zawo zoyambirira ndizowoneka ngati kuyabwa ndi kuwotcha pamalo a jekeseni, komanso khungu la khungu ndi kutupa kwawo.

Zikakhala kuti zizindikiro ngati izi zikuwoneka, muyenera kufunsa chithandizo kuchokera kwa dokotala ndikusintha kuti mupeze insulin kuchokera kwa anthu, koma nthawi yomweyo muchepetseni.

Atrophy ya adipose minofu ndi vuto lofanananso kwa odwala matenda ashuga ndi kugwiritsa ntchito insulin nthawi yayitali. Izi zimachitika chifukwa chakuwongolera pafupipafupi kwa insulin pamalo amodzi. Izi sizimayambitsa mavuto ambiri kuumoyo, koma malo omwe jakisoni amayenera kusinthidwa, popeza mulingo wawo wolowetsa umakhala wolakwika.

Pogwiritsa ntchito insulin kwa nthawi yayitali, mankhwala osokoneza bongo amathanso kuchitika, omwe amawonetsedwa ndi kufooka kwa mutu, kupweteka mutu, kutsika kwa magazi, ndi zina zambiri. Pankhani ya mankhwala osokoneza bongo, ndikofunikira kufunsa dokotala nthawi yomweyo.

Mwachidule

Pansipa tikambirana mndandanda wa mankhwala omwe amapezeka ndi insulin omwe amagwiritsidwa ntchito nthawi zambiri pochiza matenda a shuga. Amaperekedwa pazidziwitso zokhazokha, simungathe kuzigwiritsa ntchito popanda chidziwitso cha dokotala mulimonse. Kuti ndalamazo zigwire bwino ntchito, ziyenera kusankhidwa mokhazikika!

Yabwino kwambiri yochezera pang'ono insulin. Muli insulin yaumunthu. Mosiyana ndi mankhwala ena onse, imayamba kuchita zinthu mwachangu kwambiri. Pambuyo pakugwiritsidwa ntchito, kuchepa kwa shuga m'magazi kumawonedwa pambuyo pa mphindi 15 ndipo kumakhalabe m'malo ena owonekera kwa maola ena atatu.

Humalog mu mawonekedwe a cholembera

Zizindikiro zazikulu pakugwiritsira ntchito mankhwalawa ndi izi:

shuga wodalira matenda a shuga
Matupi awo sagwirizana ndi insulin ina.
hyperglycemia
kukana kugwiritsa ntchito mankhwala ochepetsa shuga,
shuga wodalira insulin asanafike opaleshoni.

Mlingo wa mankhwalawa amasankhidwa payekha. Kumayambiriro kwake kumatha kuchitika pang'onopang'ono komanso m'njira zamitsempha. Komabe, kupewa mavuto kunyumba, tikulimbikitsidwa kupatsana mankhwala pokhapokha musanadye.

Mankhwala osokoneza bongo amakono, kuphatikiza Humalog, ali ndi zotsatira zoyipa. Ndipo pankhaniyi, mwa odwala ndi momwe amagwiritsidwira, mankhwalawa nthawi zambiri amapezeka, kuchepa kwa masomphenya, matupi ndi milomo.

Kuti mankhwala azigwira ntchito pakapita nthawi, ayenera kusungidwa bwino.

Ndipo izi ziyenera kuchitidwa mufiriji, koma siziyenera kuloledwa kuziziritsa, chifukwa pamenepa malonda amataya katundu wake wochiritsa.

Insuman Rapid

Mankhwala enanso okhudzana ndi ma insulin osankha mwachidule kutengera timadzi ta munthu. Mphamvu ya mankhwalawa imafika pachimake patatha mphindi 30 kuchokera pakukonzekera ndipo imapereka chithandizo chokwanira kwa thupi kwa maola 7.

Insuman Rapid ya subcutaneous makonzedwe

Chochita chimagwiritsidwa ntchito mphindi 20 musanadye chilichonse. Pankhaniyi, tsamba la jakisoni limasintha nthawi iliyonse. Simungapereke jakisoni m'malo awiri. Ndikofunikira kuti musinthe nthawi zonse. Mwachitsanzo, nthawi yoyamba imachitika m'chigawo chamapewa, chachiwiri m'mimba, chachitatu pamphaka, etc. Izi zimapewe kuwonongeka kwa minofu ya adipose, yomwe wothandizirayo amakwiya.

Biosulin N

Mankhwala osokoneza bongo omwe amalimbikitsa chinsinsi cha kapamba. Ili ndi mahomoni ofanana ndi anthu, omwe amalekeredwa mosavuta ndi odwala ambiri ndipo samasangalatsa kwambiri mawonekedwe. Zochita za mankhwalawa zimachitika ola limodzi pambuyo pakukonzekera ndikufika pachimake patatha maola 4-5 jekeseni. Imakhalabe yothandiza kwa maola ambiri.

Zingachitike kuti munthu atalowetsa mankhwalawa ndi mankhwala ofanana, ndiye kuti akhoza kudwala hypoglycemia. Zinthu monga kupsinjika kwambiri kapena kudya zakudya zodumphadwala kumatha kuyambitsa kuwonekera kwake atagwiritsidwa ntchito ndi Biosulin N. Chifukwa chake, ndikofunikira kwambiri poigwiritsa ntchito kuyeza miyezo ya shuga ya magazi nthawi zonse.

Gensulin N

Zimatanthauzanso ma insulin apakati omwe amawonjezera kupanga kwa ma pancreatic. Mankhwalawa amaperekedwa mosavuta. Kugwiranso ntchito kwake kumapezekanso ola limodzi pambuyo pa kukhazikitsa ndipo kumatenga maola. Nthawi zambiri zimayambitsa kupezeka kwa zotsatira zoyipa ndipo zimatha kuphatikizidwa mosavuta ndi ma insulin omwe amakhala nthawi yayitali kapena osakhalitsa.

Zosiyanasiyana zamankhwala Gensulin

Insulin yayitali, yomwe imagwiritsidwa ntchito kuwonjezera pancreatic insulin secretion. Zovomerezeka kwa maola. Mphamvu yake yokwanira imatheka patadutsa maola awiri pambuyo pa makonzedwe. Imaperekedwa nthawi imodzi patsiku. Mankhwalawa ali ndi mawonekedwe ake, omwe ali ndi mayina otsatirawa: Levemir Penfill ndi Levemir Flexpen.

Mankhwala ena omwe akhala akuchita kwa nthawi yayitali omwe amagwiritsidwa ntchito mwachangu kuchepetsa shuga m'magazi a shuga.

Kuchita kwake kumakwaniritsidwa patatha maola 5 mutatha kuyang'anira ndipo kumapitilira tsiku lonse.

Makhalidwe a mankhwalawa, omwe amafotokozedwa patsamba lovomerezeka la wopanga, akuwonetsa kuti mankhwalawa, mosiyana ndi kukonzekera kwina kwa insulin, amatha kugwiritsidwa ntchito ngakhale mwa ana opitirira zaka 2.

Pali zokonzekera zambiri za insulin. Ndipo kunena kuti ndi yabwino kwambiri ndizovuta kwambiri. Tiyenera kumvetsetsa kuti chamoyo chilichonse chimakhala ndi zake ndipo m'njira zake zimagwirizana ndi mankhwala ena ake. Chifukwa chake, kusankha kwa insulin kukonzekera kuyenera kuchitika payekha komanso kokha ndi dokotala.

Insulin analogues ndi mafotokozedwe awo

Insulin ndi mahomoni omwe amapangidwa mwachilengedwe m'thupi. Kasitomala amapanga insulin yambiri tsiku lililonse pakachuluka shuga. Magazi a shuga m'magazi nthawi zambiri amakwera atatha kudya. Thupi lathu, lomwe limapukusa chakudya, "limasinthira" kukhala shuga, lomwe nthawi zina limatchedwa glucose.

Insulin m'thupi lanu imagwira ntchito ngati kiyi yomwe imatsegula maselo kuti ipereke shuga. Selo lililonse mthupi limakhala ndi chotchinga kukhoma lake, lomwe limatchedwa receptor. Insulin imalowa mu lokoyi ngati kiyi, kulola shuga kulowa m'maselo.

Thupi likamalephera kupanga insulin yokwanira, shuga m'magazi limatsekeka m'maselo. Shuga m'magazi atatsekedwa m'maselo, amakhala m'magazi.

Kodi shuga yowonjezerayi imapangitsa anthu kumva zizindikiro za matenda ashuga, monga kutopa kwambiri kapena ludzu losatha, nthawi zambiri mokwanira kuti anthu otere adadzifunsa, akhoza kulowetsa insulin ndi chiyani?

Mitundu ya Insulin Therapy

M'badwo woyamba wa insulin yokumba, wopangidwa mu 1980s. Posachedwa, mapangidwe a insulin. Amagwira ntchito munjira zosiyanasiyana. Mitundu ina ya ma insulin analogi imachita zinthu mwachangu kuposa ena.

Mtundu wa insulin womwe wapangidwa posachedwapa umatchedwa "insulin analogue". Analogue ya insulini imapezeka m'mitundu iyi:

Kuchita motalika. Mtunduwu umachedwa. Amagwira ntchito nthawi yayitali kuti achepetse shuga pakati pa chakudya ndi kugona. Insulin yomwe imatenga nthawi yayitali imatengedwa kamodzi kapena kawiri patsiku, nthawi yomweyo (asanagone), kuti apatse insulin nthawi ya maola 24. Mankhwalawa amathandizidwa makamaka pochizira matenda a shuga a 2.
Kuchita zinthu mwachangu ndi insulin. Mtunduwu uyenera kumwedwa nthawi yochepa musanadye. Zimagwira ntchito mwachangu kuti ziwongolere msanga msanga wamagazi pambuyo podya. Analogue yofulumira ya insulin imatsanzira kapangidwe ka thupi ka insulin ndi chakudya.
Okonzeka okonzeka. Kwa odwala ena, insulin yothamanga komanso yokhala nthawi yayitali imasakanikirana.

Mtundu uliwonse wa insulini umathandiza kuti shuga asayang'anitsidwe. Wodwala aliyense amafunikira insulin mosiyana. Ndipo zofuna za insulin za munthu aliyense zimatha kusintha pakapita nthawi.

Nchiyani chingalowe m'malo mwa insulin?

Ma enamel a insulin adapangidwa kuti azilingalira kutulutsa kwa insulin mthupi la munthu.

Kodi mukudziwa kuti mndandanda wa amino acid wokhudzana ndi insulin ya nyama ungafanane ndi insulin ya anthu? Porcine insulin imangosintha amino acid kuchokera pakusiyana kwa anthu, ndipo insulin ya bovine imatengera amino acid atatu.

Insulin yochokera ku mitundu ina ya nsomba imatha kugwiranso ntchito mwa anthu. Mwachitsanzo, ku Japan, insulin ya shark imagwiritsidwa ntchito kwambiri polemba biulin ya insulin ya anthu.

Insulin glulisin

Glulisin ndi analogue yatsopano yothamanga kwambiri ya insulini yovomerezeka kuti igwiritsidwe ntchito nthawi zonse ndi syringe - cholembera kapena pampu ya insulin. Ma syringe otayika amatha kugwiritsidwanso ntchito pamtunduwu. Zolemba phukusiyo akuti mankhwalawo amasiyana ndi insulin wamba yamunthu pakanthawi koyamba komanso nthawi yayifupi.

Insulin

Kuchita mwachangu insulin analogue.

Adapangidwa pogwiritsa ntchito ukadaulo wama DNA womwe umapangidwanso kuti B28 amino acid, yomwe nthawi zambiri imalowetsedwa ndi zotsalira za aspartic acid, idayikidwa motsatana mu yisiti, yisiti genome ndikupanga analogi ya insulin yomwe panthawiyo idachokera ku bioreactor. Ma analogue amenewa amathandizanso kupanga mapangidwe a hexamers kuti apange ntchito ya insulin mwachangu. Amapangidwira kuti azigwiritsa ntchito pamapampu a PPII (zida zoperekera jakisoni wa subcutaneous).

Insulin glargin

Zinapangidwa ndikusintha ma amino acid atatu. Zida zochepa zowerengeka zimasunthira mu yankho la magazi, ndipo insulin ya basal imasungidwa mpaka maola 24.

Madzi am'magazi atalowa mkati mwa alkaline sing'anga, Glargin imatulutsa msanga ndipo kenako imasokonekera, pang'onopang'ono kuonetsetsa kuti insulini imalowa m'magazi.

Kukhazikika kwa insulin ya insulin yomwe ili pang'onopang'ono kuposa NPH ya insulin yaumunthu.

Chifukwa chake, tidazindikira momwe insulini ingasinthidwe, komabe, poyerekeza ndi insulin yaumunthu, ma analog insulins angayambitse zotsatira zoyipa, monga kutaya chikumbumtima, ulesi ndi kulemera, zomwe sizingawoneke tikamamwa insulin.

Insulin pochiza matenda a shuga

Tsiku labwino kwa onse! Pomaliza, manja anga adafika pa insulin ya mahomoni. Ayi, lero sindilankhula za mahomoni amunthu komanso chifukwa chake amafunikira, koma ndinena za kukonzekera kwa insulin pochiza anthu omwe ali ndi matenda ashuga.

M'mbuyomu, ndidalemba zambiri za mapiritsi okhala ndi mapiritsi ochepetsa shuga, mwachitsanzo, nkhani ya "Dongosolo Lolimbikitsa Pachithandizo Cha Matenda A shuga Atsopano" onena za Januvia, Galvus, Baetu ndi Viktoza, komanso nkhani ya "Medication Metformin - Malangizo Ogwiritsira Ntchito" - za Siofor, Glucofage ndi ma fanizo ena a metformin.

Chidziwitso munkhaniyi chithandizadi anthu onse omwe ali ndi matenda ashuga a 1 komanso anthu omwe ali ndi matenda a shuga a mtundu wa 2 pa insulin. Ndikuuzani mwachidule za mbiri ya insulin.

Insulin - pancreatic mahomoni, omwe aphunzira posachedwapa kugwiritsa ntchito ngati mankhwala pochiza matenda ashuga.

Kuti muthane ndi magwiridwe antchito a kapamba, jakisoni wa insulin amagwiritsidwa ntchito, ndipo pali mitundu ingapo ya ma insulin ndipo iliyonse imakhala ndi gawo lake, koma zowonjezera pambuyo pake.

Zolemba pazaka yasayansi pamutu wakuti "Kugwiritsa ntchito mankhwala a insulin pothana ndi matenda ashuga"

KULAPA KWA ZINSINSI ZOFUNIKIRA PAKATI PA ZINSINSI ZA DIABETES MELLITUS

E.B. Bashnina, N.V. Vorokhobina, M.M. Sharipova

St. Petersburg Medical Academy of Postgraduate Education, Russia

MALANGIZO OTHANDIZA MU CHIPANGIZO CHA DIABETES MELLITUS

E.B. Bashnina, N.V. Vorohobina, M.M. Sharipova

St. Petersburg Medical Academy of Postgraduate Study, Russia

Kukhazikitsidwa kwa ma insulin analogos - m'badwo wachitatu wa kukonzekera kwatsopano kwa insulin - muzochita zamankhwala akhala akutukuka kwambiri pothandizira mankhwalawa a shuga mellitus m'zaka zaposachedwa. Pakadali pano komanso kwa nthawi yayitali insulin analog ikugwiritsidwa ntchito bwino mu matenda ashuga, ndikupanga zotsatira zabwino kwambiri poyerekeza ndi kugwiritsa ntchito insulin yaumunthu. Pharmacodynamic ndi pharmacokinetic machitidwe a insulin analog amapereka mokwanira kwathunthu pazotsatira za insulin ya amkati, kuphatikizapo basal insulini komanso kuyankha kwa insulin pakulowetsa chakudya, kukwaniritsa kuyamwa kokhutiritsa kwa glycemic kwa odwala omwe ali ndi mtundu 1 ndi 2 matenda osokoneza bongo komanso kusintha matendawo nthendayo. Kuwunika kwa kafukufuku komwe kwaperekedwa posachedwa kuti kuwunikidwe kukuwonetsa kukhathamira ndi ziyembekezo zakugwiritsidwa ntchito kwa angency-and extension-insulin analog. Mawu osakira: matenda a shuga, insulin, insulin.

Kuyambira 1921 - nthawi yopeza komanso kugwiritsa ntchito insulin koyamba - kapangidwe kazokonzekera kake kwasintha kwambiri. Kukonzekera kwa insulin kwamakono, kwa nthawi yayitali komanso pakati, komanso kuyendetsedwa m'njira zosiyanasiyana, ngakhale kuli kofunikira kwambiri kuyeretsa komanso kusasunthika, sikungafanane ndi mbiri ya tsiku ndi tsiku ya insulin m'magazi aanthu wathanzi, kutalika kwake kwakakhazikika mutatha kudya, komanso kubisala kwatsopano.

Chimodzi mwazomwe chapita patsogolo pakukonzanso insulini kwakhala kusintha kwa zochita zolimba kwambiri za basulin. Kupita patsogolo kwaposachedwa kwaposachedwa kwa ukadaulo wa DNA komweko kwapangitsa kusintha kwa molekyulu ya insulin ya anthu yomwe yasintha ma pharmacokinetics mothandizidwa ndi ma subulaneous oyang'anira ma insulin 1-8 awa.

Kwazaka 20 zapitazi, oposa 1 miliyoni a insulin analogue, koma 20 okha ndi omwe adayesedwa pachipatala. Mpaka pano, 5 analogues ya ultrashort action insulin adawerengera kuchokera kwa iwo - В28Ьу8В29Рго (insulin lyspro), В9А8рВ2701и, ВУУ, 1

Sulin Glargine (NOE 901) ndi insulin detemir (YoooBo1, NN304) 9, 10.

Mphamvu ya matenda a insulin analogues imatsimikiziridwa ndi izi:

- kumangiriza kwa insulin zolandilira mu minofu yeniyeni,

- kuchuluka kwa zochita za metabolic ndi matogenic,

- zamankhwala olimbitsa thupi komanso thupi,

Zochita zamankhwala zakhala zikuphatikizapo kufananiza ndi ultrashort insulin - insulin lispro (humalog), insulini aspart (novorapid), insulin glulisin (apidra). Popanga izi za insulin, asayansi adatsata izi:

- kumawonjezera kuchuluka kwa mayamwidwe ndi kuyambika kwa insulin, ndikupanga mawonekedwe othandizira kuperekera mankhwalawa musanadye komanso kuchepetsa chiopsezo cha postprandial hyperglycemia,

- kuchepetsa kutalika kwa insulin kanthu ndi imathandizira kuchotsa kwa magazi seramu, potero kuchepetsa mwayi kukhala postabsorption hypoglycemia mwa odwala matenda a shuga.

Kusintha kwa masanjidwe achilengedwe a amino acid mu kapangidwe ka molekyulu yopanga ma cell insulin mwa kusintha kwa mankhwala, chifukwa cha zomwe apeza muukadaulo waukadaulo wa DNA, kunathandizira kuwonjezeka kwa kusiyanitsidwa kwa hexamers, komwe, kunawonjezera kuchuluka kwa mayamwa ndi kuyamba kwa zochitika zazifupi za insulin 5, 11, 12.

Kugwira bwino ntchito kwa ma insulin anthawi yochepa kwambiri kwatsimikiziridwa m'maphunziro ambiri, adayesedwa m'mazaka onse omwe ali ndi matenda amtundu wa 2 komanso mtundu wa 2, ngati mankhwala omwe amapangira jekeseni wa subcutaneous komanso kulowetsedwa kosalekeza kwa insulin - CSII (Continuous Subcutaneous Insulin infusion) kugwiritsa ntchito pampu ya insulin. Zinawonetsedwa kuti ma analogu amenewa ali ndi katundu wa pharmacodynamic komanso pharmacokinetic, ngakhale kuti kusiyana kochenjera kumawonekera pakupenda mayeso ena azachipatala.

Pambuyo pothandizidwa ndi subcutaneous, ma insulin anthawi yochepa amakhala otengeka ndi plasma mwachangu kuposa majini opanga majini, amakhala ndi nthawi yofupikirako. Kutalika kwakukulu kwa humalogue, novorapide, ndi glulisin komwe kumayendetsedwa mosadukiza kumakhala kokwezeka kwambiri, ndipo kuchuluka kwa ndende kumafikiridwa kale kwambiri poyerekeza ndi ma insulins aanthu, kubwereranso kosavuta kwa ndende ya mankhwalawo pamlingo woyambira kumadziwika. Kuphatikiza apo, kuchuluka kwa mayamwidwe ndi mphamvu ya hypoglycemic ya analogues sizimayimira pawebusayiti yawo. Mankhwala amalimbikitsidwa kuti aziperekedweratu pakudya kapena pambuyo pake 13-18.

Zakhazikitsidwa kuti ma-insulin anthawi yocheperako-yochepa amachepetsa kukwera kwa glucose bwino kwambiri kuposa ma insulins aumunthu, popanda chiopsezo chokhala ndi postabsorption hypoglycemia. Chiwerengero cha zochitika zosakhutiritsa za postprandial glycemia mukamagwiritsa ntchito analogues imachepetsedwa ndi 21-57% 12, 19-21.

Kutsika kwa kuchuluka kwa postprandial kwa glycemia kunawonedwa m'maphunziro azachipatala pogwiritsa ntchito humalog, Novorapid ndi glulisin m'mapampu a insulin. Mankhwalawa adakhala othandiza komanso otetezeka akagwiritsidwa ntchito mu SSII 11, 12, 22. Mwachitsanzo, poyerekeza humalogue, Novorapid ndi insulin ya anthu odwala omwe amathandizidwa ndi analogue, panali nthawi zosavomerezeka (kuphulika kwa pampu, ndi zina zambiri) kuposa gulu odwala kulandira insulin yaumunthu.

Kugwiritsidwa ntchito kwa ma insulin anthawi yocheperako kumachepetsa kuchuluka kwa zochitika za hypoglycemic, kuphatikiza usiku ndi hypoglycemia yayikulu.

kemia, imakhala yokhazikika pamatenda a glycemia masana komanso njira yokhazikika yodwala 4, 12. Mwayi uwu ukuwonetsedwa pakufufuza komwe kunaposa odwala 1000 omwe ali ndi matenda amtundu wa 1 ndi mtundu wa 2, omwe adawonetsa kuti zochitika za hypoglycemia panthawi ya mankhwala a Lyspro insulin anali 12% nthawi zambiri. Zotsatira za mayeso akulu azachipatala okwana 8 zikuwonetsa kuti kuchuluka kwa matenda oopsa a hypoglycemia kwa odwala omwe ali ndi matenda amtundu wa 1 amatsika pafupifupi 30% mukamagwiritsa ntchito insulin lyspro. Mankhwalawa amathandizira odwala omwe ali ndi matenda a shuga 1 amtundu wokhazikika, chiwopsezo chotenga matenda obwera chifukwa cha usiku amachepetsa ndi 72% poyerekeza ndi mankhwala a insulin. Chizindikiro ichi chinakwaniritsidwa nthawi imodzi ndikusunga kwambiri glycemic control.

Zotsatira za mayesero ambiri azachipatala zawonetsera mwayi wa mitundu yonse itatu ya ultrashort poyerekeza ndi glycated hemoglobin (HL1e) poyerekeza ndi ma insulin opangidwa ndi chibadwa cha anthu.

Zambiri kuchokera pagulu lofufuza zamayeso azachipatala pazakuwongolera ndi zovuta za matenda ashuga (BSST) zikuwonetsa kuti kuchepa kwa HL1c kuchokera pa 8 mpaka 7.2% kumachepetsa chiopsezo cha zovuta za microvascular ndi 25-53%, kutengera mtundu wa zovuta.

Kafukufuku woyamba komanso wokhutiritsa kwambiri wakhungu wofufumitsa kawiri-kawiri kuyerekezera lyspro ndi insulin ya anthu ndi SBP adawonetsa kuti kugwiritsidwa ntchito kwa analogue kumayendetsedwa ndi glucose wotsika kwambiri wamagazi atatha kudya (ola limodzi pambuyo pa chakudya chilichonse, shuga wamagazi anali ochepa kuposa kuposa 1 mmol / L), malo otsika a HL1C (8.35 motsutsana 9.79%) okhala ndi pafupipafupi pamikhalidwe ya hypoglycemic. Izi zidatsimikiziridwa ndi kafukufuku wotsatira. Pakafukufuku wogwiritsa ntchito njira zingapo za jakisoni mwa odwala 66 omwe ali ndi matenda a shuga 1, kuchuluka kwa HL1c atasamutsa odwala kuchokera ku insulin yaumunthu nthawi zonse kupita ku insulin lispro ndikusintha mawonekedwe a insal insulin yotsika kuchokera ku 8,8 mpaka 8%. Pamapeto pa kafukufukuyu, kuchuluka kwa HL1c mwa odwala omwe amalandira insulin lispro anali pafupifupi 0,34% peresenti kuposa omwe amalandila insulin nthawi zonse.

Odwala omwe ali ndi matenda a shuga a mtundu 2 omwe adalandira kukonzekera kwa sulfonylurea ndi kukhazikitsidwa kwa lys-pro insulin (0.08-0.15 U / kg), kusintha kwofunikira mu boma la metabolism ya carbohydrate kunadziwika kale chakudya chilichonse. Kukhathamiritsa kwamankhwala kumeneku kunathandizira kuti kusala kudya komanso glycemia atatha kudya. Mlingo wa NL1s kwa miyezi 4 unatsika kuchoka pa 9 mpaka 7.1%.

Kuchepetsa kwa HbA1c komwe kumachitika ndi inshuwaransi ya lyspro poyerekeza ndi insulin yaumunthu kumachepetsa chiopsezo cha zovuta zakumapeto ndi 15-25%.

Maphunziro awiri akuluakulu a nthawi yayitali adawona kusintha kwa glycated hemoglobin mukamagwiritsa ntchito insulini insulin, poganizira kusintha kwa jekeseni wa basal poyerekeza ndi insulin ya anthu ndi 0.12% ndi 0.16%, motero. Makhalidwe opindulitsa a HbA1c asungidwa kosatha kwa zaka zopitilira zitatu pakufufuzidwa kwakanthawi kwamankhwala kumeneku kwa odwala opitilira 750.

Kafukufuku wokhudza kugwiritsa ntchito mphamvu kwa ma insulin anthawi yayitali-yochepa pakakhala matenda a shuga. Lyspro insulin ndiye wophunziridwa kwambiri pankhaniyi ya matenda ashuga. Kafukufuku wina wasonyeza kuti insulin lyspro imathandizira kuyendetsa bwino matenda a postprandial glycemia, omwe amachepetsa kufunikira kwa katemera wa amisala amkati mwa amayi omwe ali ndi matenda ashuga. Popeza kugwiritsa ntchito analogue kameneka kumakupatsani mwayi woti mukwaniritse gawo lofunira la postprandial glycemia ndikofunikira pa chithandizo cha amayi apakati omwe ali ndi matenda ashuga, chifukwa kuchuluka kwambiri kwa postprandial glycemia ndi chimodzi mwazomwe zimapangitsa macrosomia a fetus.

Kafukufuku wachitika mu 60s. Zaka makumi awiri zapitazo kuti aphunzire za insulin kuti ilowe mu chotchinga cha hematoplacental, adatsimikizira kuti mamolekyulu a insulin samalowa m'magazi a mwana wosabadwayo. Pambuyo pake, insulin (1-5%) inapezeka pang'ono mu umbilical artery ndipo inafika kuzungulira kwa mwana wosabadwayo. Kafukufuku waposachedwa wa vitro adawonetsa kuti lyspro insulin siimadutsa chotchinga chamagazi ndi mitundu yayikulu ya insulin. Khalidwe la lyspro insulin ndilofunika kwambiri, ngakhale kuti limafunikira chitsimikiziro chowonjezereka, popeza pali chiopsezo chotenga neonatal hyperinsulinemia ndi hypoglycemia ngati insulin ilowa m'magazi a mwana wosabadwayo. M'maphunziro a nyama, zidadziwika kuti hypoglycemia ikhoza kukhala chifukwa cha kusintha kwa teratogenic mu fetus.

Odwala omwe ali ndi matenda osachiritsika, moyo ndiwofunika komanso kudziyimira pawokha pakuwunika momwe mankhwalawa alili. Pamapeto pa mayeso azachipatala, odwala ambiri amakonda kupitiliza kulandira chithandizo ndi ma insulin anthawi yochepa. Chifukwa chachikulu chokonda izi chinali kuchepa kwa nthawi pakati pa jakisoni ndi zakudya. Kuphatikiza apo, kugwiritsa ntchito

kukonzekera kwatsopano kwa insulin kumalola odwala kuchepetsa kuchuluka kwa zakudya zapakatikati ndipo kumachepetsa chiopsezo cha mikhalidwe ya hypoglycemic.

Malinga ndi zochitika za mitogenic, ma insulins lyspro, aspart ndi glulisin samasiyana ndi insulin yosavuta yaumunthu, yomwe imawonetsa mwayi wawo wogwiritsa ntchito nthawi yayitali komanso wotetezeka muzochita zamankhwala 11, 12.

Zinapezeka kuti insulin glulisin ili ndi gawo lapadera lothandizira gawo lapansi la insulin receptor-2 (SIR-2, kapena IRS-2), lomwe silimangotenga nawo gawo pama insulin signaling, i.e. pokonzanso njira zopatsirana chiberekero cha zochita, komanso imathandiza kwambiri pakukula ndi kupulumuka kwa ma cell a kapamba. M'mayeso azachipatala, chitsimikiziro chowonjezereka cha phindu la glulisin 29, 30 chikuyembekezeredwa.

Zochita mwachidule za insulin analogi amagwiritsidwanso ntchito pazosakaniza zopangidwa kale. Zomwe zimatchedwa biphasic insulin kukonzekera kumapangidwa ndikusakaniza anulin yothamanga kwambiri ndi insulin. Gawo lodziwika bwino lomwe limakhala ndi insulini ya biphasic limabweretsa kuyambitsa mwachangu komanso kofulumira kuchitapo kanthu ndikuchotsedwa mwachangu motsatira chithunzithunzi chazinthu zakuthupi, pomwe gawo lovulazidwa, lalitali limapereka mbiri yabwino ya insulin.

M'mbuyomu, zosakanikirana zachikhalidwe zopangidwa mwakonzeka ("zosakaniza zopanda mphamvu") zimakonzedwa ndikusakanikirana kwa insulin ya anthu osakhalitsa 30% ndi insulin ya 70%. Adayambitsidwa chakudya cham'mawa komanso asanadye. NPH insulin (kulowererapo kwa Hagedorn protamine) ndi mtundu wofala wa insulin yogwira ntchito kwazaka zambiri, ukadaulo womwe Hagedorn amapanga mwa kusakaniza kuchuluka kofanana (isophan osakaniza) kwa insulin ndi protamine ndikupanga kuyimitsidwa.

Pakadali pano, zosakanizika zopangidwa ndi analogue zopangidwa ndi zinthu zambiri zogwira ntchito mwachangu (Zosakaniza Zapamwamba) zawonekera, kukulolani kuti aliyense payekha musankhe mitundu ya mankhwala ndi zosakanikirana za insulin zopangidwa kale. Mwachitsanzo, ma insulin amasakaniza 50/50, 70/30 ndi 75/25 ali ndi 50, 70 ndi 75% ya analogue ya ultrashort, motsatana.

Malinga ndi Bolli G. et al. mankhwala osankhidwa bwino osakanikirana ndi zosakanikirana zopangidwa ndi analog okhutira ndi kaphokoso ka chinthu chomwe chimagwira mwachangu chimatha kupatsa odwala matenda amtundu wa 1 omwe ali ndi vuto la glycemic lofanana

Nthawi zina bwino kuposa chikhalidwe chikhalidwe ndi bolus makasitomala osakhalitsa insulin ndi jakisoni wa basal insulin NPH. Zosakaniza zopangidwa mwakonzeka potengera ma insulin analogi othamanga zimatha kuchepetsa kuchuluka kwa postprandial hyperglycemia kuposa zosakaniza zomwe zimakonzedwa pamaziko a insulin 32-34 yamunthu. Odwala omwe amalandila okonzeka kupanga analogue 50 ndi 70 (jakisoni atatu patsiku), milingo ya glycemia inali yabwinoko kwambiri poyerekeza ndi gulu la odwala lomwe limalandira osakaniza a insulin ya anthu (ma jakisoni awiri patsiku, 70% insulin NPH). Kugwiritsa ntchito High Kusakanikirana katatu patsiku kunabweretsa kusintha kwakukulu pamlingo wa HbAlc odwala omwe ali ndi matenda a shuga a 2. Ziyenera kuganiziridwa kuti kugwiritsa ntchito kusakaniza kwa analog komwe kumapangidwira kumatsegula njira zina zatsopano mu insulin mankhwala a shuga mellitus.

Ndizodziwikiratu kuti kukonzekera kwa insulin komwe kumapangidwira mpaka pano sikungafanane kwathunthu ndi zotsatira za insal insulin. Mitundu yayitali ya insulin (NPH, Lente, Ultralente) imakhala ndi zovuta zingapo, pakati pawo ndikulephera kubwezeretsa mbiri yochepa yopanda insulin yolingana ndi mbiri yakuthupi. Kuzungulira kwakukulu mu seramu yamagazi kumafikiridwa mkati mwa maola 4-10, kenako kutsika. Mwanjira inayake, kuyamwa kumadalira momwe zinthu zilili jekeseni. Kuphatikiza apo, kuchuluka kwa mayamwidwe kumachepa mosawerengeka komanso kuwonjezeka ndi nthawi, 2, 7, 36. Zinthu izi za pharmacokinetic ndi pharmacodynamic zimawonjezera chiopsezo cha hypoglycemia, makamaka usiku.

Chimodzi mwazinthu zofunika kwambiri zomwe makampani amakono azamankhwala amapanga ndi kupangira ma insulini atsopano omwe angatenge mokwanira zotsatira za basulin insulin.

Zotsatira za zaka 15 zogwira ntchito yolimbikitsa othandizira a insulin anali mapangidwe a insulin analogues - insulin glargine ndi insulin.

Insulin glargine (lantus) ndi mndandanda woyamba wosakhala pachakudya wa insulin, analog m'badwo wachitatu, womwe umagwiritsidwa ntchito ndi ukadaulo wa DNA recombinant pogwiritsa ntchito mitundu yopanda pathogenic ya Esherichia coli. Mu kapangidwe ka molekyulu ya glargine, glycine idalowa m'malo a katsitsumzukwa 21 pa Chingwe, ndipo ma sparagins awiri amaphatikizidwa ndi zotsalira za kaboni ya B. Kusintha koteroko kwa molekyulu ya insulin ya anthu kumabweretsa kusintha kwa maloelectric point ya molekyulu ndi

mapangidwe khola pawiri, sungunuka pa pH 4.0, yomwe imapangira microprecipitate mu minofu yamafuta amkati, pang'onopang'ono kumasula pang'ono insulin glargine. Chifukwa chake, mbiri ya zochita za analogue ili pafupifupi maola 24 (aliyense payekhapayekha kuyambira maola 16 mpaka 30) ndipo alibe chiyembekezo. Izi zimakuthandizani kuti mugwiritse ntchito glargine monga basal insulin 1 nthawi patsiku. Zinawonetsedwa kuti mbiri ya zochitika za pharmacodynamic imadziwika ndi kufulumira kwa analogue, pomwe imayendetsedwa mosadukiza poyerekeza ndi NPH insulin, komanso kuphatikizidwa kwa mahomoni ambiri m'madzi a m'magazi.

Pazofunikira zazikulu zamankhwala, kinetics ya glargin yomwe imamangirira insulin receptor imafanana ndi kinetics ya insulin wamba yaumunthu, ndipo glycemia imachepetsedwa ndikulimbikitsa kupuma kwa glucose ndikutulutsa kupanikizika kwa hepatic glucose. Njira zaku thupi komanso zam'magazi zomwe zimayambitsa kuchepa kwa shuga omwe amayamba chifukwa cha insulin glargine mwa odwala omwe ali ndi matenda amtundu wa 1 komanso odzipereka athanzi ali ofanana ndi omwe amayambitsidwa ndi insulin 37, 39.

Kuphatikiza kwa analogue kumakhala ndi insulin yokwanira, yomwe imakhalabe kwa maola osachepera 24. Kufupika pambuyo pang'onopang'ono kwa insulin glargine yolembedwa ndi 123 Ndinachepetsa kwambiri odzipereka athanzi poyerekeza ndi NPH-insulin, ndikuchepa kwa radioacaction ya 25% inali 8, 8 ndi 11.0 motsutsana ndi maola 3.2. Ndikofunikira kuti mwa odzipereka athanzi, kuyamwa kwa mankhwala omwe ali ndi mulingo wambiri wa zinc - 30 μg / ml - anali wopanda pawebusayiti. Kuzingirira kwa glargine kosatha kunakwaniritsidwa patatha masiku 2-4 atatha jekeseni woyamba wa 37-39. Malinga ndi Heise T. et al. kuperewera kwa kukonzekera kwa mankhwalawa kumachotsa kufunika kochepetsa kuchuluka kwa glargine pambuyo poyambira chithandizo. Insulin glargine imapangidwa pang'ono pang'onopang'ono mwa michere iwiri yogwira; mankhwala osasintha komanso ma metabolites amapezeka mu plasma.

Mphamvu yachipatala ya insulin glargine poyerekeza ndi insulin NPH ya odwala omwe ali ndi mitundu 1 ndi 2 matenda a shuga adayesedwa pamayeso angapo azachipatala, kuphatikiza 12 multicenter osasankhidwa "maphunziro" a 5 komanso ochepa 5. M'maphunziro onse, mankhwalawa adaperekedwa 1 kamodzi patsiku nthawi yogona, ndipo NPH-insulin, monga lamulo, idaperekedwa kamodzi (nthawi yogona) kapena kawiri (m'mawa komanso pogona), kawiri pa tsiku. Ma insulin omwe amagwira ntchito mwachidule ankayendetsedwa molingana ndi ma regimens omwe akhazikitsidwa kale. Kusintha kochulukira kuzidziwitso zamitundu

glycemia mankhwalawa ndi insulin glargine poyerekeza ndi NPH-insulin odwala omwe ali ndi matenda ashuga 1. Milandu ya hypoglycemia yodziwika inali yodziwika kwambiri ndi insulin NPH, ndipo kuchuluka kwa zochitika za nocturnal hypoglycemia kunali kwapamwamba pochiza ndi NPH-insulin 37, 39.

Kafukufuku wa STA - "Kuyerekeza mphamvu ndi chitetezo cha Lantus mwa ana omwe ali ndi matenda ashuga amtundu umodzi kamodzi patsiku asanagone poyerekeza ndi NPH-insulin kamodzi kapena kawiri pa tsiku kwa milungu 24 ya chithandizo", yochitidwa m'maiko 12 ndi m'malo 30 omwe akukhudza ana 349 azaka zapakati pa 5 mpaka 16, adawonetsa kuchepa kwakukulu kwa kusala kwa glycemia mwa ana omwe amalandira glargine poyerekeza ndi ana omwe adalowetsedwa ndi insulin ya anthu. Kutsika kwapakati pa shuga m'magazi kunali 1.2 mmol / L motsutsana 0,7 mmol / L. Pogwiritsa ntchito shuga ochepera magazi, kuchuluka kwa zochitika za nocturnal hypoglycemia kunachepa, makamaka kwa ana osakwana zaka 11.

Miyezo yapakati ya glycated hemoglobin inachepa chimodzimodzi onse ndi glargine mankhwala (kuyambira -0.35 mpaka -0.8%) komanso ndi mankhwala a insulini ndi NPH (kuchokera -0.38 mpaka -0.8%).

Kuyesedwa kwachipatala komwe asayansi aku Germany sanakuwonetsere kukugwirizana pakati pa nthawi ya masiku kuti jakisoni wa analogue (m'mawa, chakudya chamadzulo, kapena pogona) ndi glycemia.

Pakadali pano, palibe kukayika kuti kugwiritsa ntchito insulin yocheperako kupitilira pamankhwala ochiritsa pakamwa kungathetsenso matenda a shuga.

M'maphunziro ambiri okhudzana ndi odwala omwe ali ndi matenda a shuga a 2 panthawi ya mankhwala a insulin glargine ndi NPH-insulin palimodzi ndi kukonzekera kwa sulfonylurea, milingo ya glycemia idasinthika kwambiri ndi kuchepa kwakukulu kwa pafupipafupi kwa hypoglycemia, makamaka usiku - m'malo a 10.0-31.3 % motsutsana ndi 24.040.2%, motsatana. Odwala omwe adakwaniritsa zomwe akufuna kusala magazi a glucose amakhalanso ocheperapo kwambiri amamva zochitika za hypoglycemia yodziwika ndi insulin glargine chithandizo kuposa NPH-insulin (33.0% motsutsana 50.7%). Mayeso azachipatala adawonetsa kuchepa kwakukulu kwa kuchuluka kwa HL1c (ndi 1.24%) mwa odwala omwe ali ndi matenda a shuga 2 omwe ali ndi insulin glargine poyerekeza ndi NPH-insulin (0.84%) 7, 11, 37.

Pakuyerekeza kwa odwala omwe ali ndi matenda a shuga a 2, kuwonjezeka kwa thupi ndi glargine sikunali kofanana ndi

ndi NPH-insulin, kuphatikiza apo, poyesa kamodzi, kuwonjezeka kocheperako kwamankhwala kunawonetsedwa pamankhwala omwe ali ndi analog. Olembawo amavomereza kuti palibe kuwonjezeka kwakukulu kwamankhwala olimbitsa thupi mwa odwala omwe ali ndi matenda amtundu wa 2 omwe adalandira insulin glargine. Zambiri zomwe zimatengedwa kwakanthawi mpaka miyezi 36 kwa odwala omwe ali ndi matenda a shuga 1 ndikugwiritsa ntchito glargine adawonetsa kuchuluka kwapakati pa thupi (ndi 0.75 kg) 41, 42.

Malinga ndi otsogolera odwala matenda ashuga, kupatsika kwa mankhwala a cellulin ndi pharmacodynamic poyerekeza ndi ma insulin omwe akhala akuchita kwa nthawi yayitali kumathandizanso kusintha kwa mtundu wa 2 wodwala mellitus wophatikiza mankhwala (insulin kuphatikiza mankhwala a hypoglycemic), kugwiritsa ntchito koyambirira komwe, malinga ndi malingaliro amakono, ndikulonjeza kwambiri njira yosinthira kayendedwe ka glycemic, kuchepetsa pafupipafupi komanso kupewa kutukuka kwa mtima. Olembawo amakhulupirira kuti anulin iyi ya insulin ndi chida chotsimikizika pothandiza odwala omwe ali ndi matenda a shuga 2, mellitus 7, 41.

Pali malipoti a kuphatikiza kwakukulu kwa kuphatikiza kwa insulin analoques ya nthawi yayitali komanso yochepa, yomwe imayambitsidwa m'njira zosiyanasiyana zochizira matenda a shuga 1, poganizira zotsatira za magawo ena a matenda ndi a metabolic. Chosangalatsa ndichakuti zomaliza zimachokera pazotsatira za mayesero ena azachipatala. Chifukwa chake, pakufufuza komwe kunachitika mwa odwala 57 omwe ali ndi matenda a shuga 1 amiyezi isanu ndi umodzi, kufunikira kwa kugwiritsa ntchito glargine osakanikirana ndi lyspro insulin, yoyendetsedwa molingana ndi pulogalamu yowonjezereka, ikufanizidwa ndi lyspro insulin yothandizira yomwe imayendetsedwa ndi jekeseni wokhazikika wokhazikika. Onse omwe ali mgulu la odwala omwe amalandila ma insulin analogues molingana ndi njira yabwino kwambiri, komanso pagulu la odwala omwe adalowetsedwa ndi Lyspro insulin pogwiritsa ntchito njira ya SBI, kuchuluka kwa hypoglycemic kunachepa chimodzimodzi, glycated hemoglobin ndi glycemia panthawi zosiyanasiyana patsiku zimayenda bwino.

Kafukufuku wosasinthika wa achinyamata 26 omwe ali ndi matenda a shuga 1 adawonetsa kuwongolera kwakanthawi kwamasabata 16 ndi glargine osakanikirana ndi pre-prandial management of humalog poyerekeza ndi kuphatikiza kwa NPH-insulin ndi insulin yokhazikika ya anthu. Kuphatikiza kwa glargine ndi lyspro insulin kunachepetsa zochitika za asymptomatic nocturnal hypoglycemia poyerekeza ndi kuphatikiza insulin / insulin NPH nthawi yokwanira 43%. Kuphatikiza apo, motsutsana ndi maziko ogwiritsa ntchito insulin glargine, kwambiri

Kusintha pang'ono pang'onopang'ono pakusala magazi.

Kafukufuku wina wachipatala, yemwe adachitika masabata 32 ndi odwala 48 omwe ali ndi matenda a shuga 1, kuti aphunzire moyo wa odwala omwe amagwiritsa ntchito insulin analogues ya glargine ndi lispro poyerekeza ndi NPH yaumunthu komanso chithandizo chokwanira cha insulin, adawonetsa kuti odwala adakhutira ndi mankhwalawa anali okwera kwambiri kwa iwo omwe amalandira ma insulin analogues kuposa odwala omwe adapatsidwa insulin. Olemba ambiri amakhulupirira kuti basal chopanda chopanda insulin glargine chophatikizana ndi ma ultra-yochepa yocheza chisanachitike maulendo ang'onoang'ono amatha kupereka bwino pakulimbana kwa glycemic ndikuchepetsa kwakukulu muzochitika za hypoglycemia poyerekeza ndi regimens yamankhwala yogwiritsira ntchito insulin yaumunthu.

M'mayesero azachipatala osankhidwa mwadzidzidzi, zomwe zimachitika pobwera chifukwa chogwiritsa ntchito insulin glargine zinali zofanana ndi za mankhwalawa a insulin NPH. Zokhudza jakisoni wambiri, zomwe nthawi zambiri zimakhala zopanda pake, zinali zotsatira zoyipa kwambiri pa chithandizo cha glargine, zimawonedwa mwa 3-4% odwala.

Zomwe zilipo pakali pano zikuwonetsa kuti insulin glargine siyodwalanso kuposa NPH-insulin, ndipo palibe malipoti a kuchuluka kwakukulu kwa ma antibodies ku Escherichia coli. Odwala omwe ali ndi gawo lomaliza la matenda a shuga a nephropathy omwe amathandizidwa ndi insulin glargine sanasonyeze kwenikweni kulolera kwa mankhwalawa. Kafukufuku wazinyama sanawonetse vuto pakukhazikitsa mluza ndi mwana wosabadwa ndipo sanawonetse kufooka kwa mankhwalawo. Mitogenic zochitika za glargine ndizofanana ndi insulin yamunthu.

Mlingo wa insulin glargine amatsimikiza kwa wodwala aliyense komanso amasinthidwa mogwirizana ndi mseru wa glycemia. M'mayesero azachipatala kwa odwala omwe sanalandire insulin maphunziro asanachitike, chithandizo chinayambitsidwa ndi mlingo umodzi wa tsiku lililonse wa 10 IU ndikupitiliza jakisoni imodzi tsiku lililonse mu 2-100 IU. Odwala omwe adalandira insulin NPH ndi Ultralente kamodzi patsiku lisanachitike kuyesedwa adapatsidwa glargine mu mlingo wofanana ndi insulin ya anthu. Komabe, pazochitika zomwe insal human insulin idaperekedwa kale kwa odwala kawiri patsiku, mlingo wa analog unachepetsedwa ndi 20%, kenako kuchuluka kwa mankhwalawa kunasinthidwa molingana ndi kuchuluka kwa shuga.

Zotsatira za kafukufuku wambiri zikuwonetsa kukhutira kwakukulu kwa odwala omwe ali ndi matenda amtundu wa 1 ndi mtundu wa 2 omwe amathandizidwa ndi glargine.

Analogue ina yayitali ya insulin ndi insulin detemir (NN304). Molecule yake ilibe amino acid threonine pamalo B30, mmalo mwake, amino acid lysine yomwe ili pamalo B29 imaphatikizidwa ndi acetylation ku mafuta otsalira a maatomu 14 a kaboni. Pambuyo pa subcutaneous makonzedwe pamaso pa zinc ndi phenol, de-temir amapanga hexamers, mbali yamtundu wamafuta otsalira amathandizira kuwonjezeredwa kwa hexamers, komwe kumachepetsa kudzipatula kwa hexamers ndi kulowetsedwa kwa insulin. Mu monomeric boma 14-C, mafuta acid unyolo pamalo B29 limamangidwa kuti albin mu subcutaneous mafuta. Kutalika kwa zochita za analog kumachitika chifukwa cha kuphatikiza kwa hexamer ndi albin. Chizindikiro chowzungulira ndichoposa 98% chomangiriridwa ku albumin ndipo kachigawo kakang'ono kake kopanda (kosasunthika) kamatha kuyanjana ndi insulin receptor. Kuzindikira pamaso pa nthaka ndizosungunuka pa pH yosaloledwa, chifukwa chake, gawo lochepetsa la analog limakhalabe lamadzi, mosiyana ndi insulin NPH ndi glargine, yomwe ili ndi depstalline depot.

Analogue imachulukitsa kuchitapo kanthu chifukwa cha kulowetsedwa pang'onopang'ono m'magazi komanso kulowerera pang'onopang'ono kwa insulin yomwe imamangidwa ku albumin m'magulu a chandamale 13, 47. Ngakhale atagwirizana kwambiri ndi analogue ndi albumin, detemir sikuwonetsa mgwirizano ndi ena okhudzana ndi izi ndi mankhwala a albin. Kuyesa kwa vitro kunawonetsa kuti mitogenicity ya detemir ndiyotsika kuposa ya insulin.

Poyerekeza ndi NPH-insulin, detemir imayamwa pang'onopang'ono kuchokera pamalowo jakisoni pang'onopang'ono komanso ndi nsonga yosatchulika. Kusiyanitsa kwakukulu kwapakati pamunthu aliyense wamagulu onse a pharmacokinetic kunadziwika poyerekeza ndi insulin NPH 50, 51 ndi insulin glargine. Chiwopsezo cha machitidwe a hypoglycemic mukamagwiritsira ntchito kuwonongeka poyerekeza ndi NPH-insulin imatsitsidwa kwambiri pamlingo womwewo wa glycemia. Panali chizolowezi chakuchepa kwa chiwerengero cha matenda a glycemia masana komanso kuchepa kwa chiwerengero cha milandu pa wodwala aliyense. Mukamagwiritsa ntchito Detemir, magwiritsidwe ntchito ake a glucose osavuta, kuthamanga kwa glucose osasunthika, komanso mbiri ya glycemic yausiku inali yokhazikika poyerekeza ndi mbiri ya NPH-insulin 11, 13.

Gawo lachitatu la mayesero azachipatala, kusintha pang'ono koma kwakukulu pamankhwala a HbA1c kunadziwika, ndipo mapindu a insulin amaperekanso kuwongolera kwa glycemic control, motero HbA1c.

Kutengera ndi zomwe zaperekedwa mu kuwunikiraku, ndikulimbikitsidwa kuti njira zamakono zamatenda a insulin mothandizidwa ndi insulin analoguise ziyambike machitidwe a dokotala wabanja. Zamankhwala

Ubwino wogwiritsa ntchito ma insulin analogue mu mtundu 1 ndi matenda amtundu wa 2 umayendera limodzi ndi kusintha kwaumoyo wa odwala komanso kuchepa kwamatenda obwera chifukwa chodwala.

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