Kugwiritsa ntchito mankhwala a shuga a insulin

Kuchita insulin mankhwala a shuga, makampani opanga mankhwala amapanga mitundu yosiyanasiyana yamankhwala.

Mankhwalawa amasiyana m'njira zingapo.

Zomwe zimapangitsa kusiyanitsa mankhwala omwe ali ndi insulin ndi awa:

• komwe zimachokera
• kuchuluka kwa mankhwala,
• nthawi ya mankhwala.

Pakukonza njira zochizira matenda a shuga mellitus, njira zosiyanasiyana za insulin zomwe zimayikidwa mthupi la wodwalayo zimagwiritsidwa ntchito. Popanga mtundu wa chithandizo, dokotala akuwonetsa:

1. mtundu wa insulin yomwe imagwiritsidwa ntchito jekeseni,
2. nthawi ya mankhwala mu thupi la wodwala matenda a shuga,
3. kuchuluka kwa mlingo umodzi wa mankhwalawa.

Kupambana kwa mankhwalawa kumadalira kukwaniritsidwa kolondola kwa zofunikira zonse pokonzekera njira ya insulin.

Kuwerengera kuchuluka kwa mankhwala omwe amagwiritsidwa ntchito kumachitika ndi endocrinologist. Mukamasankha jekeseni ya jakisoni, nthawi ya makonzedwe a mankhwala ndi mtundu wa mankhwalawa, dokotala ayenera kuganizira zotsatirazi zonse zomwe zimapezeka pakuwunika kwa wodwala komanso zomwe zimachitika chifukwa cha matenda a shuga. Munthu aliyense ali ndi njira yakeyake yamatendawa, choncho palibe njira zomveka zochizira.

Mukamajambula njira yochizira matenda a insulin, mitundu ingapo ya mankhwala okhala ndi insulin ingagwiritsidwe ntchito. Mankhwala regimen angagwiritsidwe ntchito:

• ma insulin apamwamba kwambiri,
• mankhwala osokoneza bongo,
• moyo wapakatikati,
• insulin yayitali
• Kukonzekera kukhala ndi kuphatikiza.

Chimodzi mwa mankhwala omwe amagwiritsidwa ntchito popanga mankhwala a insulin ndi ma insulin omwe amakhala nthawi yayitali.

Kugwiritsira ntchito insulin kwa nthawi yayitali sikungalepheretse kulumikizana kwa glucose m'magazi a m'magazi a wodwala matenda a shuga. Pazifukwa izi, mtundu uwu wa mankhwalawa sagwiritsidwa ntchito ngati pakufunika kubweretsa ziwonetsero zamagazi m'thupi la wodwalayo kuzowonetsa zomwe zili pafupi kwambiri ndi chikhalidwe chathupi.

Izi ndichifukwa choti insulin yomwe imakhala nthawi yayitali imakonzanso thupi la munthu.

Yaitali insulin mankhwala a shuga mellitus

Insulin yayitali imagwiritsidwa ntchito ngati pakufunika kukhala ndi insulin yachilengedwe m'magazi a magazi kwa nthawi yayitali pamimba yopanda kanthu.

Kutengera ndi zomwe wodwala adziyang'anira pawokha ndikudziwunika komwe adapeza pakuyang'ana kwa thupi, adokotala amawona ngati pakufunika kubweretsa insulin yayitali mthupi m'mawa, asanadye.

Maziko omwe amapanga dongosolo la insulin Therapy amatengedwa chifukwa chodziwunikira masiku asanu ndi awiri apitawa. Kuphatikiza apo, zochitika zina, ngati zilipo, zimakhudzidwa ndi chitukuko cha dongosolo la mankhwalawo.

Masiku ano, imodzi mwazinthu zodziwika bwino zotulutsidwa ndi Levemir ndi Lantus. Izi zokhala ndi insulin zomwe zimagwiritsidwa ntchito pochiza matenda a shuga 1 ndi mtundu 2. Kukhazikitsidwa kwa Mlingo wa mankhwalawa kumachitika molingana ndi kugwiritsa ntchito maola 12 aliwonse kapena maola 24 aliwonse.

Insulin yotalikirapo imatha kutumikiridwa mosasamala mtundu wa mankhwala omwe amapezeka pakanthawi kochepa. Kugwiritsa ntchito mtunduwu wa insulin palokha pazinthu zina za insulini regimen. Izi ndichifukwa choti odwala omwe ali ndi matenda a shuga amatha kufunafuna jakisoni wa ma insulin osiyanasiyana okhala ndi nthawi yayitali. Njira iyi yothandizira insulini imalola kugwiritsidwa ntchito kwa ma insulin osiyanasiyana kuti asungitse kuchuluka kwa mahomoni m'thupi la munthu pamikhalidwe yofunikira kwambiri mwa thupi, zomwe zimalepheretsa kukula kwa zovuta zazikulu mwa anthu.

Kugwiritsira ntchito insulin yayitali mu regimen yochiritsira kumakuthandizani kuti mufanizire kupanga kwa insulin insulin ndi kapamba, zomwe zimalepheretsa kukula kwa gluconeogeneis m'thupi. Kuphatikiza apo, ma insulin omwe amakhala nthawi yayitali amagwiritsidwa ntchito pochita insulin kuti apewe kufa kwa maselo a pancreatic omwe amachititsa kuti mahomoni achilengedwe azikhala.

Njira imeneyi imalola mtsogolo, pakukhazikitsa thupi ndi njira zonse za kagayidwe kazakudya, kukana insulini.

Zisonyezo za mankhwala a insulin

Odwala omwe ali ndi matenda amtundu wa 1 amagwiritsa ntchito insulin kuyambira tsiku loyambirira la matenda mpaka kumapeto kwa moyo. Mtundu wachiwiri, mapiritsi amayikidwa kuti achepetse shuga m'magazi, koma ndi chitukuko cha matenda ophatikizika kapena zovuta za shuga, insulin ndiyofunikira. Wodwalayo amatha kusamutsidwa kwathunthu kuti apakidwe jakisoni panthawi yodwala, kenaka ndikuwapatsa mankhwala ophatikiza - mapiritsi ndi jakisoni.

Ndi mawonekedwe a boma la insulin, dokotala akhoza kuletsa kapena kutsimikizira kupitiliza kwake.

Mankhwala a insulin makamaka ngati ali ndi matenda a shuga 2

• matupi a ketone m'magazi, mkodzo (ketoacidosis), osatengera kuchuluka kwake,
• matenda, maziko a supplement,
• ngozi ya cerebrovascular (stroke) kapena coronary (myocardial infarction),
• Hyperosmolar coma, ndi ketoacidosis, lactic acidosis,
• kuchuluka kwa kutupa kwamkati mwa ziwalo zamkati (mwachitsanzo, bronchitis, pyelonephritis) kapena matenda osachiritsika (chifuwa chachikulu, fungal, herpes).
• zotumphukira zotupa - retinopathy (kusintha kwammbuyo), nephropathy (kuwonongeka kwa impso), kupweteka kwam'manja miyendo (kupweteka, zilonda zam'mimba, kuphwanya kwamkati),
• pachimake kutupa kwa kapamba (kapamba), chiwonongeko chake (kapamba) kapena kuchotsa (kapamba),
• kuvulala kwambiri, kufunika kwa opaleshoni,
• mimba
• kuwonda mwadzidzidzi.

Insulin imaperekedwanso kwa odwala omwe ali ndi kuthekera kwa kufikira msinkhu wofunidwa ndi chizindikiro cha mafuta metabolism (cholesterol yayikulu ndi triglycerides) ndi zakudya ndi mapiritsi. Ndi matenda amtundu 1, pazochitika zonsezi, kuchuluka kwa mlingo, kusintha kwa kayendetsedwe ka kayendetsedwe kake, ndi njira yochiritsira ndiyofunikira.

Ndipo izi ndizokhudza chithandizo cha matenda a shuga 1.

Mitundu ya insulin ndi mitundu yake

Mayiko ambiri asiya kwathunthu kupanga insulin ya nyama. Chifukwa chake, mankhwala onse amapezeka ndi biosynthesis. Amatha kubwereza kwathunthu kapangidwe ka timadzi tating'onoting'ono ta anthu kapena kusiyana pang'ono ndi iwo (analogues). Ma insulini amaphatikiza nthawi yayifupi (yaifupi) komanso yapakatikati. Chifukwa cha kusintha pamapangidwe awo, ma analogi a mahomoni apeza luso lotha kuchita zinthu mwachangu (ultrashort) kapena kuchepetsedwa (nthawi yayitali, yayitali).

Ultra lalifupi

Amayamba kutsika magazi m'mphindi 15 pambuyo pakubayidwa mkatikati, ndipo patatha maola 1.5, ndende yake imayamba kuchepa. Izi zimakuthandizani kuti mulowetse mankhwalawa pafupi ndi nthawi yakudya. Mothandizidwa ndi mahomoni ochita masewera olimbitsa thupi, ndizotheka kusintha mankhwalawo nthawi zina pomwe zovuta kudziwa pasadakhale kuchuluka kwa zomwe wodwala angadye. Chifukwa chake, amalamulidwa pafupipafupi kwa ana aang'ono kapena chifukwa cha kukhumudwa m'matumbo.

Zowonongekazo zimaphatikizapo mtengo wokwera, komanso kufunikira kowonjezera makonzedwe, ngati mukufuna kukonzekera pakati pazakudya zazikulu. Mayina amalonda - Novorapid, Humalog, Apidra.

Zosavuta (zazifupi)

Mtundu wofala kwambiri wa mankhwala opaka jakisoni wopewa shuga kuchokera ku chakudya. Kukhazikika kwa chochitika kumachitika pakadutsa mphindi 30 mpaka 40 kuchokera kumayambiriro, kuchuluka kumafika ndi maola 2,5, ndipo nthawi yonse ndi maola 7. Amayambitsidwa pansi pakhungu pakakonzedwa komanso mu mtsempha wowawa kwambiri. Kupangidwa ndi opanga pansi pa mayina:

• Actrapid NM
• Humulin R,
• Gensulin P,
• Insuman Rapid.

Kutalika kwapakati

Ndi mankhwala, mphamvu yayitali yomwe imaperekedwa ndi kuphatikiza mapuloteni kuchokera ku trout - protamine. Chifukwa chake, amasankhidwa kuti ndi NPH - protamine ya Hagedorn. Mankhwalawa amatchedwanso isophan-insulin. Izi zikutanthauza kuti mamolekyulu onse a protamine amalumikizidwa ndi mamolekyulu onse a mahomoni. Katunduyu (kusowa kwa mapuloteni aulere) kumapangitsa kuti pakhale zosakanikirana za insulin NPH komanso zazifupi.

Pambuyo jekeseni, mankhwalawa amayamba kugwira ntchito pambuyo pa ola limodzi, ndipo nsonga yake imadziwika ndi maola 5-10. Izi zimawonetsetsa kuti shuga wamba amakhala bwino pakati pa chakudya. Ngati mungabayire mahomoni madzulo, ndiye kuti mutha kupewa zodabwitsazi m'mawa - kulumpha mu shuga m'masiku ochepa.

Mankhwala otsatirawa ndi a insulin-NPH:

• Gensulin N,
• Humulin NPH,
• Insuman Bazal,
• Protafan NM.

Kutalika (kotalikitsa) kachitidwe

Chifukwa chakuti mankhwalawa a nthawi yayitali amachedwa kukonzekera, kutsika kwa shuga ndikotheka kutatha maola 6.7 pambuyo pa kuwongolera. Pofuna kupewa hypoglycemia, ma insulin omwe amatchedwa opanda zopanda pake apangidwa. Amawonetsa bwino momwe magwiridwe am'madzi am'mimbamo amatulutsira timadzi timene timapezeka mwa anthu athanzi.

Mankhwala Lantus ndi Levemir amayamba kuchepetsa shuga pambuyo maola 6, ndipo nthawi yonse ya kutsika kwawo kwa shuga ili pafupi ndi maola 24. Nthawi zambiri amathandizidwa madzulo asanagone kapena kawiri - m'mawa komanso madzulo.

Kuphatikizidwa

Amakhala ndi mankhwala osakanikirana ndi insulin (NPH ndi yochepa) kapena kaphatikizidwe ka analogues (insulin-zinc-protamine ndi ultrashort). Nthawi zonse pamakhala manambala pa botolo la mankhwala. Amawonetsa kachigawo kakang'ono kafupi. Mwachitsanzo, Mikstard 30 NM - izi zikutanthauza kuti mu 30% muli insulini yochepa kwambiri.

NPH ndi zazifupi zimayimiridwa ndi Humulin M3 ndi Mikstard NM, ndi analogues - Novomiks, Humalog mix. Osakaniza amalimbikitsidwa kwa odwala matenda ashuga omwe ali ndi katundu wambiri watsiku ndi tsiku komanso zakudya, komanso kuvuta jakisoni. Monga lamulo, amaperekedwa kwa odwala okalamba omwe ali ndi vuto lowona, parkinsonism omwe ali ndi matenda a shuga a 2.

Kuwerengetsa kwa insulin

Cholinga cha insulini yoyendetsera ndikupangitsa kuti shuga azikhala wathanzi pang'ono. Ndikofunikira kuti musalole kusintha kwawo mwadzidzidzi. Chifukwa chake, ngati muli ndi matenda omwe angopezedwa kumene, kuchepetsa shuga sikofunikira, ndikofunikira kuti mukwaniritse pang'onopang'ono komanso kukhazikika kwake. Nthawi zambiri, mulingo wa 0,5 IU pa 1 makilogalamu amalemu amthupi amayamba. Pochitika kuti matendawa apezeka kale ali ndi vuto la ketoacidosis, adotolo amalimbikitsa mayendedwe a 0.75-1 / kg.

Miyezi 2,5 mpaka pambuyo pa kugwiritsa ntchito insulin motsutsana ndi maziko a metabolism ya carbohydrate, pamadza nthawi yomwe "kupuma" kapamba kumayamba kupanga mahomoni ake. Nyengo iyi imatchedwa "honeymoon", imapezeka kwambiri kwa achinyamata ndi achinyamata. Kufunika kwamakonzedwe a mahoni kumachepetsedwa. Kawirikawiri sizikupezeka kwathunthu, kawirikawiri mlingo wofunikira ndi 0-0-0.3 U / kg.

Pakadali pano, ndikofunikira kupeza mulingo wambiri womwe sunayambitse shuga, koma osakana kupereka mankhwalawa. Ngati mupitiliza kuperekera mankhwala mahomoni moyenera, ndiye kuti nthawi ya "uchi" itha kukulitsidwa pang'ono.

Mtsogolomo, kuwonongeka kwa maselo kumachitika mosalephera, ndipo wodwalayo amakhazikitsa zofuna zake za mahomoni, kutengera zaka, masewera olimbitsa thupi, komanso zakudya. Pafupifupi, sikulimbikitsidwa kupitilira muyeso wa magawo 40, omwe atha kukhala onenepa kwambiri.

Kuyambitsa chithandizo, kugawa kwa mankhwala otsatirawa kungagwiritsidwe ntchito:

• tisanadye chakudya cham'mawa 4,
• tisanadye chakudya chamtundu 4,
• tisanadye chakudya chamtundu wa 3,
• musanagone magawo 11 owonjezera (kapena m'mawa ndi madzulo, mayunitsi 5.5).

Mlingo wonse suyenera kupitirira 1 U / kg. Tsiku lotsatira, kutengera muyeso wa shuga, kuchuluka kwa timadzi timene timasinthidwa.

Matenda a shuga a insulin

Maloto a wodwala aliyense amene ali ndi matenda amtundu wa 1 amatenga piritsi limodzi kapena jekeseni imodzi patsiku. M'malo mwake, kuchuluka kwa timadzi timene timayamwa. Chifukwa chake, odwala ambiri amalimbikitsidwa ka 4-5 kugwiritsa ntchito insulin m'malo mwa jakisoni 2.

Cholimba ndi zosavuta

Mitundu iwiri ya mankhwala ndi yofunika. Mankhwala okhazikika omwe amagwiritsidwa ntchito kwa nthawi yayitali amathandizidwa madzulo asanagone kuti ayeserere kumbuyo (mosalekeza) katulutsidwe ka timadzi tomwe timakhala ndi thanzi kapamba. Ngati jakisoni imodzi sikokwanira kuthana ndi shuga osala kudya, kapena mlingo wowerengeka ndiwokwera kwambiri, ndiye kuti majekeseni awiri a insulin yayitali amaperekedwa - m'mawa ndi madzulo. Ponseponse, theka la kuchuluka kwa tsiku ndi tsiku limagwera pa mankhwala owonjezera.

Chapafupifupi chimaperekedwa kwa mphindi 30 chakudya chisanachitike. Mlingo wake mu 50% ya zowerengera. Gawo lililonse la insulin limathandizira kuyamwa kwa 10 g zama chakudya.

Chifukwa chake, mwachitsanzo, ngati wodwalayo adayambitsa magawo anayi, ndiye kuti izi zikutanthauza kuti payenera kukhala magawo anayi a mkate kapena 40 g malinga ndi glucose wangwiro mu chakudya. Zolemba zawo pazogulitsa zimatha kutsimikiziridwa ndi matebulo kapena kulemba.

Ultra-yochepa bolus base

Mukamagwiritsa ntchito mankhwala othamanga, amathandizidwa musanadye chakudya (Apidra, Humalog) kapena mphindi 10 (Novorapid). Nthawi yovomerezeka ndiyoyambira mphindi 15 musanadye komanso mpaka mphindi 20 mutatha (mabulamu). Kuti muthane ndi maziko a maziko (maziko), jakisoni 2 (m'mawa ndi madzulo) a insulin yayitali nthawi zambiri amalembedwa. Malamulo ena onse kuwerengera Mlingo ndi kugawa kwake sikusiyana ndi kugwiritsa ntchito kukonzekera kwakanthawi.

Kudziletsa

Ngakhale pali mitundu ina ya insulin yowerengeka, pakuchita sizingatheke kudziwa momwe wodwalayo amayankhira. Zimatengera izi:

• momwe jakisoni adachitikira, momwe chakudya chidawerengedwa,
• kulekerera payekha kwa chakudya chamagulu ndi mankhwala,
• kupezeka kwa kupsinjika, matenda ophatikizika,
• mulingo wakuchita zolimbitsa thupi.

Chifukwa chake, ngakhale ndi malangizo onse a dokotala, odwala nthawi zina sangathe kukwaniritsa zowonetsa. Ndikofunikira kwambiri, makamaka kumayambiriro kwa chithandizo, kusinthasintha pakudya ndi kudziwa shuga pamaso pamajekeseni aliwonse, maola awiri atatha kudya, komanso mphindi 30 asanagone. Osachepera kamodzi pa sabata, kuyeza 4 m'mawa.

Poyamba, chithandizo samakwaniritsa shuga wabwino, chifukwa thupi limafunikira nthawi kuti ikonzenso. Mulingo wokwanira ndi (mmol / l):

• pamimba yopanda kanthu 4-9,
• mutatha kudya kapena muyeso - mpaka 11,
• pa maola 22 - 5-10.9.

Kudziwa kuchuluka kwa chiphuphu cha shuga kumathandizira kudziwa hemoglobin miyezi itatu iliyonse. Tsoka ilo, simungatenge mlingo umodzi ndikuumatira kwa moyo wanu wonse. Chifukwa chake, mitengo yonse yowerengedwa imasinthidwa nthawi zonse, mankhwala a insulin amasintha kwa wodwala, ndipo amafunika kuyang'anira kuchuluka kwa shuga m'magazi.

Mfundo zachakudya

Ngati wodwala amupatsa mankhwala othandizira, ndiye kuti malamulo ofunika kwambiri azakudya ndi:

• Kutsatira kwambiri zakudya zamafuta malinga ndi mtundu wa insulin "ya chakudya". Wodwala akayamba kufupikitsa ndi kudya atangolowa jakisoni, ndiye kuti pachimake pa zomwe achite m'magazi, kuchuluka kwa chakudya kumachepa, kuchitika kwa hypoglycemia.
• Kudya kwa chakudya chama carbohydrate nthawi imodzi sikuyenera kupitirira magawo asanu ndi awiri a mkate, ngakhale atakhala ochepa kwambiri muzakudya zina, kugawa yunifolomu tsiku lonse kumafunikira (zigawo za mkate 6 ndi zikuluzikulu komanso ziwiri zamakudya akudya).
• Ngati pakufunika kuchedwetsa jakisoni ndi nthawi yakudya, ndiye kuti izi ndizotheka mkati mwa maola 1-1,5, nthawi yayitali ingayambitse kutsika kwa shuga.
• Ndikofunikira kuti zitsimikizire kuchuluka kwa zakudya tsiku lililonse kuchokera kumizere, masamba, zipatso, zipatso ndi zipatso.
• Zomwe zimapezeka m'mapuloteni ndi: nyama yokonda, nsomba, nsomba zam'madzi. Zopangira mkaka ndizofunikira muzakudya, koma ziwerengero zake zimaganiziridwa m'magawo a mkate.
• Zonsezi komanso kusowa kwa chakudya zimasokoneza njira za metabolic ndipo zimayambitsa zovuta.

Onerani kanema wa matenda ashuga:

Chakudya chizikhala 6 - zitatu zazikulu, zokhazikika zazakudya ziwiri komanso chakudya chachiwiri chamadzulo maola awiri asanagone. Ngati wodwala agwiritsa insulin ya ultrashort, ndiye kuti ndizotheka kukana zokhwasula-khwasula.

Zomwe mungathe kudya popanda zoletsa

Osawerengera kuchuluka kwake ndizotheka pazinthu zotere:

• nkhaka, zukini, kabichi, amadyera,
• tomato, biringanya, tsabola belu,
• nandolo zazing'ono ndi nyemba zobiriwira
• kaloti
• bowa (pakalibe kuphwanya).

Zamasamba onsewa amadya bwino kwambiri m'njira zamaladi, zophika kapena zophika. Kukhwanyata kapena kudyetsa mafuta sikulimbikitsidwa. Muzakudya zopangidwa kale, mutha kuwonjezera batala (mpaka 20 g) kapena mafuta a masamba (mpaka supuni 3).

Zomwe ziyenera kuchepetsedwa ndikuchotsedwa kwathunthu

Mlingo wa izi:

• nyama kapena nsomba (pafupifupi 150 g pa ntchito iliyonse),
• mkaka kapena zakumwa mkaka (2 makapu onse),
• tchizi mpaka 30% (pafupifupi 60 g), kanyumba tchizi 2-5% (100 g),
• mbatata - chinthu chimodzi
• chimanga - supuni ziwiri,
• nyemba - mpaka supuni 4 mu yophika,
• chimanga ndi pasitala - mpaka 100 g ya yophika,
• buledi - mpaka 200 g,
• zipatso - 1-2 zipatso zosakhudzidwa,
• mazira - 1 tsiku lililonse.

Ndikofunikira kuchepetsa kugwiritsa ntchito kirimu wowawasa, kirimu (osaposa supuni 1-2 patsiku), mtedza ndi mbewu (mpaka 30 g), zipatso zouma (mpaka 20 g).

Kutulutsa kwathunthu kumafunikira kuchokera:

• nyama yamafuta, nsomba za nkhuku,
• zokazinga, zokometsera,
• mayonesi, ketchup ndi msuzi wofananira,
• ayisikilimu
• shuga ndi zinthu zomwe zili nazo, ufa woyera,
• nyama zosuta, masoseji, masoseji,
• Zakudya zamzitini marinade
• wokondedwa, zipatso ndi zipatso zabwino,
• confectionery yonse
• mowa
• msuzi wolimba
• mpunga, semolina,
• nkhuyu, nthochi, mphesa,
• madzi a mafakitale opanga.

Ndipo izi ndizokhudza kukhudzidwa kwa matenda ashuga.

Kukhazikitsidwa kwa insulin kumawonetsedwa ngati matenda amtundu 1, komanso vuto, zovuta za mtundu 2. Ma insulini onse amagawidwa m'mitundu malinga ndi nthawi yochitapo kanthu. Kuwerengera Mlingo kumachitika payekhapayekha. Chothandiza kwambiri ndicho chiwembu cholimbitsa insulin. Mulinso mankhwala a mahomoni amtundu wa nthawi yayitali komanso waifupi (wa ultrashort). Panthawi yamankhwala, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi, kutsatira malamulo a zakudya.

Hypoglycemia imapezeka mu matenda osokoneza bongo osachepera kamodzi mu 40% ya odwala. Ndikofunikira kudziwa zizindikiro zake ndi zomwe zimayambitsa kuti muyambe kulandira chithandizo munthawi yake ndikukhala ndi prophylaxis yokhala ndi mtundu 1 ndi 2. Usiku ndizowopsa.

Ngati matenda amtundu wa 2 akhazikika, chithandizo chimayamba ndikusintha kwa zakudya ndi mankhwala. Ndikofunikira kutsatira malingaliro a endocrinologist, kuti muchepetse vutoli. Ndi mankhwala ndi mankhwala atsopano ati amtundu wa shuga omwe mwakumana nawo?

Kuti mumvetsetse mitundu ya shuga yomwe ilipo, kudziwa kusiyana kwawo kungakhale molingana ndi zomwe munthu amatenga - amadalira insulin kapena pamapiritsi. Ndi mtundu uti wowopsa kwambiri?

Ngati matenda a shuga a mtundu woyamba akhazikitsidwa, chithandizo chizikhala ndi kuperekera insulin yayitali. Komabe, lero pali njira yatsopano pakuthandizira matenda a shuga - mapampu otukuka, zigamba, zopopera ndi zina.

Kulephera ndi matenda a shuga kumapangidwa, kutali ndi odwala onse. Apatseni, ngati pali vuto lodzithandiza nokha, mutha kulipeza ndi kuyenda kochepa. Kuchotsedwa kwa ana, ngakhale ndi shuga yemwe amadalira insulin, ndi kotheka pazaka za 14. Gulu liti ndipo amalembetsa kuti?

Kusankhidwa kwa Insulin Yowonjezera

Kutulutsa kwa insulin m'magazi sikuyima mozungulira wotchi, ngakhale kukhalapo kapena kusowa kwa chakudya. Usiku ndi masana, pomwe chakudya chimodzi chakhala chikugwiritsidwa kale ndipo chinacho sichinafike, mawonekedwe am'mbuyomu amakhala osungika. Ndikofunikira kuti shuga amasweke, omwe amalowa m'magazi kuchokera m'masitolo a glycogen. Kuti muwonetsetse maziko, ngakhale khola, kukhazikitsa insulin yayitali ndikofunikira. Kutengera zomwe tafotokozazi, zikuwonekeratu kuti mankhwala abwino ayenera khalani ndi yayitali, yofananira, simunatchulidwe nsonga zapamwamba ndi zopondera.

Pazifukwa izi:

Kusankha kwa insulin yayitali ndi udindo wa dokotala. Zimatengera kulanga kwa wodwalayo, kupezeka kwatsalira kwa mahomoni ake, chizolowezi cha hypoglycemia, kuuma kwa zovuta, kuchuluka kwa kusala kwa hyperglycemia.

Momwe mungasankhire insulin yayitali:

1. Nthawi zambiri, zokonda zimaperekedwa kwa ma insulin analogues, omwe ndi othandiza kwambiri komanso amaphunziridwa.
2. Ma Protamine othandizira amagwiritsidwa ntchito nthawi zambiri ngati njira ina ilibe. Ma insulin a NPH amatha kupereka chindapusa chokwanira cha mtundu wa 2 shuga kumayambiriro kwa mankhwala a insulin, pomwe kufunika kwa mahomoni kumakhalabe kotsika.
3. Tresiba itha kugwiritsidwa ntchito bwino ndi mtundu woyamba wa anthu ashuga, omwe samakonda kutsika magazi ndikuyamba kumva zizindikiro za hypoglycemia koyambirira. Ndi matenda a shuga a 2, Tresib ndiye mtsogoleri wosagonjetseka pamsika wa insulin, chifukwa amaphatikiza bwino ndi othandizira pakamwa, amakhala ndi zotulukapo, ndipo amachepetsa pafupipafupi hypertlycemia yausiku.

Kuchuluka kwa insulin kwa nthawi yayitali kumagawidwa m'mawa ndi usiku makonzedwe, mlingo wawo nthawi zambiri umasiyana. Kufunika kwa mankhwalawa kumatengera kuopsa kwa matenda ashuga. Njira zingapo zapangidwa pakuwerengera kwake. Zonsezi zimafunikira magawo angapo a shuga. Kusankhidwa kwa mankhwalawa kumatenga nthawi, popeza kuchuluka kwa nthawi yayitali ya insulini kumasinthidwa kulingalira za mawonekedwe a mayamwidwe ndi kuwonongeka kwa mahomoni m'thupi la wodwala winawake. Kukhazikitsidwa kwa mlingo woyambira "ndi maso" kumabweretsa chiwopsezo chachikulu cha matenda ashuga, ndikukulitsa zovuta za matendawa.

Kukula kwa mlingo wosankhidwa bwino ndikubwino kwa kudya kwa glycemia, kuchepa kwam'mapapo komanso kusapezeka kwa hypoglycemia. Masana, kusinthasintha kwa shuga musanadye kumayenera kukhala ochepera 1.5 mmol / l - momwe mungawerengere moyenera muyezo wa insulin.

Kuwerengedwa kwa nthawi yamadzulo

Woyamba kusankha kuchuluka kwa insulin yochulukirapo, iyenera kupereka mulingo wa shuga usiku komanso m'mawa mutadzuka. Mu shuga mellitus, "zodzuka zam'mawa" nthawi zambiri zimawonedwa. Uku ndikuwonjezereka kwa glycemia m'mawa kwambiri, chifukwa cha kuwonjezeka kwa katulutsidwe ka mahomoni omwe amachepetsa mphamvu ya insulin. Mwa anthu athanzi, kutulutsidwa kwa insulin kumawonjezeka panthawiyi, motero shuga amakhazikika.

Mu shuga mellitus, kusinthasintha kumeneku kungathetsedwe kokha ndi kukonzekera kwa insulin. Kuphatikiza apo, kuchuluka kwa mankhwalawa kumachepetsa shuga m'magazi kuti akhale abwinobwino, koma kumapangitsa kutsika kwambiri kwa glycemia koyambira komanso pakati pausiku. Zotsatira zake, wodwala matenda ashuga amadwala malodza, mtima wake komanso thukuta lake limakulirakulira, mitsempha yake imadwala.

Kuti muthane ndi vuto la hyperglycemia m'mawa, osachulukitsa mlingo wa mankhwalawa, mutha kugwiritsa ntchito chakudya cham'mbuyomu, moyenera - maola 5 musanayambitse insulin yayitali. Munthawi imeneyi, shuga onse azakudya azikhala ndi nthawi yoti adutse m'magazi, kusintha kwa timadzi tambiri tating'onoting'ono kumatha, ndipo insulin yayitali ingasinthe glycogen ku chiwindi.

Chiwerengero cha Algorithm:

1. Kuti mudziwe kuchuluka kwa mankhwalawa jakisoni wamadzulo, manambala a glycemic kwa masiku angapo amafunikira. Muyenera kukhala ndi chakudya cham'mawa molondola, kuyeza shuga musanagone, kenako m'mawa mutangodzuka. Ngati m'matumbo glycemia anali wamkulu, miyeso imapitilira masiku ena anayi. Masiku omwe chakudya chidayandikira sachotsedwa pamndandanda.
2. Kuti muchepetse chiopsezo cha hypoglycemia, kusiyana kocheperako pakati pa miyeso iwiriyi kumasankhidwa masiku onse.
3. Chidziwitso cha insulin chimawerengedwa. Uku ndiye kukula kwa kuchepa kwa glycemia atakhazikitsa gawo limodzi la mahomoni. Mwa munthu wolemera makilogalamu 63, gawo limodzi la insulin yowonjezera limatsitsa shuga ndi 4.4 mmol / L pafupifupi. Kufunika kwa mankhwalawa kukukula molingana ndi kulemera. PSI = 63 * 4.4 / kulemera kwenikweni. Mwachitsanzo, ndi kulemera kwa 85 kg, PSI = 63 * 4.4 / 85 = 3.3.
4. Mlingo woyambira amawerengedwa, ndi wofanana ndi kusiyana kocheperako pakati pa miyezo isanayambe kugona ndi m'mawa, yogawidwa ndi PSI. Ngati kusiyana ndi 5, lowetsani nthawi yogona musanadye magawo 5 / 3.3 = 1.5.
5. Kwa masiku angapo, shuga amayeza pambuyo podzuka, kutengera deta iyi, kuchuluka kwa insulini kumasinthidwa. Ndikwabwino kuti musinthe mankhwalawa pakadutsa masiku atatu, kusintha kulikonse kuyenera kupitirira gawo limodzi.

Ndi mtundu 2 wa shuga, shuga m'mawa amatha kukhala otsika kuposa nthawi yogona. Pankhaniyi, insulin yayitali sichikhala ndi jekeseni yamadzulo. Ngati glycemia atatha kudya chakudya chamadzulo, amapanga mankhwala othamanga a mahomoni othamanga. Insulin yayitali pazolinga izi sizingagwiritsidwe ntchito, imayendetsedwa chimodzimodzi.

Ngati kusintha kwa mlingo kumalephera

Hypoglycemia usiku ikhoza kubisika, ndiye kuti, wodwalayo m'maloto samva chilichonse ndipo sakudziwa za kukhalapo kwawo. Kuti mupeze kuchepa kobisika kwa shuga m'magazi, miyezo imachitika kangapo usiku: pa maola 12, 3 ndi 6. Ngati 3 koloko m'magazi a glycemia ali pafupi ndi malire ochepa, tsiku lotsatira amayeza mu 1-00, 2-00, 3-00. Ngati chisonyezo chimodzi sichinachite bwino, zimawonetsa bongo

Anthu ena omwe ali ndi matenda ashuga omwe amafuna insulin yaying'ono akukumana ndi zomwe zimachitika kuti timadzi tambiri timachepa m'mawa, ndipo sikokwanira kuthetsa vuto lodzuka m'mawa. Kuwonjezeka kwa mankhwalawa pamenepa kumabweretsa nocturnal hypoglycemia. Izi zimawonedwa mukamagwiritsa ntchito NPH-insulin yokha, komanso Lantus, Tujeo ndi Levemira.

Ngati pali mwayi wazachuma, mutha kukambirana za kufunikira kwa insulini yayitali ndi dokotala. Zochita za Treshiba usiku wonse, ndiye kuti shuga m'magazi amakhala achilendo popanda jakisoni wowonjezera. Munthawi ya kusintha, kuwongolera pafupipafupi kwa glycemia kumafunikira kuti muchepetse kuchepa kwake masana.

Ambiri a endocrinologists amalimbikitsa kusinthira ku Treshiba kokha kuti awonetsetse. Anthu odwala matenda ashuga, omwe othandizira amatsimikizira kuti amapereka chindapusa cha matendawa, akulangizidwa kuti apewe insulin yatsopano mpaka wopangayo atachitapo kafukufuku wokwanira ndipo akudziwa zambiri za mankhwalawo.

Kusankhidwa kwa Mlingo wam'mawa

Insulin yayitali masana imafunikira kuti muchepetse shuga zakudya zikagayidwa kale. Zakudya zomanga thupi kuchokera ku chakudya zimalipitsidwa ndi mahomoni afupiafupi. Kuti mphamvu zake zisasokoneze kusankha kuchuluka kwa insulini yowonjezera, muyenera kufa ndi njala tsiku lina.

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsiratu matenda ashuga. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipira mtengo wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Meyi 18 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

Kuwerengetsa kwa tsiku ndi tsiku mlingo wa algorithm:

1. Sankhani tsiku laulere kwathunthu. Idyani chakudya cham'mawa. Pangani kuchuluka kwa magazi mutadzuka, pambuyo pa ola limodzi, kenako katatu pakatha maola anayi aliwonse. Nthawi yonseyi yomwe simutha kudya, madzi okha ndi omwe amaloledwa. Pambuyo muyeso wotsiriza mutha kudya.
2. Sankhani shuga wochepa kwambiri patsiku.
3. Kuwerengera kusiyana pakati pa mulingo uno ndi chandamale, chomwe 5 mmol / l amatengedwa.
4. Muwerenge insulin tsiku lililonse: gawani kusiyana ndi PSI.
5. Pakatha sabata, bwerezani miyezo pamimba yopanda kanthu, ngati kuli kotheka, sinthani mlingo wake potengera deta

Ngati kusala kudya kwanthawi yayitali kuli koletsedwa kwa odwala matenda ashuga, muyezo ungachitike m'magawo angapo: woyamba kulumphira chakudya cham'mawa, tsiku lotsatira - nkhomaliro, tsiku lotsatira - chakudya chamadzulo. Kuyambira pakudya mpaka kuyeza shuga ayenera kutenga maola 5 ngati wodwalayo wavulala jakisoni wofupikiratu wa insulin musanadye, ndipo pafupifupi maola 7 ngati insulin ya anthu yagwiritsidwa ntchito.

Mawerengero Achitsanzo

Wodwala wodwala matenda a shuga a mtundu wachiwiri wolemera makilogalamu 99 sakukwanira kuchepetsa shuga, motero amamuika mankhwala a insulin. Kuwerengera tsiku ndi tsiku insulin yayitali, timayeza:

Mtengo wocheperako ndi 7.2. Kusiyana kwake ndi gawo la chandamale: 7.2-5 = 2.2. PSI = 63 * 4.4 / 96 = 2.9. Mlingo wofunikira tsiku lililonse = 2.2 / 2.9 = 0,8 mayunitsi, kapena 1 unit. zokhala ndi zozungulira.

Kuyerekeza malamulo a kuwerengera Mlingo wam'mawa ndi wamadzulo

Ndi matenda 2 a shuga, sikofunikira kuti mukhale ndi insulin yayifupi komanso yayitali. Zitha kuzindikirika kuti kapamba payekha imapilira kupereka maziko oyambira, ndipo mahomoni owonjezera safunika. Ngati wodwala amatsatira zakudya zamafuta ochepa, mwina sipangakhale chifukwa chochepa cha insulin musanadye. Ngati wodwala matenda ashuga amafuna insulin yayitali kwa onse usana ndi usiku, mlingo wa tsiku ndi tsiku umakhala wotsikirapo.

Pakadutsa matenda a shuga 1, mtundu ndi kuchuluka kwa mankhwalawo amafunikira nthawi zambiri amasankhidwa kuchipatala. Malamulo kuwerengera omwe ali pamwambapa angagwiritsidwe ntchito kusintha mlingo ngati woyamba anali kusiya kupereka chipepeso chabwino.

Zoyipa za NPH-Insulin

Poyerekeza ndi Levemir ndi Lantus, ma NPH-insulins ali ndi zovuta zingapo zazikulu:

• sonyezani kuchuluka kwakukulu kwa ntchito pambuyo pa maola 6, chifukwa chake musayerekeze kubisala kwakumbuyo, komwe kumakhala kokhazikika,
• Kuwonongeka kosasinthika, kotero zotsatira zake zingakhale zosiyanasiyana masiku osiyana,
• Nthawi zambiri zomwe zingayambitse matenda ashuga. Chiwopsezo cha kusinthika kwa anaphylactic chimachulukitsidwa ndi maantibayotiki, ma radiopaque, NSAIDs,
• Ndiwo kuyimitsa, osati yankho, chifukwa chake zimatengera kusakanikirana kwathunthu kwa insulin ndikutsatira malamulo ake.

Ma inshuwiti amakono samakhala opanda zofooka izi, chifukwa chake kugwiritsa ntchito mankhwalawa matenda a shuga ndikofunikira.

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yosungira shuga m'manja? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >>