Insulin ndi mankhwala ofunikira, yasintha miyoyo ya anthu ambiri omwe ali ndi matenda ashuga.

M'mbiri yonse yamankhwala ndi mankhwala azaka za 20, mwina gulu limodzi lokha lamankhwala lofunikanso lomwe lingathe kusiyanitsidwa - awa ndi maantibayotiki. Iwo, monga insulin, adalowa mankhwala mwachangu ndikuthandizira kupulumutsa miyoyo yambiri ya anthu.

Tsiku la matenda ashuga limachitika pachikondwerero cha World Health Organisation chaka chilichonse, kuyambira 1991 pa tsiku lobadwa la katswiri wofufuza zamankhwala ku Canada F. Bunting, yemwe anapeza insulin ndi J.J. Macleod. Tiyeni tiwone momwe timadzi timeneti timapangidwira.

Kodi pali kusiyana kotani pakati pa kukonzekera kwa insulin wina ndi mnzake

Kuchuluka kwa kuyeretsa.
Zomwe zimalandila ndiku nkhumba, bovine, insulin ya anthu.
Zowonjezera zomwe zimaphatikizidwa ndi yankho la mankhwalawa ndizosunga, othandizira, ndi ena.
Kusintha
pH yankho.
Kutha kusakaniza mankhwala achidule komanso osakhalitsa.

Insulin ndi mahomoni omwe amapangidwa ndi maselo apadera mu kapamba. Ndi puloteni wokhala ndi mitundu iwiri, yomwe imaphatikizapo 51 amino acid.

Pafupifupi magawo 6 biliyoni a insulini amwedwa chaka chilichonse padziko lapansi (gawo limodzi ndi ma micrograms a 42). Kupanga insulini kumakhala kwadzaukadaulo kwambiri ndipo kumachitika kokha kudzera mwa njira za mafakitale.

Magwero a insulin

Pakadali pano, kutengera gwero la zopangidwazo, nkhumba insulin ndi kukonzekera kwa insulin ya anthu ndizayokha.

Ma insulin a nkhumba tsopano ali ndi kuyeretsa kwambiri, ali ndi vuto labwino, ndipo palibenso zotsutsana nazo.

Kukonzekera kwa insulin kwaumunthu kumagwirizana kwathunthu pakupanga kwamankhwala ndi mahomoni amunthu. Nthawi zambiri zimapangidwa ndi biosynthesis pogwiritsa ntchito ma genetic engineering technology.

Opanga akuluakulu amagwiritsa ntchito njira zopangira zotere zomwe zimatsimikizira kuti malonda awo amakwaniritsa zonse zabwino. Palibe kusiyana kwakukulu machitidwe aumunthu ndi porcine monocomponent insulin (i.e., oyeretsedwa kwambiri) adapezeka; mokhudzana ndi chitetezo cha mthupi, malinga ndi maphunziro ambiri, kusiyana kwake ndi kochepa.

Zinthu zothandiza zomwe zimagwiritsidwa ntchito popanga insulin

Mu botolo ndi mankhwalawa muli yankho lomwe silokhala ndi insulin ya mahomoni, komanso mankhwala ena. Aliyense wa iwo ali ndi gawo linalake:

kuchuluka kwa zochita za mankhwala,
njira yothetsera matenda
kukhalapo kwa buffer katundu wa yankho ndi kukhalabe wosalimba pH (acid-base balance).

Kukula kwa insulin

Kuti apange insulin yowonjezera, yomwe ndi imodzi mwa mankhwala awiri, zinc kapena protamine, imawonjezeredwa ku yankho la insulin yachilendo. Kutengera izi, ma insulin onse amatha kugawidwa m'magulu awiri:

protamine insulin - protafan, insuman basal, NPH, humulin N,
zinc-insulin - insulin-zinc-suspensions a mono-tard, tepi, humulin-zinc.

Protamine ndi mapuloteni, koma mayendedwe osokoneza monga mawonekedwe a ziwonetsero kwa iwo ndi osowa kwambiri.

Kupanga malo osagwirizana ndi yankho, yankho la phosphate limawonjezedwanso kwa ilo. Tiyenera kukumbukira kuti insulini yokhala ndi phosphates ndiyoletsedwa kuphatikiza insulin-zinc kuyimitsidwa (ICS), popeza zinc phosphate imayambira munthaka iyi, ndipo zochita za zinc-insulin zimafupikitsidwa m'njira yosadalirika.

Zida zophera tizilombo

Zina mwazomwe zimapangidwira, malinga ndi njira zamatenda ndi tekinoloje, ziyenera kuyambitsidwa pakukonzekera, zimakhala ndi zotsatsira matenda. Izi zimaphatikizapo cresol ndi phenol (onse aiwo ali ndi fungo linalake), komanso methyl parabenzoate (methyl paraben), yomwe ilibe fungo.

Kuyambitsidwa kwa chilichonse chosungirako ndipo kumapangitsa fungo linalake la insulin. Zosungirako zonse zomwe zimapezeka kuti zimapezeka mu insulin sizikukhudza.

Protamine ma insulins nthawi zambiri amaphatikizapo cresol kapena phenol. Phenol sangathe kuwonjezeredwa ku mayankho a ICS chifukwa amasintha mphamvu ya ma cell ma cell. Mankhwalawa akuphatikizapo methyl paraben. Komanso, ayoni a zinc amagwiritsa ntchito njira yotsatsira.

Chifukwa cha chitetezo chamtunduwu cha anti-bacterial ambiri, chitetezo chimagwiritsidwa ntchito popewa kukula kwa zovuta zomwe zingayambike chifukwa cha kuipitsidwa kwa bakiteriya pamene singano imayikidwa mobwerezabwereza mu vial yankho.

Chifukwa cha kukhalapo kwa njira yotchinjirizira, wodwalayo angagwiritse ntchito syringe yomweyo popanga jakisoni wa mankhwalawa kwa masiku 5 mpaka 7 (malinga ngati amangogwiritsa ntchito syringe). Kuphatikiza apo, mankhwala osungira amayesetsa kuti musamwe mowa pakhungu musanalowe, koma pokhapokha ngati wodwalayo apanga jakisoni yekha ndi syringe ndi singano yopyapyala.

Insulin Syringe Calibration

Pokonzekera insulin yoyamba, gawo limodzi lokha la mahomoni linali mu mlomo umodzi wa yankho. Pambuyo pake, kupsinjika kunawonjezeka. Zokonzekera zambiri za insulin m'mabotolo omwe amagwiritsidwa ntchito ku Russia zimakhala ndi magawo 40 mu 1 ml ya yankho. Mbale zambiri zimayikidwa chizindikiro cha U-40 kapena 40 mayunitsi / ml.

Amapangidwira kuti azigwiritsidwa ntchito ponseponse, kungofuna insulini yotere ndikuwunika kwawo kumapangidwa molingana ndi mfundo iyi: syringe ikadzaza ndi 0,5 ml yankho, munthu amapeza magawo 20, 0,35 ml amagwirizana ndi magawo 10 ndi zina zotero.

Chizindikiro chilichonse pa syringe ndi chofanana ndi voliyumu inayake, ndipo wodwalayo amadziwa kale kuchuluka kwamagawo omwe ali mgawoli. Chifukwa chake, kuwerengera kwa ma syringes ndikumaliza kwa kuchuluka kwa mankhwalawa, kuwerengera pakugwiritsa ntchito insulin U-40. Magawo anayi a insulin ali mu 0,1 ml, 6 mayunitsi - mu 0,15 ml ya mankhwalawa, ndi zina mpaka magawo 40, omwe amafanana ndi 1 ml yankho.

Ma millor ena amagwiritsa ntchito insulin, 1 ml yomwe muli mayunitsi 100 (U-100). Mankhwala oterewa, ma syringe amtundu wapadera amapangidwa, omwe ali ofanana ndi omwe takambirana pamwambapa, koma amawayika mosiyanasiyana.

Ikutengera izi ndende iyi (ndiyokwera ka2,5 kuposa muyezo). Pankhaniyi, kuchuluka kwa insulin kwa wodwalayo, kumene, kumakhalabe chimodzimodzi, chifukwa kumakwaniritsa kufunikira kwa thupi kwa kuchuluka kwa insulini.

Ndiye kuti, ngati m'mbuyomu wodwalayo adagwiritsa ntchito mankhwalawo U-40 ndikubaya mayunitsi 40 a mahomoni patsiku, ndiye kuti alandiranso magawo 40 omwewo atabayidwa insulin U-100, koma jekeseni kochulukirapo ka 2,5. Ndiye kuti, magawo 40 omwewo azikhala mu 0,4 ml ya yankho.

Tsoka ilo, si madokotala onse komanso makamaka odwala matenda a shuga omwe amadziwa izi. Mavuto oyamba adayamba pomwe ena mwa odwala adayamba kugwiritsa ntchito ma insulin injector (ma syringe pens) omwe amagwiritsa ntchito ma penfill (ma cartridge apadera) okhala ndi insulin U-40.

Ngati mudzaza syringe ndi yankho lolembedwapo U-100, mwachitsanzo, mpaka mpaka mayunitsi 20 (i.e. 0.5 ml), ndiye kuti bukuli lidzakhala ndi magawo 50 a mankhwalawo.

Nthawi iliyonse, ndikudzaza ma syringes U-100 ndi ma syringe enieni ndikuyang'ana pazidutswa zomwe zadulidwa, munthu adzalandira mlingo wa 2,5 kuposa womwe wawonetsedwa pamlingo wa chizindikiro ichi. Ngati dokotala kapena wodwala sazindikira vuto ili, ndiye kuti mwayi wokhala ndi vuto lalikulu la hypoglycemia ndiwokwera chifukwa cha mankhwala osokoneza bongo omwe nthawi zambiri amachitika.

Kumbali ina, nthawi zina pamakhala ma insulin omwe amawongolera makamaka mankhwala a U-100.Ngati syringe yotere imadzazidwa molakwika ndi njira yokhazikika ya U-40, ndiye kuti mlingo wa insulini mu syringe udzakhala wocheperapo ndi theka kuposa womwe walembedwa pafupi ndi chizindikiro chofananira pa syringe.

Zotsatira zake, kuwonjezereka kwamphamvu kwa glucose kumatha kuchitika koyamba. M'malo mwake, zonse, ndizomveka - pachidutswa chilichonse cha mankhwalawa ndikofunikira kugwiritsa ntchito syringe yoyenera.

M'mayiko ena, mwachitsanzo, Switzerland, malingaliro adaganiziridwa mosamalitsa, malinga ndi kusintha koyenera komwe adapanga kuti insulin ikonzekere idalembedwa kuti U-100. Koma izi zimafunikira kuyanjana kwambiri ndi onse omwe ali ndi chidwi: madokotala a akatswiri ambiri, odwala, anamwino ochokera m'madipatimenti aliwonse, akatswiri a zamankhwala, opanga, olamulira.

M'dziko lathu, ndizovuta kwambiri kusamutsa odwala onse kuti agwiritse ntchito insulini U-100 kokha, chifukwa, mwakuthekera, izi zidzatsogolera kuchuluka kwa zolakwika posankha mtundu.

Kuphatikiza kwafupikitsidwe wa insulin yayitali komanso yayitali

Mankhwala amakono, chithandizo cha matenda ashuga, makamaka mtundu woyamba, nthawi zambiri chimachitika pogwiritsa ntchito mitundu iwiri ya insulin - yochepa komanso yayitali.

Zingakhale zosavuta kwa odwala ngati mankhwala omwe ali ndi mphamvu zosiyanasiyana atha kuphatikizidwa mu syringe imodzi ndikuperekedwa nthawi yomweyo kuti musavulaze khungu kawiri.

Madokotala ambiri sakudziwa chomwe chimapangitsa kuti athe kusakaniza ma insulin osiyanasiyana. Maziko ake ndi mankhwala ndi galenic (yotsimikizika ndi kapangidwe kake) yoyanjanitsidwa kwaatalikirana ndi yayifupi.

Ndikofunika kwambiri kuti posakaniza mitundu iwiri ya mankhwala, kuyambitsa mwachangu insulin sikufupika kapena kutha.

Zatsimikiziridwa kuti mankhwala omwe amagwira ntchito mwachidule amatha kuphatikizidwa jekeseni m'modzi ndi protamine-insulin, pomwe kuyamba kwa insulin yocheperako sikunachedwe, chifukwa insulle insulin siyimangidwa kuti ipangike.

Poterepa, wopanga mankhwalawo alibe ntchito. Mwachitsanzo, amatha kuphatikizidwa ndi humulin H kapena protafan. Kuphatikiza apo, zosakaniza izi zimatha kusungidwa.

Ponena za kukonzekera kwa zinc-insulin, kwakhala kuti kwayamba kalekale kuti insulini-zinc-suspension (crystalline) singaphatikizidwe ndi insulin yochepa, chifukwa imamangilira ma zinc ion kwambiri ndikusintha kukhala insulin yotalikilapo, nthawi zina pang'ono.

Odwala ena amapereka mankhwala ochepetsa, ndiye, osachotsa singano pansi pakhungu, amasintha pang'ono pang'ono, ndipo zinc-insulin imabayidwa.

Malinga ndi kayendetsedwe ka kayendetsedwe kameneka, kafukufuku wina wasayansi wambiri wachitika, chifukwa chake sitinganene kuti pazochitika zina ndi jakisoni mankhwalawa amaphatikizika ndi insulin ndipo mankhwala omwe amangogwiritsa ntchito pakanthawi kochepa amatha kupanga pansi pa khungu, omwe amachititsa kuti matendawo asamayende bwino.

Chifukwa chake, ndikwabwino kupaka insulin yayifupi mosiyana ndi zinc-insulin, pangani jekeseni awiri osiyana m'malo a khungu omwe ali osachepera 1 cm kupatula wina ndi mnzake.

Wophatikiza insulin

Tsopano makampani opanga mankhwala amapanga kukonzekera komwe kumakhala ndi insulin yochepa pamodzi ndi protamine-insulin mwachiwonetsero chokwanira. Mankhwalawa akuphatikizapo:

Zophatikiza zomwe ndizothandiza kwambiri ndizomwe kuchuluka kwa insulin kwa nthawi yayitali kuli 30:70 kapena 25:75. Kuwerengera kumeneku kumasonyezedwa nthawi zonse mu malangizo ogwiritsira ntchito mtundu uliwonse wa mankhwala.

Mankhwala oterewa ndi oyenera kwambiri kwa anthu omwe amatsatira kudya kosalekeza, olimbitsa thupi nthawi zonse. Mwachitsanzo, nthawi zambiri amagwiritsidwa ntchito ndi odwala okalamba omwe ali ndi matenda amtundu wa 2.

Ma insulin osakanikirana sakhala oyenera kukhazikitsidwa kwa mankhwala omwe amadziwika kuti "osinthika" a insulin, pakakhala koyenera kuti asinthe nthawi zonse mlingo wa insulin.

Mwachitsanzo, izi zikuyenera kuchitika pakusintha kuchuluka kwa chakudya chamagulu m'zakudya, kuchepetsa kapena kukulitsa zochitika zolimbitsa thupi, ndi zina zambiri. Pankhaniyi, mlingo wa basal insulin (womwe umakhala nthawi yayitali) sungasinthe.

Insulin yaumunthu ndi chida chothandiza kupangira odwala omwe ali ndi mitundu yoyamba komanso yachiwiri ya matenda ashuga. Ndi chipangizo chamajini chomwe chimasungunuka kwambiri mu zakumwa. Kuvomerezedwa kuti mugwiritse ntchito ngakhale mukakhala ndi pakati.

Actrapid, Humulin, Insuran.

INN: Semi-yopanga insulin yaumunthu.

Kodi amapangidwa ndi chiyani?

Mutha kukhala munjira izi:

Kugwiritsa ntchito mankhwala enaake a insulin,
Zotsatira zake, momwe majini osinthika a yisiti kapena Escherichia coli amakhudzidwa, mabakiteriya a coli.

Insulin yotere ndi biphasic. Imayeretsedwa koyamba, kenako imapangidwa kupanga mankhwala omaliza. Kapangidwe kamankhwala awa sikosiyana kwambiri ndi insulin yoyera yopanga mankhwala. Ena okhazikika, othandizira opha zamphamvu ndi zotsekemera zomwe zimapangitsa mabakiteriya kuti awonjezeranso munthu.

Mtundu waukulu wamasulidwe ndi yankho la jakisoni. 1 ml ikhoza kukhala ndi ma insulin 40 kapena 100 a insulin.

Zotsatira za pharmacological

Mankhwalawa akukhudzana ndi ma insulin osakhalitsa. Fomu yeniyeni ya insulin-receptor pamwamba pa michere yambiri ya maselo, yomwe imawonekera pambuyo poyanjana mwachindunji ndi mawonekedwe a membrane a cell. Kuphatikizika kwa cycloo oxygenase mkati mwa maselo a chiwindi ndi mawonekedwe a mafuta akuwonjezeka.

Insulin imatha kulowa mwachindunji m'maselo a minofu. Poterepa, machitidwe onse omwe amapezeka m'maselo amasinthidwa. Kuphatikizika kwa michere yofunika ya hexokinase ndi glycogen synthetase kumakulanso.

Kuchulukana kwa shuga m'magazi kumatsika chifukwa chogawa mwachangu mkati mwa maselo. Kutsimikizika kwake kwabwino ndi matupi onse amthupi kumachitika. Pali kukondoweza kwa machitidwe a glycogenogeneis ndi ma cell lipogenis. Mapangidwe a mapuloteni amapangidwa mwachangu. Mlingo wa kupangira shuga kwa maselo a chiwindi umachepetsedwa kwambiri pochepetsa kuwonongeka kwa ulusi wa glycogen.

Pharmacokinetics

Kuchuluka kwa mayamwidwe a insulin nthawi zambiri kumadalira momwe zinthu zomwe zimagwirira ntchito zimathandizira. Zambiri zimachitika chifukwa cha mlingo womaliza, kuchuluka kwa insulini mu jakisoni wa jekeseni komanso pamalo omwe jakisoniyo yayamba. Timalizi zimagawidwa mosiyanasiyana. Insulin siyingalowe chotchinga cha placenta.

Itha kuwonongeka pang'ono ndi insulinase mwachindunji m'chiwindi. Imapukusidwa makamaka mwa kusefa impso. Kuthetsa theka-moyo sikudutsa mphindi 10. Kuchuluka kwa insulin koyera m'magazi kumawonedwa mkati mwa ola limodzi pambuyo pake. Zotsatira zake zimatha mpaka maola 5.

Zisonyezero zakugwiritsa ntchito insulin yaumunthu

Pali ma pathologies angapo omwe chithandizo chimasonyezedwa:

lembani 1 ndi matenda ashuga 2
matenda ashuga acidosis,
ketoacidotic chikomokere,
matenda a shuga pa nthawi yomwe ali ndi pakati.

Pakakhala mkhalidwe wokondweretsa wodwala, ayenera kuchipatala. Ngati thanzi silikuyenda bwino, hemodialysis imachitidwa. Nthawi zina, pakakhala zovuta zina, chitani mankhwala mosamala. Mlingo ndi nthawi yayitali ya mankhwala amatsimikiziridwa ndi kupezeka dokotala potengera zovuta zamatenda zomwe matendawa ali nawo.

Momwe mungatengere insulin yaumunthu

Mlingo ndi njira yotsogoza mwachindunji imatsimikiziridwa pokhapokha pa shuga ya magazi, komanso maola awiri mutatha kudya. Kuphatikiza apo, phwando limatengera kuuma kwa chitukuko cha glucosuria.

Nthawi zambiri, subcutaneous makonzedwe. Chitani mphindi 15 chakudya chachikulu chisanachitike. Pa matenda a shuga a ketoacidosis kapena chikomokere, inshuwarayo imabayira jekeseni, nthawi zonse kudzera m'mitsempha ya gluteus, opaleshoni iliyonse isanachitike.

Ndikulimbikitsidwa kupereka mankhwalawa katatu pa tsiku. Pofuna kupewa zilonda zam'mimba zambiri, simungathe kumeza mankhwalawo m'malo omwewo. Ndiye dystrophy yama subcutaneous yamafuta siziwona.

Akuluakulu tsiku lililonse mlingo 40 ndi ana, ndipo kwa ana ndi magawo 8. Nthawi zonse oyendetsera kasamalidwe kawiri pa tsiku. Ngati pali chosoweka chotere, ndiye kuti mutha kulandira insulin mpaka kasanu.

Zotsatira zoyipa za insulin yaumunthu

Mukagwiritsidwa ntchito, zotsatirazi zotsatirazi zimakonda kukhala:

matupi awo sagwirizana: urticaria, edema ya Quincke,
kupuma movutikira, kugwa kwamwadzidzidzi,
hypoglycemia: kutuluka thukuta kwambiri, khungu lake, kugwedezeka kwambiri, kugona mosalekeza, kukhumudwa, kugona tulo, migraine, kusakwiya kwambiri, kutopa, kuona kwam'maso ndikulankhula, kupindika kwa minofu ya nkhope,
hypoglycemic coma,
hyperglycemia ndi acidosis: pakamwa mokhazikika, kukhumudwa kwambiri, khungu la nkhope,
chikumbumtima
kuwona kwakachepera
kuyamwa ndikutupa pamalo omwe mankhwalawo adathandizidwa.
mawonekedwe a kutupira kwa nkhope ndi miyendo, kuphwanya Refraction.

Izi zimachitika kwakanthawi ndipo sizifunikira chithandizo chilichonse chamankhwala. Amadutsa pang'onopang'ono atachotsa ndalamazo.

Malangizo apadera

Musanakumane yankho mwachindunji kuchokera m'botolo, muyenera kulionadi kuti likuwonekera bwino. Ngati matenda atayamba, mankhwalawa sayenera kumwa.

Mlingo wa insulin umasinthidwa motere:

matenda opatsirana
Kulakwitsa chithokomiro
Matenda a Addison
hypopituitarism,
matenda ashuga okalamba.

Nthawi zambiri, kuwonetsedwa kwa hypoglycemia yamphamvu imayamba. Zonsezi zimayamba chifukwa cha mankhwala osokoneza bongo, kukhazikika kwa insulin komwe kumachokera munthu, kufa ndi njala, kutsegula m'mimba, kusanza komanso zizindikiro zina za kuledzera. Hypoflycemia yofatsa imatha kuyimitsidwa pomwa shuga.

Ngati zizindikiro zazing'ono za hypoglycemia zikuwoneka, muyenera kulankhulana ndi katswiri nthawi yomweyo. Wofatsa, kusintha kwa mankhwalawa kungathandize. M'mavuto akuchulukirapo, mankhwala ogwiritsira ntchito doporization ayenera kugwiritsidwa ntchito. Nthawi zambiri, kuchotsa kwathunthu kwa mankhwala kapena kulandira chithandizo kumafunikira.

Kumbukirani kuti m'dera la kayendetsedwe ka chiwongola dzanja, mitundu ina ya mafuta m'mimba imatha kuwonekera. Koma izi zitha kupewedwa ndikusintha malo a jakisoni.

Gwiritsani ntchito pa nthawi yoyembekezera komanso mkaka wa m`mawere

Kuwongolera kuchuluka kwa shuga mthupi la mayi wapakati ndikofunikira. Mu trimester yoyamba, kufunika kwa insulin yoyera kumachepera pang'ono, ndipo kumapeto kwa nthawi kumawonjezeka.

Pa yoyamwitsa, mayi angafunike kusintha kwa insulin ndi zakudya zapadera.

MP ilibe mutagenic komanso ma genetically poizoni.

Bongo

Zizindikiro zosokoneza bongo zimatha kuchitika pafupipafupi:

hypoglycemia - kufooka, thukuta kwambiri, khungu la pakamwa, kunjenjemera kwa malekezero, lilime lonjenjemera, njala,
hypoglycemic chikomokere ndi chindoko.

Chithandizo chake chimakhala chodziwikiratu. Hypoglycemia yofatsa imatha kudutsa shuga kapena zakudya zamafuta ambiri.

Glucagon woyela amapaka jekeseni kuti aletse zizindikiro za kuchuluka kwa mankhwala osokoneza bongo.Ngati mwayamba kukomoka mwadzidzidzi, mpaka 100 ml ya njira yothetsera ya dextrose imayendetsedwa mpaka wodwalayo atachoka.

Kuchita ndi mankhwala ena

Yankho la insulin yopanga ndi yoletsedwa kuphatikiza ndi njira zina za jakisoni. Zotsatira zazikulu za hypoglycemic zimangowonjezereka ngati zimagwiritsidwa ntchito limodzi ndi sulfonamides, Mao inhibitors, ndi anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine ndi ena a beta-blockers amathandizanso pakugwiritsa ntchito mankhwalawa.

Mphamvu ya hypoglycemic imafooka mukatengedwa ndi mahomoni akuluakulu a chithokomiro, njira za kulera, glucagon, estrogens, heparin, sympathomimetics ambiri, antidepressants, antagonists a calcium, morphine ndi nikotini.

Modziletsa amakhudza insulin pakamwa shuga a beta-blocker, reserpine ndi pentamidine.

Kuyenderana ndi mowa

Kumwa insulin sikugwirizana ndi kumwa mowa. Zizindikiro za kuledzera zikuchulukirachulukira, ndipo zotsatira za mankhwalawo zimachepetsedwa kwambiri.

Pali mitundu ingapo yofunika:

Berlinsulin N Mwachizolowezi,
Diarapid CR,
Wotsimikiza
Insulin Actrapid,
Insuman Rapid,

Zosungidwa zamankhwala

Amasungidwa pa kutentha osaposa + 25 ° C pamalo otetezedwa kwambiri kuchokera kwa ana aang'ono. Ndikofunika kupewa dzuwa lowongolera mwachindunji.

Ndikofunikira kuonetsetsa kuti yankho silitaya kuonekera kwake, ndipo palibe mawonekedwe pansi. Izi zitachitika, ndiye kuti mankhwalawo sangathe kugwiritsidwa ntchito.

Wopanga

Pali mabungwe angapo omwe amapanga insulin yaumunthu:

Sanofi (France),
NovoNordisk (Denmark),
EliLilly (USA),
Pharmstandard OJSC (Russia),
National Biotechnology OJSC (Russia).

Nditapeza insulin yoyeretsa kwambiri, funso linadzuka pakukula kwa mitundu ya insulin. Mukugwiritsa ntchito njira zodziwira kuchuluka kwa insulin m'magazi, ma antibodies mpaka insulin adapezeka. Kafukufuku awonetsa kuti odwala omwe amagwiritsa ntchito bovine / porcine insulin anali ndi antibodies ambiri kuposa kugwiritsira ntchito insulin yokha.

Ma antibodies awa atha kukhala osokoneza insulin, omwe angayambitse kukana insulini, komanso kutulutsa kwa insulin, hypoglycemia yopanda chidwi. Yakwana nthawi yoti asinthe ma bovine insulin ndi nkhumba, koma odwala m'maiko ena anakana kugwiritsa ntchito insulin ya nkhumba pazifukwa zachipembedzo.

Vutoli lakhala maziko othandizira "insulin ya anthu." Mu 1963, nthawi ya "insulin yaumunthu" idayamba atatha a Mirsky ndi anzawo a insulin kuchokera ku zikondamoyo, ndipo kuyambira 1974, atatulukira pakupanga mankhwala kuchokera ku amino acids, kuthekera kwa kuphatikizika kwathunthu kwa mankhwala a insulin yaanthu.
Mu 1979-1981 Ukadaulo wa ma DNA wa biosynthetic ndi njira yopangira yopangira insulin mwa kuyika enzyme m'malo mwa amino acid molekyu (Markussen). Semi-yopanga insulin yaumunthu yopangidwa kuchokera ku nkhumba, dzina lake lolondola ndi insulini yosinthika ya nkhumba. Pano sichigwiritsidwa ntchito.

Mndandanda wa amino acid mu molekyu ya porcine ndi insulin yaumunthu ndi yofanana, kupatula kwa amino acid yomaliza ya B unyolo: mu porcine insulin - alanine, mwa anthu - threonine. Njira yopangira theka ndiyomwe imapangitsa chidwi cha alanine ndi kulowetsedwa ndi threonine. M'zaka khumi zapitazi, njira yopangira insulin yatsala pang'ono kusinthidwa ndi imodzi yachilengedwe. Njira ya biosynt synt (genetic engineering) yopanga insulin ya anthu ndi njira yosinthira chidziwitso chakuchiziwidwa cha zinthu zazamoyo kuti zigwirizane ndi mapuloteni akunja.
Insulin ya biosynthetic yaumunthu imapangidwa pogwiritsa ntchito ukadaulo wa DNA.

Pali njira ziwiri zazikulu.
1. Patulani kaphatikizidwe pogwiritsa ntchito majini osinthika.
2. Kuchokera kwa proinsulin wopangidwa ndi bakiteriya wosinthika mwa majini.

Phenol kapena metacresol amagwiritsidwa ntchito ngati cholembera kuti asungidwe antimicrobial state insulins a insulin yochepa ndi isophanes, ndipo paraben (methyl parahydroxybenzoate) imagwiritsidwa ntchito pa mtundu wa Lente insulins. Kutengera mtundu wamatenda a shuga, mankhwala a insulin amasonyezedwa pafupifupi 30-30% ya odwala. Awa ndi odwala omwe ali ndi matenda amtundu 1 shuga, omwe amapanga 10-15% odwala onse omwe ali ndi matenda ashuga, komanso odwala omwe ali ndi mtundu wa 2 shuga.
Mpaka pano, mankhwala a insulin akadali njira yokhayo ya pathogenetic yomwe imasunga moyo ndi kuthekera kugwira ntchito kwa odwala omwe ali ndi matenda amtundu wa 1.

Chifukwa chake, mankhwala a insulin amakhalapo amoyo wonse, omwe, kumene, amabweretsa zovuta zina kwa wodwalayo chifukwa chofunikira kukhalabe ndi vuto la kuphatikiza kagayidwe kamphamvu kwambiri pafupi ndi la munthu wathanzi. Palibenso njira ina yothandizira kulowetsedwa kwa insulin, ngakhale kungokhala kutsanzitsa kwa zotsatira za thupi. Momwe zimakhalira nthawi zonse, insulin imalowa nthawi yomweyo m'mitsempha ya chotupa, kenako ku chiwindi, komwe imatha kulumikizidwa, theka limakhala paliponse. Zonsezi zimachitika mwachangu kwambiri kotero kuti mulingo wa glycemia ukhoza kusungidwa m'malo osaneneka ngakhale mutadya. Njira ina imawonedwa ndi insulin yolumikizidwa ndi khungu: yachedwa kulowa m'magazi ndipo makamaka m'chiwindi, pambuyo pake kuchuluka kwa insulin m'magazi kumakhala kosachulukirapo kwa nthawi yayitali. Koma njira zamakono zogwirira ntchito zamankhwala a insulin zimapangitsa kuti njira ya odwala omwe ali ndi matenda a shuga a mtundu wa I ikhale pafupi kwambiri. Izi zitha kuchitika kokha pophunzitsa odwala omwe ali ndi matenda ashuga.

Kufunika kochita mapulogalamu ophunzitsira odwala matenda ashuga kwadziwika. Pofika mu 1925, m'modzi mwa apainiyawa a insulin, a E. Joslin, amaphunzitsa odwala zomwe amawona kuti ndizofunikira kwambiri pakuchita bwino kwa mankhwala: kutsimikiza mtima katatu kwa glycosuria komanso kusintha kwa mlingo wa insulin kutengera zomwe wapeza. Kufunika kwamankhwala othandizirana kunalibe. Koma pobwera insulin kukonzekera, chitukuko cha mankhwala a insulin sichinasinthe. Odwala anali oletsedwa kusintha pawokha mankhwala a insulin, amapaka jekeseni wokhazikika pokhapokha kamodzi patsiku, ndipo kwa zaka zambiri anaiwalako za thanzi labwinobwino, kupirira chiopsezo cha hypoglycemia ndi kufunika kwakukhalira kuchipatala.

Pofika kumayambiriro kwa zaka za m'ma 80, akatswiri a matenda ashuga anali atayeretsa kwambiri mankhwala a insulin, insulin ya anthu, njira zowongolera zoperekera insulin (zotaya za insulin ndi ma cholembera), ndi njira zowonetsera glycemia ndi glycosuria pogwiritsa ntchito zingwe zoyeserera. Mosiyana ndi ziyembekezo, kugwiritsa ntchito kwawo kokha sikunachititse kuchepa kwa kuchuluka kwa zovuta za shuga komanso kusintha kosalekeza pakubwezeretsanso kwa kagayidwe kazakudya. Malinga ndi kutsimikiza kosavomerezeka kwa akatswiriwo, njira yatsopano inafunikira yomwe ingalole kuyendetsa bwino matenda osachiritsika ophatikizira wodwalayo pakulamulira kwake matenda ashuga ndi chithandizo chake. Pakadali pano, mawu oti "maphunziro achire" amavomerezedwa ndi World Health Organisation, ndipo ndi gawo lofunika kwambiri pochiza matenda amtundu uliwonse. Pokhudzana ndi odwala omwe ali ndi matenda a shuga 1, izi makamaka zikutanthauza kuti wodwalayo ayenera kukhala wodziwa kwambiri za insulin.

Zolinga zamatenda a insulin odwala omwe ali ndi matenda amtundu wa 1:
1) kusintha kagayidwe kagayidwe kazakudya (mwachidziwikire, kusintha kagayidwe kakang'ono ka magazi, kuletsa kuchuluka kwake, hyperglycemia, glycosuria ndi hypoglycemia atatha kudya, mokwanira - kuthetseratu zovuta zamatenda a shuga, ketosis, hyperglycemia, kutchulidwa, nthawi zambiri kumachitika kapena mosazindikira. achina
2) sinthani zakudya zanu ndikukhalanso ndi thupi labwino odwala,
3) sinthanso mafuta kagayidwe (malinga ndi cholesterol yokwanira, L PNP, L PVP, triglycerides, mu seramu yamagazi),
4) kusintha moyo wabwino ndikukhala ndi moyo wabwinobwino komanso waulere wodwala,
5) kuteteza chitukuko kapena kuchepetsa maselo a mitsempha ndi mitsempha ya shuga.

Mapamba amunthu, pazifukwa zosiyanasiyana, nthawi zambiri sangatulutse insulini. Kenako muyenera kugwiritsa ntchito majini okhala ndi insulin, yomwe imalowa m'malo mwa insulin ya anthu.

Mtundu wa insulin waumunthu umapezeka kapena mu kapangidwe ka Escherichia coli, kapena kuchokera ku insulin ya insulin ndikusintha amino acid.

Kuti muyesere magwiridwe antchito a kapamba amunthu, ma jakisoni a insulin amachitika. Mtundu wa insulin umasankhidwa kutengera mtundu wa matenda komanso thanzi la wodwalayo. Insulin imatha kutumikiridwa kudzera m'mitsempha kapena intramuscularly. Kwa chithandizo cha moyo wonse komanso chautali, jakisoni wa subcutaneous amagwiritsidwa ntchito nthawi zambiri.

Zolemba za insulin

Matenda a shuga omwe amadalira a insulin amafunikira chithandizo cha moyo wonse. Moyo wa munthu umadalira kupezeka kwa insulin. Matendawa amadziwika kuti ndi mliri wosagonjetseka ndipo ndiwo wachitatu pofalikira padziko lapansi.

Kwa nthawi yoyamba, insulin idapangidwa kuchokera ku zikondamoyo za galu. Patatha chaka chimodzi, mankhwalawo adayamba kugwiritsidwa ntchito. Pambuyo pa zaka 40, adatha kupanga mahomoni munthawi ya mankhwala.

Pambuyo kanthawi, mitundu ya insulin yokhala ndi kuyeretsa kwambiri idapangidwa. Ntchito ikuchitikanso kuti mupange insulin yaumunthu. Kuyambira 1983, mahomoni awa adayamba kumasulidwa pamsika wamafuta.

M'mbuyomu, anthu odwala matenda ashuga ankalandira mankhwala opangidwa ndi nyama. Tsopano mankhwalawa ndi oletsedwa. M'mafakitala, mutha kungogula ma genetic engineering, kupanga mankhwalawa kumangotengera kusintha kwa chinthu cha jini mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya a E. coli umagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kutulutsa timadzi tambiri timadzi tambiri.

Insulin yamakono yamankhwala ndi yosiyana:

nthawi yowonetsera, pali yochepa, ultrashort komanso insulin yotalikilapo,
kutsatira kwa amino acid.

Palinso mankhwala osakanikirana omwe amatchedwa osakaniza. Mu kapangidwe ka ndalama zotere mumakhala insulin yokhala ndi nthawi yayitali komanso yochepa.

Kupeza insulini kungathenso kuwonetsedwa mu matenda monga:

Lactic acid, matenda ashuga ndi hypersmolar,
Mtundu 1 wa matenda a shuga a insulin
Ndi matenda, chithandizo cha opaleshoni, kuchulukitsa kwa matenda osachiritsika,
Matenda a shuga ndi / kapena kuwonongeka kwa chiwindi, pakati komanso pobereka.
Type 2 osagwirizana ndi insulin omwe amadalira matenda a shuga
Zotupa za khungu la Dystrophic,
Kulimbitsa kwambiri munjira zosiyanasiyana,
Njira yayitali yopatsirana.

Kutalika kwa insulin

Potengera nthawi ndi magwiridwe antchito, insulin imasiyanitsidwa:

ultrashort
mwachidule
nthawi yayitali
kuchitapo kanthu kwanthawi yayitali.

Ultrashort amalowetsa zinthu pambuyo jakisoni. Kuchuluka kwake kumatheka pambuyo pa ola limodzi ndi theka.

Kutalika kwa zochita kumafika maola 4. Insulin yamtunduwu imatha kutumikiridwa musanadye kapena musanadye. Kupeza insulini sikutanthauza kupuma pakati pa jakisoni ndi chakudya.

Ultrashort insulin sikufuna zakudya zowonjezera pamtunda wa kuchitapo, komwe kuli kosavuta kuposa mitundu ina. Insulin yotere imaphatikizapo:

Ma insulin afupia amayamba kuchita pambuyo pa theka la ola. Chiwongola dzanja chikuyambira patatha maola atatu. Zochitazo zimatha pafupifupi maola 5. Insulin yamtunduwu imaperekedwa musanadye, muyenera kukhalabe ndi pakati pa jakisoni ndi chakudya. Kudya kumaloledwa pambuyo pa mphindi 15.

Kugwiritsa ntchito insulin yocheperako, muyenera kukhala ndi mankhwalawa patatha maola ochepa jakisoni. Nthawi ya chakudya iyenera kuyenderana ndi nthawi yapamwamba ya mahomoni. Ma insulin afupia:

Himulin Wokhazikika,
Khalid
Monodar (K50, K30, K15),
Insuman Rapid,
Humodar ndi ena.

Ma insulini apakatikati ndi mankhwala osokoneza bongo omwe nthawi yayitali ya maola 12-16. Mtundu woyamba wa shuga, insulin yamunthu imagwiritsidwa ntchito ngati maziko kapena basal. Nthawi zina muyenera kupanga jakisoni 2 kapena katatu patsiku m'mawa ndi madzulo ndi gawo la maola 12.

Insulin yotere imayamba kugwira ntchito pambuyo pa maola 1-3, ikufika pachimake patatha maola 4-8. Kutalika ndi maola 12-16. Mankhwala apakatikati akuphatikizapo:

Humodar br
Protafan
Humulin NPH,
Novomiks.
Insuman Bazal.

Ma insulin omwe amakhala nthawi yayitali amakhala a insulin kapena oyambira insal. Munthu angafunike jakisoni imodzi kapena iwiri patsiku. Amagwiritsidwa ntchito pochiza matenda a shuga a 2.

Mankhwala amakhala ndi cumulative effect. Mphamvu ya Mlingo imawonekera kwambiri pambuyo masiku atatu. Wothandizirana kwa nthawi yayitali amagwira ntchito patatha maola 4-6 jakisoni. Zochita zawo zapamwamba zimachitika m'maola 11 mpaka 14, izi zomwe zimachitika pafupifupi tsiku limodzi.

Mwa zina mwa mankhwalawa, pali ma insulin omwe alibe phindu. Ndalama zotere zimachitika modekha ndipo nthawi zambiri zimatsata momwe masoka achilengedwe amakhala mwa munthu wathanzi.

Izi insulini ndi monga:

Lantus
Monodar Long,
Monodar ultralong,
Ultralente
Ultralong,
Humulin L ndi ena,
Lantus
Levemir.

Zotsatira zoyipa ndi vuto la kumwa

Ndi bongo wa insulin yokonzekera mwa anthu, zotsatirazi zingaoneke:

Zofooka
Thukuta lakuzizira
Pallor
Kudzanjenjemera
Kusweka mtima
Mutu
Njala
Zingwe.

Zonsezi pamwambapa zimawonetsedwa ngati zizindikiro za hypoglycemia. Ngati mkhalidwe wayamba kumene ndipo mukuyamba kale, mutha kuchotsa zizindikirazo mwaumoyo. Pachifukwa ichi, tengani zinthu zokhala ndi shuga komanso chakudya chamafuta ambiri.

Komanso yankho la dextrose ndi glucagon limatha kuyambitsidwa m'thupi. Wodwala akayamba kuperewera, njira yosinthika ya dextrose iyenera kuperekedwa. Amagwiritsidwa ntchito mpaka mkhalidwe utasintha.

Odwala ena amatha kuyambitsidwa ndi insulin. Zina mwazizindikiro zazikulu ndi:

Kutha
Kutupa,
Urticaria,
Kuthamanga
Thupi
Kutsitsa magazi.

Hyperglycemia imachitika chifukwa cha mankhwala ochepa kapena chifukwa cha matenda opatsirana, komanso chifukwa chosagwirizana ndi zakudya. Nthawi zina munthu amakumana ndi lipodystrophy komwe mankhwalawa amaperekedwa.

Mukamagwiritsa ntchito mankhwalawa angathenso kuchitika kwakanthawi:

Kupeza wolowa mmalo m'malo mwa insulin ya anthu ndi njira yabwino yochizira matenda ashuga. Thupi limathandiza kuchepetsa kuchuluka kwa glucose m'magazi, chifukwa chakuti glucose amatha kulowa bwino ndi maselo, momwe kayendedwe kamayendedwe ake amasinthira. Mankhwalawa amalowa m'malo mwa insulin ya anthu, koma amayenera kumwedwa pokhapokha ngati akuwongolera adokotala, chifukwa pakhoza kukhala zovuta zina.

Malangizo ofunikira kuti mugwiritse ntchito

Amayi omwe ali ndi matenda ashuga ayenera kudziwitsa oyang'anira azaumoyo za zakutsogolo kapenanso kukhala ndi pakati. Gulu ili la azimayi nthawi zambiri okhala ndi mkaka wa m'mawere limasowa kusintha kwamankhwala, komanso zakudya.

Pophunzira za kuwopsa kwa kukonzekera kwa insulin, asayansi sanapeze zotsatira za mutagenic.

Ndikofunika kudziwa kuti kufunika kwa mahomoni kumatha kuchepa ngati munthu ali ndi vuto la impso. Munthu amatha kusamutsidwira ku mtundu wina wa insulin kapena mankhwala omwe ali ndi dzina lina loyang'aniridwa pokhapokha akuyang'aniridwa ndi achipatala.

Mlingo uyenera kusinthidwa ngati zochitika za insulin, zamtundu kapena mitundu, zasinthidwa. Kufunika kwa insulin kungachepetse ndi matenda otsatirawa:

Ntchito zosakwanira za adrenal, chithokomiro cha England
Hepatic ndi aimpso kulephera.

Ndi kupsinjika kwa m'maganizo kapena matenda ena, kufunika kwa insulin kumawonjezeka. Kusintha kwa mankhwalawa kumafunikanso ndi kulimbitsa thupi.

Zizindikiro za hypoglycemia, ngati insulin ya anthu imagwiridwa, ikhoza kutchulidwa kochepa kapena zosiyana ndi zomwe zinali ndi kuyambitsa kwa insulin yoyambira nyama.

Ndi matenda a shuga wamagazi, mwachitsanzo, chifukwa cha chithandizo champhamvu ndi insulin, zonse kapena mawonekedwe ena a hypoglycemia amatha, zomwe anthu ayenera kudziwitsidwa.

Zoyambirira za hypoglycemia zimatha kusintha kapena kukhala zofatsa pochiza matenda ashuga kapena kugwiritsa ntchito beta-blockers.

Zotsatira zoyipa zam'deralo zimatha kuyambika pazifukwa zosakhudzana ndi mphamvu ya mankhwalawa, mwachitsanzo, kuyambitsa khungu pakhungu ndi mankhwala kapena jakisoni wosayenera.

Nthawi zina, mapangidwe a zonse sayanjana, chithandizo chofunikira ndikofunikira. Desensitization kapena kusintha kwa insulini kungafunenso.

Ndi hypoglycemia mwa anthu, chidwi ndi kuthamanga kwa zomwe psychomotor zimatha kuchepa. Izi zitha kukhala zowopsa nthawi zomwe ntchitozi ndizofunikira. Mwachitsanzo, kuyendetsa galimoto kapena njira zosiyanasiyana.

Izi ndizofunikira kwambiri kwa anthu omwe ali ndi vuto losazindikira, lomwe ndi harbinger la hypoglycemia. Muzochitika izi, adotolo omwe amafunikira ayenera kuwunikira kufunika koyendetsa galimoto modekha. Kanemayo munkhaniyi ayankhula za mitundu ya insulin.

Insulin yopangidwa ndi chibadwa cha anthu ndi gawo la jakisoni yankho la matenda a shuga. Gwiritsani ntchito mankhwalawa mosamala, muyezo wokhazikitsidwa ndi mankhwala, apo ayi, phwando limadzala ndi zovuta kapena mankhwala osokoneza bongo. Kuphatikiza apo, adokotala ali ndi udindo wopereka mankhwala ndikuwachiza, popeza pali mitundu yambiri ya insulin, iliyonse yomwe ili ndi mawonekedwe enieni a zochita.

Genulin engineering insulin - ndi chiyani?

Insulin imakhudzana ndi ma metabolic ambiri a thupi la munthu, kotero zotsatira zazikulu zimawonekera pakuchepetsa katundu - zimatsitsa kuchuluka kwa shuga m'magazi. Komabe, pazifukwa zambiri, kapamba nthawi zambiri amaletsa kupangika kwa mahomoni, kenako insulin yopangidwa mwanjira ina.

Insulin yopangidwa mwabadwa imatha kulocha insulin yaumunthu, ndipo imapezedwa ndi mankhwala mwa kuphatikiza Escherichia coli kapena m'malo mwa amino acid ya mahomoni a porcine.

M'mbuyomu, hormoneyi idapangidwa kuchokera ku nyama zapancreatic, koma posakhalitsa njirayi idasinthidwa ndi kuphatikizidwa ndi mankhwala. Mankhwala opangidwa ndi nyama adakhalabe, koma amawonedwa ngati osagwira ntchito. Pakapangira mankhwala, pakakhala pano, mtundu wa osagwirizana ndi matenda a E. coli kapena yisiti umagwiritsidwa ntchito. Chifukwa chake pangani zosiyana. Makhalidwe abwino a ndalamazi ndi awa:

kutsatira kwa amino acid
zochita nthawi - ultrashort, yayifupi, nthawi yayitali komanso nthawi yayitali.

Kutalika kwa zochita za mankhwala

Njira yothetsera insulin imasiyana pakadutsa kachitidwe. Kusiyana pakati pa zida zomwe zalembedwa patebulo:

Ultrashort

4	Zotsatira zimachitika mkati mwa ola limodzi ndi theka	Apidra, Humalog
	Amaloledwa kulowa zonse musanadye komanso pambuyo pake
	Palibe chifukwa chokhalira kuluma kuti muchiritse
Mwachidule	5	Zotsatira zimachitika mkati mwa theka la ola	Actrapid, Insulin Rapid, Humodar
		Mankhwala chikuyendetsedwera mphindi 15 asanadye
		Mukufuna akamwe zoziziritsa kukhosi maola angapo jakisoni
Yapakatikati	12-16	Mphamvu ya machiritso amadziwika pambuyo pa maola 4-8	Protafan, Novomiks, Humulin NPH
		Zimafunikira kulowa m'mawa ndi madzulo
		Ntchito mtundu 1 shuga
Kuchita motalika	24	Mphamvu ya kuchiritsa pambuyo maola 4-6	"Monodar Long", "Levemir", "Ultralente"
		Kutsatira mahomoni achilengedwe
		Ntchito mtundu 2 shuga

Insulin yochepa: momwe mungabayitsire anthu mankhwala. Malangizo a insulin ya anthu oti agwiritse ntchito

Actrapid, Humulin, Insuran.

INN: Semi-yopanga insulin yaumunthu.

Kodi insulin yayifupi imagwira ntchito mpaka liti?

Ndi subcutaneous makonzedwe, mphamvu yayitali kwambiri ya mankhwalawa imawonedwa, yomwe imachitika pakadutsa mphindi 30 mpaka 40, nthawi yomwe chimbudzi cha chakudya chodyedwa chimachitika.

Mutatha kumwa mankhwalawa, nsonga ya insulin imatheka pambuyo pa maola awiri ndi atatu. Kutalika kumatengera mlingo womwe umaperekedwa:

ngati ma 4 UNITS - 6 UNITS, nthawi yodziwika bwino ndi pafupifupi maola 5,
ngati 16 mayunitsi kapena kupitilira apo, itha kufika maola 6-8.

Pambuyo pakutha kwa chochitikacho, mankhwalawa amachotsedwa m'thupi ndi mahomoni olimbana ndi mahomoni.

Pali zokonzekera zambiri za insulin, zomwe mankhwala omwe amapezeka patebulopo ndi otchuka kwambiri:

Zosindikizidwa zomwe zalembedwazo zimawoneka ngati zomangamanga pamtundu wa anthu, kupatula Monodar, womwe umatchedwa nkhumba. Amapezeka mu mawonekedwe a njira yosungunuka mumbale. Zonse zimapangidwa kuti zithandizire matenda a shuga amtundu 1 komanso 2. Nthawi zambiri zotchulidwa musanayambe mankhwala.

Mankhwala sanaperekedwe kwa azimayi oyembekezera komanso oyembekezera, chifukwa insulini yamtunduwu simalowa m'matumbo ndi mkaka wa m'mawere.

Izi ndi zomwe zapangidwa posachedwapa mu pharmacology. Amasiyana ndi mitundu ina yonse monga momwe zimakhalira nthawi yomweyo, ndikupanga shuga m'magazi. Mankhwala odziwika bwino ndi awa:

Mankhwalawa ndi fanizo la munthu la munthu. Ndiwothandiza panthawi yomwe muyenera kudya, koma kuchuluka kwake sikudziwika, pakakhala zovuta kudziwa kuchuluka kwa insulin yokumba. Mutha kudya kaye, kenako kuwerengera ndi kumwa mankhwalawo. Popeza zochita za insulin ndizothamanga, chakudya sichikhala ndi nthawi yokwanira.

Insulin iyi ya ultrashort idapangidwa kuti izigwiritsidwa ntchito pamene anthu omwe ali ndi matenda ashuga amaswa zakudya zawo ndikudya maswiti ambiri kuposa omwe adalimbikitsa. Nthawi zambiri muzochitika zotere mumakhala kuchuluka kwambiri kwa shuga, komwe kumatha kubweretsanso thanzi. Kenako mankhwalawa atha kuthandiza. Nthawi zina, pomwe wodwala sangathe kudikirira kwa mphindi 40, ndikulakwira chakudyacho kale, inshuwaransi yamtunduwu ikhoza kuphatikizidwanso.

Insulin yotereyi sikuti imaperekedwa kwa odwala omwe amatsatira malamulo onse azakudya. Nthawi zambiri, ngati ambulansi yokha yolumphira shuga.

Sipakhudzidwa mu amayi apakati omwe ali ndi matenda a shuga. Amaloledwa kugwiritsidwa ntchito, ngakhale pali toxosis ya mimba.

Phindu la ultrashort insulini ndikuti:

muchepetse kuchuluka kwa shuga m'magazi usiku, makamaka kumayambiriro kwa kutenga pakati,
thandizirani kusintha matendawa msanga mwa mayi woyembekezera panthawi ya cesarean,
kuchepetsa chiopsezo cha zovuta mukatha kudya.

Mankhwalawa ndi othandiza kwambiri mwakuti amatha kusinthitsa shuga pakanthawi kochepa, pomwe mlingowo umathandizidwa pang'ono, zomwe zimathandiza kupewa zovuta zingapo.

Momwe mungawerengere insulin yochepa - njira za anthu odwala matenda ashuga

Pali njira zingapo zowerengera mtundu umodzi wa insulin yochepa, womwe umapezeka pansipa:

Mlingo umodzi wothandizirana ndi insulin mwachidule samangotengera kuchuluka kwa shuga m'magazi, komanso zakudya zomwe zimamwa. Chifukwa chake, pakuwerengera nkoyenera kuganizira mfundo zotsatirazi:

Chiyeso cha chakudya chamoto ndi magawo a buledi (XE). Chifukwa chake, 1 XE = 10 g shuga,
Pa XE iliyonse muyenera kulowa gawo limodzi la insulin. Kuti muwerengedwe molondola kwambiri, tanthauzo lake limagwiritsidwa ntchito - 1 unit ya insulin imachepetsa mahomoni ndi 2.0 mmol / l, ndi 1 XE ya chakudya chamafuta imakwera ku 2.0 mmol / l, kotero pa 0.28 mmol / l iliyonse yomwe imaposa 8, 25 mmol / l, 1 unit ya mankhwala imayendetsedwa,
Ngati chakudyacho chilibe chakudya, kuchuluka kwa mahomoni m'magazi sikukwera.

Kuti kuwerengera kumakhala kosavuta, tikulimbikitsidwa kusunga zolemba motere:

Mawerengero Achitsanzo: Ngati mulingo wa glucose ndi 8 mmol / l musanadye, ndipo zakonzedwa kuti mudye 20 g ya chakudya chama carbohydrate kapena 2 XE (+4.4 mmol / l), ndiye kuti mutadya shuga mutha kufika pa 12,4, pomwe zizolowereka 6. Chifukwa chake, ndikofunikira kuyambitsa magawo atatu a mankhwalawa kotero kuti index ya shuga igwere ku 6.4.

Mlingo uliwonse wa insulin umasinthidwa ndi adotolo, koma sayenera kukhala apamwamba kuposa ma PIECES, omwe amawerengedwa pa kilogalamu imodzi ya kuchuluka kwake. Uwu ndiye mlingo waukulu.

Mankhwala osokoneza bongo amatha kubweretsa zovuta.

Nthawi zambiri, dokotala amatsatira malamulo otsatirawa:

Ngati matenda a shuga a mtundu woyamba wangopezedwa kumene, muyezo wosaposa 0,5 / kg mankhwala.
Ndikulipirira kwabwino chaka, mankhwalawa ndi 0.6 U / kg.
Ngati kusakhazikika kumawonedwa mu mtundu 1 wa shuga, shuga amasinthasintha, ndiye kuti 0,7 U / kg amatengedwa.
Ndi matenda a shuga ophatikizika, mlingo ndi 0.8 IU / kg.
Ndi ketacidosis, 0,9 U / kg amatengedwa.
Ngati pakati mu trimester yomaliza ndi mayunitsi 1.0 / kg.

Mitundu yonse ya insulin nthawi zambiri imayendetsedwa chimodzimodzi asanadye. Ndikulimbikitsidwa kuti musankhe madera amthupi la munthu pomwe mitsempha yayikulu ya magazi siyidutsa, pali ma amana amafuta ochepa.

Ndi makonzedwe a venous, zochita za insulin zidzakhala nthawi yomweyo, zosavomerezeka pamankhwala amasiku onse. Chifukwa chake, kuyamwa kwa mankhwalawa kumalimbikitsidwa, zomwe zimapangitsa kuti mayendedwe a insulin ayambe kulowa m'magazi.

Mutha kusankha pamimba, koma osangolimbitsa mkati mwa masentimita 6 kuchokera ku navel. Pamaso jakisoni, muyenera kutsuka malowa ndikusamba m'manja ndi sopo ndikuuma. Konzani chilichonse chomwe chikufunika munjira yake: syringe yotayidwa, botolo lomwe lili ndi mankhwala komanso pedi. Onetsetsani kuti mwamaliza bwanji!

Chotsatira, muyenera kutsatira malangizo awa:

Chotsani kapu ku syringe, ndikusiya kapu ya mphira.
Chitani ndi singano ndi mowa ndikuyika mosamala mu botolo ndi mankhwala.
Sonkhanitsani kuchuluka kwa insulin.
Tulutsani singano ndikutulutsa mpweya, kutsogoza wopondayo mpaka dontho la insulin lithe.
Ndi chala chachikulu ndi chofiyira, tengani kachikopa kakang'ono. Ngati subcutaneous mafuta wosanjikiza ndi wandiweyani, ndiye kuti timayambitsa singano pamakona madigiri 90, ndi yopyapyala - singano ndiyofunika kupendekeka pang'ono pakona madigiri 45. Kupanda kutero, jekeseni sangakhale wosinjirira, koma wamitsempha. Ngati wodwalayo alibe kulemera kwambiri, ndibwino kugwiritsa ntchito singano yopyapyala komanso yaying'ono.
Pang'onopang'ono komanso bwino insulin. Kuthamanga kuyenera kumayendera yunifolomu pakukonzekera.
Syringe ikapanda kanthu, chotsani singano yomweyo pansi pa khungu ndikumasula khola.
Ikani kapu yoteteza pa singano ya syringe ndikuitaya.

Simungakhale malo amodzi nthawi zonse, ndipo mtunda kuchokera pa jakisoni wina kupita kwina uzikhala wa masentimita awiri. Majekeseni enanso: koyambirira m'ntchafu imodzi, kenako kwina, kenako kumatako.Kupanda kutero, kuphatikizika kwamafuta kumatha kuchitika.

Kuchuluka kwa mahomoni kumadalira kusankha malo. Mofulumira kuposa zonse, insulin imatengedwa kuchokera kukhoma lakutsogolo kwa m'mimba, kenako mapewa ndi matako, ndipo pambuyo pake kuchokera kutsogolo kwa ntchafu.

Ndikofunika kubayira m'mimba, kuti chochitikacho chichitike mwachangu akangodya.

Kuti mudziwe zambiri zamomwe mungagwiritsire ntchito kupatsa insulin, onani nkhani iyi kapena kanema wotsatira:

Pomaliza, ndikofunikira kudziwa kuti simungathe kusankha nokha mankhwala osankha mwachidule, kusintha mlingo wake popanda mankhwala a dokotala. Ndikofunikira kukhazikitsa, pamodzi ndi endocrinologist, dongosolo la kayendetsedwe kake malinga ndi regimen ndi kuchuluka kwa chakudya chomwe chimatengedwa. Ndikofunika kuti musinthe nthawi zonse jakisoni, sungani bwino mankhwalawo, onani masiku omwe atha. Ndipo pakusintha pang'ono komanso zovuta, funsani dokotala.

Insulin yochita mwachidule ndi mahomoni enaake omwe amafunikira kuwongolera kuchuluka kwa shuga m'magazi. Imayambitsa ntchito ya magawo a kapamba nthawi yayifupi, ndipo imasungunuka kwambiri.

Mwachizolowezi, insulini yokhala ndi nthawi yochepa imaperekedwa kwa anthu omwe gawo lamtunduwu wa endocrine amatha kupangidwira mahomoni mosadalira. Kuphatikizika kwakukulu kwa mankhwalawa m'magazi kumadziwika pambuyo pa maola awiri, kumachotsedwa kwathunthu m'thupi mkati mwa maola 6.

Mthupi la munthu, magawo amtundu wa kapamba ndi omwe amapanga insulin. Popita nthawi, ma cell a beta samatha kugwira ntchito zawo, zomwe zimapangitsa kuti magazi azikhala ndi shuga ambiri.

Insulin yochepa ikamalowa m'thupi, imayambitsa zomwe zimapangitsa kuti shuga azigwira. Izi zimathandiza kuti shuga asanduke shuga ndi mafuta. Komanso, mankhwalawa amathandizira kukhazikitsa mayamwidwe a shuga m'magazi a chiwindi.

Dziwani kuti mankhwala ngati amenewo mapiritsi sangabweretse mtundu uliwonse wa matenda ashuga 1. Poterepa, zigawo zomwe zimagwira zimagwera kwathunthu m'mimba. Pankhaniyi, jakisoni ndikofunikira.

Kuti musamavutike kuyendetsa ntchito ma syringes, ma syringes kapena mapampu a insulin amawaika. Insulin yofupikitsa imapangidwira zochizira matenda a shuga m'magawo oyamba.

Kuti chithandizo cha insulin chochepa chikhale chothandiza momwe mungathere, malamulo ena angapo ayenera kutsatira:

Kubaya jekeseni ndikofunikira musanadye.
Jekeseni imaperekedwa pakamwa pofuna kupewa.
Kuti insulini imamwidwe wogawana, tsamba la jakisoni liyenera kutetezedwa kwa mphindi zingapo.
Kumbukirani kuti kusankha kwa mankhwala omwe ali ndi ntchito kuyenera kuperekedwa ndi adokotala okha.

Mlingo uliwonse wa insulin yochepa uyenera kuwerengera aliyense payekhapayekha. Kuti muchite izi, odwala ayenera kudziwa bwino ulamuliro. Mlingo umodzi wa mankhwalawa amapangira chakudya, chomwe ndi chofanana mumtengo umodzi.

Yesaninso kutsatira malangizo awa:

Ngati kuchuluka kwa shuga m'magazi ndikwabwinobwino, ndiye kuti kuchuluka kwake kwa mankhwalawa kuti muchepetse kukhala zero. Mlingo wa zomwe zimagwiritsidwa ntchito umatengedwa kutengera kuchuluka kwa mikate yomwe amafunika kukonzedwa.
Ngati mulingo wa glucose ndiwokwera kwambiri kuposa wabwinobwino, ndiye kuti pa gawo lililonse la mkate liyenera kukhala ma 2 a insulin. Pankhaniyi, muyenera kulowa nawo musanadye.
Panthawi ya matenda opatsirana kapena pakutupa, Mlingo wa insulin ukuwonjezeka ndi 10%.

Posachedwa, anthu adabayidwa pokhapokha ndi insulin yopanga, yomwe ili yofanana kwambiri ndi zochita za anthu. Ndiotsika mtengo kwambiri, motetezeka, sizoyambitsa mavuto. Ma hormone a nyama omwe adagwiritsidwa ntchito kale - omwe amachokera m'magazi a ng'ombe kapena nkhumba.

Mwa anthu, nthawi zambiri ankayambitsa mavuto osiyanasiyana.Insulin yokhala ndi nthawi yochepa imapangidwira kuti imathandizira kupanga zachilengedwe pancreatic insulin. Pankhaniyi, munthu ayenera kudya chakudya chokwanira kuti asataye mtima kwambiri m'magazi.

Ndizosatheka kunena mosasamala kuti ndi insulin yochepa ndiyiti yabwino. Dokotala m'modzi yekha ndiye ayenera kusankha izi kapena mankhwalawa. Adzachita izi ataphunziridwa mozama. Pankhaniyi, ndikofunikira kuganizira zaka, jenda, kulemera, kuuma kwa matendawa.

Ubwino wakutsata insulini yochepa ndikuti umayamba kugwira ntchito mkati mwa mphindi 15-20 pambuyo pa kuperekedwa. Komabe, imagwira ntchito kwa maola angapo. Mankhwala odziwika bwino ndi Novorapid, Apidra, Humalag.

Insulin yogwira ntchito yayifupi imagwira ntchito kwa maola 6-8, zonse zimatengera wopanga ndi mlingo wa chinthu chomwe chikugwira. Yake kwambiri mumagazi amapezeka patatha maola 2-3 pambuyo pake.

Magulu otsatirawa a insulin ndi omwe amadziwika:

Umisiri wa Majini - Rinsulin, Actrapid, Humulin,
Zopanga - Biogulin, Humodar,
Monocomponent - Monosuinsulin, Actrapid.

Ndizosatheka kunena mosasamala kuti ndi insulin yochepa ndiyiti yabwino. Mankhwala ena ayenera kuperekedwa mwa njira iliyonse ndi dokotala. Komanso, onse ali ndi Mlingo wosiyanasiyana, kutalika kwa zochita, zoyipa ndi zoyipa.

Ngati mukufunika kusakaniza ma insulin osiyanasiyana nthawi, muyenera kusankha mankhwala kuchokera kwa omwewo. Chifukwa chake zidzakhala zothandiza kwambiri ngati zikugwiritsidwa ntchito limodzi. Musaiwale kudya utatha mankhwala kuteteza chitukuko cha matenda ashuga.

Nthawi zambiri, insulin imapangidwira kukonzekera kwa ntchafu, ntchafu, kutsogolo, kapena pamimba. Nthawi zina, makonzedwe a intramuscular kapena intravenous amasonyezedwa. Odziwika kwambiri ndi makatiriji apadera, omwe amatha kulowa nawo mankhwalawa.

Jakisoni wotsekemera uyenera kuchitika kwa theka la ola kapena ola limodzi asanadye. Popewa kuvulaza khungu, tsamba la jakisoni limasinthasintha. Mukatha kubaya, pukuta khungu lanu kuti lifulumire njira yoyendetsera.

Yesetsani kuchita chilichonse mosamala kuti zoteteza zisalowe m'mitsempha yamagazi. Izi zimabweretsa kumverera kowawa kwambiri. Ngati ndi kotheka, insulini yocheperako imatha kusakanikirana ndi mahomoni ofananawo. Pankhaniyi, kuchuluka kwa jekeseni ndi kapangidwe kake ka majakisidwe kuyenera kusankhidwa ndi adokotala.

Akuluakulu omwe ali ndi matenda a shuga amatenga magawo 8 mpaka 24 a insulin tsiku lililonse. Pankhaniyi, mlingo umatsimikiziridwa malinga ndi chakudya. Anthu omwe ali ndi hypersensitive to zigawo zikuluzikulu, kapena ana sangatenge zosaposa ma Uniti 8 patsiku.

Ngati thupi lanu silikuwona bwino timadzi tambiri, ndiye kuti mutha kumwa mankhwala ambiri. Kumbukirani kuti kusuntha kwa tsiku ndi tsiku sikuyenera kupitirira 40 Misonkhano patsiku. Pafupipafupi kugwiritsa ntchito pamenepa maulendo 800, koma ngati kuchepetsedwa ndi insulin yayitali - pafupifupi 3.

Ngati munthu wakhala akutenga insulin yocheperako kwa nthawi yayitali, ndipo pakali pano pakufunika kuti amusinthe kuti amuchiritse ndi mahomoni ofananawo a nthawi yayitali, amatumizidwa kuchipatala. Kusintha konse kuyenera kuyang'aniridwa ndi ogwira ntchito pachipatala.

Chowonadi ndi chakuti zochitika ngati izi zimatha kupangitsa kuti acidosis ikhale ndi matenda osokoneza bongo kapena matenda ashuga. Njira zoterezi ndizowopsa kwa anthu omwe ali ndi vuto laimpso kapena chiwindi.

Insulin yochepa pakapangidwe kake monga mankhwala ili pafupifupi chimodzimodzi ndi zomwe zimapangidwa ndi thupi la munthu.Chifukwa cha izi, mankhwalawa nthawi zambiri samayambitsa matupi awo sagwirizana. Nthawi zina, anthu amamva kuyabwa ndikusokonekera pamalo opangira jakisoni wa chinthucho.

Akatswiri ambiri amalimbikitsa kubaya insulin m'mimba. Chifukwa chake amayamba kuchita zinthu mwachangu kwambiri, ndipo mwayi wolowa m'magazi kapena mitsempha ndi wochepa kwambiri. Kumbukirani kuti pambuyo pa mphindi 20 pambuyo pa jakisoni muyenera kudya kanthu kena kokoma.

Ola limodzi pambuyo jakisoni ayenera kukhala chakudya chokwanira. Kupanda kutero, mwayi wokhala ndi vuto la hypoglycemic ndiwambiri. Munthu amene amapatsidwa insulin ayenera kudya bwino komanso mokwanira. Zakudya zake ziyenera kukhazikitsidwa ndi zakudya zomanga thupi zomwe zimadyedwa ndi masamba kapena chimanga.

Ngati mutaba jakisoni wambiri, palinso chiopsezo chokhala ndi vuto la hypoglycemic motsutsana ndi kuchepa kwakukulu kwa ndende yamagazi.

Mutha kuzindikira kukula kwazomwe zikuwonetsedwa:

Njala yayikulu
Kusanza ndi kusanza
Kuzunguzika
Mdima m'maso
Chisokonezo
Kuchulukitsa thukuta
Zosangalatsa pamtima
Kumverera kwa nkhawa komanso kusakwiya.

Ngati mukuwona kuti muli ndi vuto limodzi la insulin yocheperako, muyenera kumwa nthawi yomweyo tiyi wotsekemera momwe mungathere. Zizindikiro zikafooka, gwiritsani ntchito gawo lalikulu la mapuloteni ndi chakudya. Mukachira pang'ono mudzasowa kugona.

Kumbukirani kuti kugwiritsa ntchito insulin posakhalitsa pamafunika kutsatira malamulo ena.

Muyenera kusunga mankhwalawo mufiriji, koma osati mufiriji,
Mbale zotseguka sizisungidwa,
M'mabokosi apadera ndizovomerezeka kusunga insulin yotseguka kwa masiku 30,
Ndi zoletsedwa kusiya insulini padzuwa lotseguka,
Osasakaniza mankhwalawa ndi mankhwala ena.

Musanagwiritse ntchito mankhwalawa, onetsetsani ngati madzi akutuluka, ngati madzi akungoterera. Komanso nthawi zonse muziyang'anira kutsatira malo osungira, komanso tsiku lotha ntchito. Izi zokha ndizomwe zithandiza kusunga moyo ndi thanzi la odwala, komanso sizingalole kukula kwazovuta zilizonse.

Ngati pali zoyipa zilizonse chifukwa chogwiritsa ntchito, muyenera kufunsa dokotala, chifukwa kukana kugwiritsa ntchito insulin kungayambitse zotsatira zoyipa kwambiri.

Nthawi zambiri, insulin yochepa imagwiritsidwa ntchito pomanga thupi. Zimawonjezera magwiridwe antchito ndi kupirira kwa munthu, komanso zimagwiritsidwa ntchito pakuuma. Mwa zabwino zosakayikira za mankhwalawa, munthu amatha kusiyanitsa kuti palibe mayeso amodzi omwe amatha kudziwa chinthu chomwechi m'magazi - chimasungunuka ndikulowa kapamba.

Dziwani kuti ndizoletsedwa kudzipereka nokha mankhwalawa, izi zimatha kubweretsa zotsatirapo zovuta, monga kuwonongeka m'moyo wabwino kapena kufa. Anthu omwe amamwa insulin amayenera kupereka magazi pafupipafupi kuti aziyang'anira kuchuluka kwa shuga.

Mwachangu insulin, mitundu yake ndi kufunika kwake pochiza matenda ashuga

Gwero lofunikira lamphamvu kwa anthu ndi chakudya chopatsa mphamvu, chomwe chimakhudzidwa ndimayendedwe ambiri m'maselo a thupi. Ngakhale zabwino zonse, zochulukirapo zimakhala ndi zovuta za metabolic zamitundu mitundu.

Zotsatira zake ndi kusintha kosasintha mu ziwalo zamkati ndi ntchito zomwe iwo amachita. Mkhalidwe wamoyo ukuipiraipira kwambiri, ndipo kukhazikitsidwa kwa zochitika za tsiku ndi tsiku kumakhala ntchito yosatheka. Mavuto omwewo amawonekera chifukwa chogwiritsa ntchito molakwika kapamba, m'malo ovuta.

Maselo a beta sangathe kutulutsa timadzi tambiri timagulu tambiri timene timayang'anira kuchuluka kwa shuga, poganizira miyambo yomwe imagwirizana ndi thupi.Akatswiri amatcha njirayi insulin.

Mankhwala omwe amapezeka ndi mtundu wina wa matenda a shuga omwe amadalira insulin, dokotala yemwe akupezekapo akhoza kukupatsani mankhwala a insulin omwe angokhala nthawi yayitali komanso mayankho a insulin, mayina ndi opanga omwe adzaperekedwe mu nkhaniyi.

Insulin ndi yomwe imapangitsa kuchepetsa shuga m'magazi.

Nthawi yomweyo, nthawi yonse yotsala (zakudya zakunja), thupi limasunthira lokha kuzunzidwa kofunikira. Mu shuga, munthu payekha amakakamizidwa kuti azisungabe izi pogwiritsa ntchito mankhwala.

Ndikofunikira. Mlingo woyenera wa mitundu yosiyanasiyana ya insulini amasankhidwa malinga ndi lingaliro la adokotala potengera momwe wodwalayo alili, mbiri ya matendawa, mayeso a labotale, ndi moyo wawo.

Kugwira kwathunthu kwa kapamba mwa munthu wathanzi kumalola thupi kuyendetsa kagayidwe kazakudya nthawi yokhazikika masana. Komanso kuthana ndi katundu wamafuta mukamadya kapena njira zopatsirana ndi zotupa m'matenda.

Chifukwa chake, kuti tisungitse shuga m'magazi, timadzi timene timakhala ndi katundu wofanana, koma kuthamanga kwina, timafunikira. Tsoka ilo, pakadali pano, sayansi sinapeze yankho lavutoli, koma chithandizo chovuta ndi mitundu iwiri ya mankhwala monga insulin yayitali komanso yayifupi yakhala chipulumutso kwa odwala matenda ashuga.

Tebulo 1. Mndandanda wa mitundu yosiyanasiyana ya insulin:

Kuphatikiza pazomwe zili pamwambazi, palinso zinthu zina za insulin, ndiye kuti, kuyimitsidwa, komwe kumakhala ndi mahomoni onse awiri. Kumbali imodzi, izi zimachepetsa kwambiri kuchuluka kwa jakisoni wofunidwa ndi wodwala matenda ashuga, omwe ndi kuphatikiza kwakukulu. Komabe, pankhaniyi, ndikovuta kukhala ndi kagayidwe kazachilengedwe.

Mukamagwiritsa ntchito mankhwalawa, ndikofunikira kukhazikitsa chakudya chamagulu ochepa, masewera olimbitsa thupi, moyo wambiri. Ichi ndichifukwa chosatheka kusankha kuchuluka kwa mtundu wa insulin pakadali pano wofunikira.

Nthawi zambiri, timadzi tambiri timene timayambira kumbuyo timatchulidwanso kuti maziko. Kudya kwake kumapereka thupi kwa insulin kwa nthawi yayitali.

Amatuluka mu minofu ya pang'onopang'ono, pang'onopang'ono, mphamvu yogwira imakuthandizani kuti mukhale ndi shuga mkati mwazonse tsiku. Monga lamulo, zosaposa jakisoni katatu patsiku ndizokwanira izi.

Malinga ndi kutalika kwa nthawi, agawidwa m'mitundu itatu:

Kutalika kwapakati. Hormoni imayamba kugwira ntchito pambuyo pa 1.5 mawola ambiri atakhazikitsa mankhwala, motero, jekeseni pasadakhale. Poterepa, mphamvu ya thunthu limapezeka osakwana maola 3-12. Nthawi yochitidwa kuchokera kwa wogwiritsa ntchito sing'anga yayambira maola 8 mpaka 12, choncho, wodwala matenda ashuga ayenera kugwiritsa ntchito katatu katatu kwa maola 24.
Kuwonetsedwa nthawi yayitali. Kugwiritsa ntchito njira yamtunduwu kwakukhalitsa kwa ma horoni kungakupatseni chiyambi cha timadzi tambiri tomwe timatha kukhalabe ndi shuga tsiku lonse. Kutalika kwa kuchitapo kwake (maola 16-18) ndikokwanira pamene mankhwalawa amathandizira m'mimba popanda kanthu komanso madzulo asanagone. Mtengo wapamwamba kwambiri wa mankhwalawa ndi wa maola 16 mpaka 20 kuchokera nthawi yomwe umalowa m'thupi.
Wopatsa chidwi kwa nthawi yayitali. Oyenera makamaka kwa okalamba ndi anthu olumala omwe amapatsidwa nthawi yayitali ya zinthu (maola 24 mpaka 36), ndipo, kutsika kwa kayendetsedwe ka kayendetsedwe kake (1 p. Mu maola 24). Kuchitikaku kumayambira maola a 6-8, ndi chiwonetsero chazinthu zambiri mkati mwa maola 16 mpaka 20 mutalowa mu minofu ya adipose.

Chithandizo cha insulin chimaphatikizapo kutsata zachilengedwe zobisika za mahomoni pogwiritsa ntchito mankhwala. Tsoka ilo, ndizosatheka kukwaniritsa zowonetsa bwino pogwiritsa ntchito mtundu umodzi wokha wamtundu wokhala ndi ma hormone.Ichi ndichifukwa chake ma insulin osakhalitsa sakhala ofunikira kwenikweni.

Dzinalo la mtundu uwu wa mahomoni limadzilankhulira lokha.

Mosiyana ndi mankhwala omwe akhala akugwira ntchito kwa nthawi yayitali, omwe amafupikitsidwa amapangidwa kuti abwezere kuthamanga kwa glucose m'thupi chifukwa cha zinthu monga:

kudya
kuchita masewera olimbitsa thupi mopitirira malire
kukhalapo kwa njira zopatsirana ndi zotupa,
kupsinjika kwakukulu ndi zinthu.

Kugwiritsa ntchito zakudya zamagulu mu chakudya kumawonjezera chidwi chawo m'magazi ngakhale akumamwa insulini yayikulu.

Pofika nthawi yayitali, mahomoni ochita zinthu mwachangu amagawidwa m'magulu awiri:

Mwachidule. Kukonzekera kwanthaŵi yochepa ya insulin pambuyo pa makonzedwe kumayamba kugwira ntchito pasanathe mphindi 30-60. Kukhala ndi chiwopsezo chokwera kwambiri, nsonga ya kukhathamira kopambana imakwaniritsidwa patatha maola 2-4 mutatha kumwa. Malinga ndi kuyerekezera kwapakati, zotsatira za mankhwalawa sizimatha maola opitilira 6.
Ultrashort insulin. Analogue yosinthidwa iyi ya mahomoni amunthu ndiwosiyana ndi ena chifukwa amatha kuchita zinthu mwachangu kuposa insulin. Patha mphindi 10-15 pambuyo pa jekeseni, chinthu chogwira ntchito chimayamba kugwira ntchito yake pakhungu ndipo izi zimachitika patadutsa mawola atatu mutabadwa. Zotsatira zimatha kwa maola 3-5. Kuthamanga komwe njira yothetsera mankhwala a ultrashort imalumikizidwira m'thupi, kumakulolani kuti mumwe musanadye kapena mutangomaliza kumene.

Ndikofunikira. Kukhazikika kwa zochita za wodwala matenda ashuga kuyenera kuyenderana ndi nthawi ya chimbudzi cha chakudya ndi mayamwidwe a chakudya kuchokera pamenepo. Nthawi ya kukhazikitsidwa kwa mankhwalawa, poganizira mtundu wa insulin ndi katundu wa thupi ndi chakudya chamagulu, muyenera kuvomerezana.

Kusankhidwa kwa hormone yoyenera kugwiritsidwa ntchito kumangokhala payekha, monga momwe zimakhalira pa mayeso a labotale, kuchuluka kwa matenda a munthu wodwala matenda ashuga, mbiri yathunthu, moyo wawo. Chosafunikira kwenikweni ndi mtengo wa mankhwalawo, chifukwa cha momwe amagwiritsidwira ntchito. Monga lamulo, iwo umachulukana mosiyanasiyana molingana ndi zovuta za kupanga kwa mankhwala, dziko lopangira, kulongedza.

Zomwe zimachitika posankha insulin. Mankhwala otchuka kwambiri

Kuchokera pazomwe zili mu gawo lapitalo la nkhaniyi, zikuwonekeratu kuti insulin yochepa ndiyani, koma osati nthawi yokhayo ndi kuthamanga kwake ndikofunikira. Mankhwala onse ali ndi mawonekedwe awo, analogue ya human pancreatic hormone sichili choncho.

Mndandanda wazinthu zamankhwala omwe muyenera kulabadira:

gwero la chiphaso
digiri ya kuyeretsa
kusamalira
pH ya mankhwalawa
wopanga ndi kusakaniza katundu.

Chifukwa chake, mwachitsanzo, analogue ya komwe nyama zimapangidwa ndikuchiritsa kapamba wa nkhumba ndikuyeretsa. Mankhwala opangidwa ndi theka, nyama zomwezi zimatengedwa ngati maziko ndipo pogwiritsa ntchito njira ya kusintha kwa enzymatic, insulin imapezeka pafupi ndi zachilengedwe. Tekinoloje izi nthawi zambiri zimagwiritsidwa ntchito ngati timadzi tambiri.

Kupanga mainjiniya kwapangitsa kuti zibwererenso maselo enieni a insulin yaumunthu omwe amapangidwa kuchokera ku Escherichia coli ndi kusintha kwasinthidwe. Ma mahormoni a Ultrashort nthawi zambiri amatchedwa okonzekera chibadwa cha insulin.

Zovuta kwambiri kupanga zothetsera zimayeretsedwa kwambiri (chopanga-mono). Zopanda zodetsa zambiri, ndizochulukirapo ndipo zimachepetsa zolakwika pakugwiritsa ntchito. Chiwopsezo cha mawonekedwe awomwe amagwiritsidwa ntchito pogwiritsa ntchito analogue ya hormone imachepetsedwa.

Kukonzekera kwa njira zosiyanasiyana zopangira, mitengo yowonekera, mafakitale, mitundu, ikhoza kuyimiridwa ndi kutsata kosiyanasiyana. Chifukwa chake, gawo lomwelo la insulin ingagwiritsidwe ntchito syringe.

Kugwiritsa ntchito mankhwala osokoneza bongo acidity ndikofunikira, izi zimapewe zomverera zosasangalatsa pamalo opangira jekeseni. Komabe, mtengo wa ndalama zotere umakhala wokwera kwambiri kuposa acidic.

Popeza kunja, sayansi ili patsogolo kwambiri pa sayansi yam'nyumba, ndizovomerezeka kuti makhwala ochokera kumayiko otukuka ndiwabwino komanso othandiza. Katundu wofunikira kuchokera kwa opanga odziwika ndiwotsika mtengo kwambiri.

Ndikofunikira. Chofunika kwambiri pakulimbitsa mankhwala a insulin si dziko lomwe limapangidwira, momwe mankhwalawo amagwiritsidwira ntchito ndi kugwiritsidwa ntchito kwawo pogwiritsa ntchito mahomoni atali ndi aafupi.

Mankhwala otchuka kwambiri achidule achidule

Popeza kuti chamoyo chilichonse chimachita chilichonse payekha ndipo chitha kupezeka ndi mankhwala amtundu wina kapena wina akhoza kusiyanasiyana. Pogwiritsa ntchito regimen ya insulin, momwe mankhwalawa amathandizidwa katatu patsiku musanadye, odwala matenda ashuga nthawi zambiri amagwiritsa ntchito mayina amafupikidwe a insulin, omwe amaperekedwa pagome.

Tebulo No. 2. Mndandanda wa othandizira odwala matenda a shuga nthawi zambiri amauza akatswiri.

Ochita zinthu mwachidule: mayina a mankhwala ndi njira yogwiritsira ntchito

Insulin ndi mahomoni omwe amapangidwa ndi ma cell a endocrine a kapamba. Ntchito yake yayikulu ndikusunga carbohydrate bwino.

Kukonzekera kwa insulini kumaperekedwa kwa odwala matenda ashuga. Vutoli limadziwika ndi kuperewera kwakwanira kwa mahomoni kapena kuphwanya kwake kuchitapo mu zotumphukira zimakhala. Mankhwala amasiyana mu kapangidwe ka mankhwala ndi kutalika kwa zotsatira zake. Mitundu yayifupi imagwiritsidwa ntchito kuchepetsa shuga yemwe wakudya ndi chakudya.

Insulin imalembedwa kuti imasinthasintha kuchuluka kwa shuga m'magawo osiyanasiyana a shuga. Zowonetsa kugwiritsa ntchito mahomoni ndi mitundu yotsatirayi yamatenda:

Mtundu woyamba wa shuga wokhudzana ndi kuwonongeka kwa autoimmune ku maselo a endocrine komanso kukula kwa kuperewera kwathunthu kwa mahomoni,
Mtundu Wachiwiri, womwe umadziwika ndi kusowa kwa insulini chifukwa cha chilema pakuphatikizika kwake kapena kuchepa kwa chidwi cha zotumphukira pazomwe zimachitika,
matenda amishuga azimayi apakati
kapamba mawonekedwe a matendawa, omwe amayamba chifukwa cha pancreatitis yovuta kapena yopweteka,
Mitundu yopanda chitetezo cha matenda - matenda am'magazi a Wolfram, Rogers, MODY 5, matenda a neonatal shuga ndi ena.

Kuphatikiza pa kuchepa kwa shuga, kukonzekera kwa insulin kumakhala ndi mphamvu ya anabolic - amathandizira pakukula kwa minofu ndikupanga mafupa. Katunduyu amagwiritsidwa ntchito pomanga thupi. Komabe, mu malangizo omwe angagwiritsidwe ntchito, chizindikirochi sichinalembetsedwe, ndipo kuyendetsa mahomoni kwa munthu wathanzi kumawopseza kuponya kwakuthwa kwa magazi - hypoglycemia. Zinthu zoterezi zimatha kutsatiridwa ndi kusokonezeka kwa chikumbumtima ndi imfa.

Kutengera njira yopangira, kukonzekera kwamtundu wa chibadwidwe ndi kufanana kwa anthu kumayesedwa. Kupanga kwamankhwala kumapeto kumakhala kwachilengedwe, chifukwa kapangidwe kazinthu kazinthu izi ndizofanana ndi insulin yaumunthu. Mankhwala onse amasiyana pakapita nthawi.

Masana, mahomoni amalowa m'magazi othamanga mosiyanasiyana. Secretion yake yoyambira imakupatsani mwayi wokhala ndi shuga wokhazikika mosasamala zakudya. Kutulutsa kwa insulin komwe kumachitika pakudya. Poterepa, kuchuluka kwa glucose omwe amalowa mthupi ndi zakudya zomwe zimakhala ndi zakudya zamafuta amachepetsa. Ndi shuga, njira izi zimasokonekera, zomwe zimabweretsa zotsatirapo zoyipa. Chifukwa chake, chimodzi mwazinthu zothandizira kuchiritsa matendawa ndikobwezeretsa mtundu woyenera wa kutulutsidwa kwa ma cell m'mwazi.

Katizidwe katemera wa insulin

Ma insulin omwe amagwira ntchito mwachidule amagwiritsidwa ntchito poyeserera katulutsidwe wamahomoni omwe amakhudzidwa ndi zakudya.Gawo lakumbuyo limathandizidwa ndi mankhwala omwe ali ndi zochita zazitali.

Mosiyana ndi mankhwala othamanga kwambiri, mitundu yowonjezereka imagwiritsidwa ntchito mosasamala chakudya.

Gulu la insulin limafotokozedwa pagome:

Fadeeva, Matenda a Anastasia. Kupewa, chithandizo, zakudya / Anastasia Fadeeva. - M: Buku la Demand, 2011. - 176 c.
Kasatkina E.P. Matenda a shuga ana. Moscow, yosindikiza nyumba "Mankhwala", 1990, 253 pp.
Watkins, Peter J. Matenda a shuga mellitus / Watkins, Peter J. .. - M .: Beanom. Laborator of Chidziwitso, 2006. - 758 c.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusayiti, kukambirana ndi akatswiri ndizofunikira nthawi zonse.

Kugwiritsa ntchito insulin yaumunthu

Kukhala bwino komanso thanzi la munthu wodwala matenda ashuga kumatengera malamulo ogwiritsa ntchito mankhwalawa. Mlingo ndi chithandizo ziyenera kuyang'aniridwa mwachindunji ndi dokotala. Kugwiritsa ntchito moyenera mankhwalawa kutengera malamulo otsatirawa.

Insulin ndi mankhwala ofunikira, yasintha miyoyo ya anthu ambiri omwe ali ndi matenda ashuga.

Mankhwala

Insulin yaumunthu ndi insulin yomwe ikukonzekera njira yolandirira ukadaulo wa DNA. Insulin yaumunthu imayang'anira kuchuluka kwa shuga m'magazi, kuchuluka kwa kagayidwe kazakudya, mafuta, mapuloteni m'magulu a ziwongo (mafupa amkati, chiwindi, minofu ya adipose). Insulin yaumunthu imatha kupanga anabolic komanso anti-catabolic. Mu minofu ya minofu, pali kuchuluka kwa glycerol, glycogen, mafuta acids, kuchuluka kwa mapuloteni komanso kuwonjezereka kwa kumwa ma amino acid, koma kuchepa kwa gluconeogeneis, lipolysis, glycogenolysis, ketogeneis, proteinabolism ndi kumasulidwa kwa amino acid. Insulin yaumunthu imamangirira ku membrane receptor (tetramer, yomwe imakhala ndi zigawo 4, 2 zomwe (beta) zimamizidwa mu membala wamtundu wa cytoplasmic ndipo zimayendetsa ntchito ya tyrosine kinase, ndipo zina ziwiri (alpha) ndi extramembrane ndipo zimayambitsa insulin receptor complex, zomwe zimadutsa Autophosphorylation. Vutoli limapangika mu maselo olimba a phosphorylates threonine ndi malekezero a serine a protein kinases, omwe amatsogolera pakupanga kwa phosphatidylinositol glycan ndipo amayambitsa phosphorylation, yomwe imayambitsa ntchito ya enzymatic m'maselo omwe akufuna. M'misempha ndi minyewa ina (kupatula ubongo), imalimbikitsa kusuntha kwamphamvu kwa glucose ndi amino acid, imachepetsa mphamvu ya mapuloteni, ndikuwonjezera njira zopangira. Insulin yaumunthu imalimbikitsa kuchuluka kwa shuga mu chiwindi monga glycogen ndipo amalepheretsa glycogenolysis (gluconeogeneis). Kusiyana kwamwini pantchito ya insulin kumadalira mlingo, jakisoni malo, zochitika zolimbitsa thupi za wodwala, zakudya ndi zina.
The mayamwidwe a insulin ya anthu zimatengera njira ndi malo oyang'anira (ntchafu, pamimba, matako), insulin, kuchuluka kwa jakisoni.Insulin yaumunthu imagawidwa mosiyanasiyana m'thupi lathu, sililowa mkaka wa m'mawere komanso kudzera mu chotchinga chachikulu. Kuwonongeka kwa mankhwalawa kumachitika m'chiwindi pochita insulinase (glutathione-insulin transhydrogenase), yomwe hydrolyzes imasokoneza mgwirizano pakati pa unyolo A ndi B ndikuwapangitsa kuti azitha kupezeka ndi ma enzymes a proteinolytic. Insulin ya munthu imachotsedwanso ndi impso (30 - 80%).

Lembani 1 ndi mtundu 2 wa matenda a shuga omwe amafunikira mankhwala a insulin (motsutsana ndi mankhwala amkamwa a hypoglycemic kapena mankhwala ophatikizika, zinthu zomwe zimagwirizana), matenda a shuga nthawi yayitali.

Mlingo ndi makonzedwe a insulin ya anthu

Njira makonzedwe a mankhwala zimatengera mtundu wa insulin. Dokotala amakhazikitsa mlingo payekhapayekha, kutengera mlingo wa glycemia.
Jekeseni wotsekemera amachitika m'chigawo cha mpanda wam'mimba, ntchafu, phewa, matako. Masamba a jakisoni ayenera kusinthidwa kuti malo omwewo sawagwiritsidwanso ntchito kangapo kamodzi pamwezi. Ndi subulinaneous ya insulin, chisamaliro chimayenera kumwedwa kuti musalowe m'mitsempha yamagazi pakubaya. Odwala ayenera kuphunzitsidwa bwino kugwiritsa ntchito insulin yobereka. Musati mutisefa jekeseni tsamba pambuyo jakisoni. Kutentha kwa mankhwala omwe amaperekedwa kuyenera kukhala kutentha kwambiri.
Kuchepetsa kuchuluka kwa jakisoni watsiku ndi tsiku kumatheka ndikuphatikiza insulin ya nthawi zosiyanasiyana zoyenera kuchitapo.
Ndi chitukuko cha thupi lawo siligwirizana, hospitalization wa wodwalayo, kuzindikira kwa mankhwala omwe anali allergen, poika mankhwala okwanira ndi m'malo insulin ndikofunikira.
Kuchedwa kwa mankhwala kapena kugwiritsa ntchito mankhwala osakwanira a insulin, makamaka kwa odwala omwe ali ndi vuto la matenda a shuga 1, kungayambitse matenda a hyperglycemia ndi matenda ashuga a ketoacidosis (mikhalidwe yomwe ikhoza kuyika pangozi moyo wa wodwalayo).
Kukula kwa hypoglycemia pogwiritsa ntchito mankhwalawa kumapangitsa kuti pakhale kuchuluka kwa zinthu zolimbitsa thupi, zolimbitsa thupi, kuphwanya zakudya, kuwonongeka kwa impso, chiwindi chamafuta.
Mlingo wa insulin uyenera kusinthidwa ngati magwiridwe antchito a tchire, gland ya adrenal, chithokomiro cha chithokomiro, impso ndi / kapena chiwindi chalephera, matenda a Addison, hypopituitarism, ndi matenda osokoneza bongo a shuga opitilira zaka 65. Komanso, kusintha kwa mlingo wa insulin kungafunike ndi kuwonjezeka kwa mphamvu zolimbitsa thupi kapena kusintha kwa zakudya zomwe mumakonda. Kudya kwa Ethanol (kuphatikizapo zakumwa zoledzeretsa) kumatha kuyambitsa hypoglycemia. Osamamwa ethanol pamimba yopanda kanthu. Ndi matenda ena ophatikizika (makamaka opatsirana), mikhalidwe yomwe imayendetsedwa ndi malungo, kupsinjika kwamalingaliro, kufunikira kwa insulin kungakulitse.
Zizindikiro zakutsogolo kwa hypoglycemia mukamagwiritsa ntchito insulin yaumwini mwa odwala ena sitha kutchulidwa kapena kusiyana ndi zomwe zimawonedwa ndikugwiritsa ntchito insulin yoyambira nyama. Ndi matenda a shuga m'magazi, mwachitsanzo, ndi mankhwala a insulin, zonse kapena zizindikiro zina zakutsogolo za hypoglycemia zitha kuzimiririka, zomwe odwala ayenera kudziwitsidwa. Zizindikiro zakutsogolo kwa hypoglycemia zimatha kuchepera kapena kusintha ndi njira yayitali ya matenda a shuga, matenda a shuga, komanso kugwiritsa ntchito ma beta-blockers.
Kwa odwala ena, kusintha kwa mlingo kumakhala kofunikira pakusintha kuchokera ku insulin yochokera ku nyama kupita ku insulin ya anthu. Izi zitha kuchitika kale poyambilira kukonzekera kwa insulin ya anthu kapena pang'onopang'ono pakangotha milungu ingapo kapena miyezi ingapo atasamutsidwa.
Kusintha kuchokera ku mtundu wina wa insulin kupita ku wina kuyenera kuchitika moyang'aniridwa ndi achipatala ndikuwongolera shuga.Kusintha kwa zochitika, mtundu (wopanga), mtundu, mitundu (waumunthu, chinyama, ma insulin analogs) ndi / kapena njira yopanga (DNA recombinant insulin kapena insulini yachikhalidwe) zitha kuchititsa kusintha kwa mlingo.
Mukamagwiritsa ntchito insulin pokonzekera nthawi yomweyo ndi mankhwala a gulu la thiazolidinedione, chiopsezo chotenga matenda a edema ndi matenda osakhazikika pamtima amachulukirachulukira, makamaka kwa odwala omwe ali ndi matenda am'magazi komanso kupezeka kwa zinthu zomwe zingayambitse matenda osalephera a mtima.
Ndi hypoglycemia wodwala, kuthamanga kwa zochitika zama psychomotor ndikuyang'anitsitsa kungachepe. Izi zitha kukhala zowopsa ngati maluso awa ali ofunikira makamaka (mwachitsanzo, kuwongolera makina, kuyendetsa magalimoto ndi ena). Odwala ayenera kulangizidwa kuti azisamala kuti ateteze kukula kwa hypoglycemia mukamachita zinthu zowopsa zomwe zimafuna kuti anthu azichita mwachangu ndi zomwe zimachitika mwachangu (kuphatikiza magalimoto oyendetsa, magwiridwe antchito). Izi ndizofunikira kwambiri kwa odwala omwe kulibe kapena owonetsa zizindikiro za hypoglycemia, komanso kukula pafupipafupi kwa hypoglycemia. Zikatero, adotolo amayenera kuwunika momwe wodwalayo angachitire.

Mimba komanso kuyamwa

Pakati pa nthawi yayitali, ndikofunikira kuti pakhale chitetezo chokwanira cha azimayi omwe amalandiridwa ndi insulin. Pa nthawi yoyembekezera komanso mkaka wa m`mawere, ndikofunikira kusintha mlingo wa insulin kuti ulipire shuga. Kufunika kwa insulin nthawi zambiri kumachepera mu trimester yoyamba ya kutenga pakati ndikuwonjezeka kwachiwiri ndi kachitatu trimester ya mimba. Kufunika kwa insulini kumatha kuchepa kwambiri pakubadwa kwa mwana ndipo pambuyo pake. Amayi omwe ali ndi matenda ashuga amafunika kudziwitsa dokotala za mimba kapena kukonzekera kwake. Mwa azimayi omwe ali ndi matenda a shuga, kusintha kwa insulin ndi / kapena zakudya kungafunike pakumuyamwa. Insulin yaumunthu sinali mutagenic mu in vitro komanso mndandanda wa vivo m'maphunziro a kawopsedwe amtundu.

Kuchita kwa insulin yaumunthu ndi zinthu zina

Zotsatira za hypoglycemic za insulin ya anthu zimachepetsedwa ndi glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisone ndi ena), amphetamines, adrenocorticotropic timadzi, flucrocortisone, calcium blockers, estrogens, baclofen, heparin, levrateroxine s, leparogrogen sodium diuretics (hydrochlorothiazide, indapamide ndi ena), amprenavir, danazol, isoniazid, diazoxide, lithiamu carbonate, chlorprotixen, sympathomimetics, nicotinic acid, beta-adrenergic agonists (mwachitsanzo, ritodrin, salbutamol, terbutaline ndi ena), ma tridclic antidepressants, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, zotumphukira za phenothiazine. Pangakhale kofunikira kuwonjezera kuchuluka kwa inshuwaransi ya chibadwa cha anthu magawo awiri mukamagwiritsidwa ntchito molumikizana ndi mankhwalawa.
Zotsatira hypoglycemic wa insulin anthu azimveka metformin, sulfonamides, repaglinide, androgens m'kamwa hypoglycemic wothandizira, testosterone, anabolic mankhwala, bromocriptine, disopyramide, guanethidine, monoamine oxidase zoletsa, angiotensin II cholandilira muzikangana, carbonic zoletsa anhydrase, fluoxetine, carvedilol, fenfluramine, angiotensin akatembenuka enzyme zoletsa (captopril , enalapril ndi ena), tetracyclines, octreotide, mebendazole, ketoconazole, clofibrate, theophylline, quinidine, chloroquine, non-steroid mankhwala odana ndi kutupa, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol ndi ena) (chigoba cha hypoglycemia, kuphatikizapo tachycardia, kuthamanga kwa magazi), ethanol ndi ethanol. Pangakhale kofunikira kuti muchepetse mlingo wa inshuwaransi ya anthu yopanga magawo awiri mukagwiritsidwa ntchito limodzi ndi mankhwalawa.
Beta-blockers, clonidine, reserpine amatha kubisa mawonetsedwe a zizindikiro za hypoglycemia.
Poyerekeza ndi maziko a atenolol (mosiyana ndi omwe samasankha-beta-blockers), zotsatira zake sizikukwera kwambiri, ndikofunikira kuchenjeza wodwala kuti ndi chitukuko cha hypoglycemia, tachycardia ndi kugwedeza kungakhale kulibe, koma kusakwiyitsa, njala, nseru kuyenera kupitilira, ndipo thukuta limakulitsa.
Kuchuluka kwa insulin ya anthu m'magazi kumakulitsidwa (chifukwa cha kuthamanga kwa mayamwidwe) mankhwala osokoneza bongo a chikonga komanso kusuta.
Poyerekeza ndi maziko a octreotide, reserpine, kusintha kwa hypoglycemic kungatheke (onse kuphatikiza ndi kufooka), kumafuna kusintha kwa insulin.
Poyerekeza ndi maziko a clarithromycin, chiwonongeko chimachepetsa ndipo, nthawi zina, zotsatira za insulin zimatha kuchuluka.
Poyerekeza ndi maziko a diclofenac, momwe mankhwala amasinthira, akagwiritsidwa ntchito palimodzi, ndikofunikira kuwongolera kuchuluka kwa shuga m'magazi.
Poyerekeza ndi metoclopramide, yomwe imathandizira kutsanulira kwam'mimba, kusintha kwa mlingo kapena machitidwe a insulin makonzedwe angafunike.
Insulin yamunthu imagwirizana mosiyanasiyana ndi mayankho a mankhwala ena.
Ngati pakufunika kugwiritsa ntchito mankhwala ena, kuphatikiza insulin ya anthu, ndikofunikira kukaonana ndi dokotala.

Zotsatira zoyipa

Hypoglycemia (nthawi zambiri kuposa momwe mumagwiritsira ntchito insulin pokonzekera nyama), AR - nthawi zambiri. Zolakwika zakanthawi kochepa - nthawi zambiri kumayambiriro kwa insulin.

Insulin ndiye mankhwala othandizira matenda a shuga a mtundu woyamba. Nthawi zina amagwiritsidwanso ntchito kukhazika mtima pansi wodwalayo ndikuwongolera moyo wake wamtundu wachiwiri wa matenda. Izi ndi chilengedwe chake ndi mahomoni omwe amatha kuthana ndi kagayidwe kazachilengedwe mu milingo yaying'ono. Nthawi zambiri, kapamba amapanga insulin yokwanira, yomwe imathandizira kukhala ndi shuga m'thupi. Koma ndi zovuta zazikulu za endocrine, mwayi wokhawo wothandiza wodwala nthawi zambiri ndi jakisoni wa insulin kwenikweni. Tsoka ilo, ndizosatheka kuzipeza pakamwa (mwanjira yamapiritsi), popeza zimawonongeka kwathunthu m'mimba ndikugaya mtengo wake wachilengedwe.

Zokonzekera zomwe zimapezeka kuchokera ku zopangira zachilengedwe

Kulandila timadzi ta nkhanu ndi ng'ombe ndi ukadaulo wakale womwe sugwiritsidwa ntchito masiku ano. Izi zimachitika chifukwa cha mankhwala ochepa omwe adalandiridwa, zomwe zimapangitsa kuti pakhale zovuta zina komanso kuyeretsa kosakwanira. Chowonadi ndi chakuti popeza mahomoni ali ndi mapuloteni, amakhala ndi ma amino acid ena.

Insulin yomwe imapangidwa mthupi la nkhumba imasiyana mu ma amino acid omwe amapangidwa ndi insulin yaumunthu 1 amino acid, ndi bovine insulin ndi 3.

Kumayambiriro ndi pakati pa zaka za zana la 20, pamene mankhwala ofananawo analibe, ngakhale insulin yotereyi inali yopambana pamankhwala ndikulola kutenga chithandizo cha odwala matenda ashuga kupita nawo kumalo ena atsopano. Ma Horoni omwe adapangidwa ndi njirayi amachepetsa shuga m'magazi, komabe, nthawi zambiri ankayambitsa zovuta komanso chifuwa. Kusiyana pakapangidwe ka amino acid ndi zosayenera zamankhwala zimakhudza mkhalidwe wa odwala, makamaka m'magulu omwe ali pachiwopsezo cha odwala (ana ndi okalamba). Chifukwa china chosalolera bwino insulin yotereyi ndi kupezeka kwa kuyamwa kwa mankhwala osagwiritsa ntchito (proinsulin), komwe sikunali kotheka kuti athetse kusiyanasiyana kwa mankhwalawa.

Masiku ano, pali ma insuge apamwamba apamwamba omwe alibe zoperewera. Zimapezeka kuchokera kapamba wa nkhumba, koma zitatha zimayatsidwa ndikuwonjezera kuyeretsa. Zili ndi mitundu yambiri ndipo zimakhala ndi zotuluka.

Insulin ya nkhumba yosinthidwa sikuti imasiyana ndi mahomoni amunthu, chifukwa chake imagwiritsidwabe ntchito

Mankhwalawa amaloledwa ndi odwala bwino ndipo samayambitsa mavuto, samachepetsa chitetezo cha mthupi ndipo amachepetsa shuga la magazi. Bovine insulin sikugwiritsidwa ntchito ngati mankhwala masiku ano, chifukwa chifukwa chakunja kwake kumakhudza chitetezo chathupi komanso machitidwe ena a thupi.

Zowonjezera zina

Kupanga kwa insulin popanda maipi mu masiku amakono kuli kosatheka kulingalira, chifukwa amatha kusintha zinthu zake zamankhwala, kuwonjezera nthawi yanthawi ndikukwaniritsa kuyera kambiri.

Mwa zomwe ali nazo, zosakaniza zina zonse zitha kugawidwa m'magulu otsatirawa:

prolongators (zinthu zomwe zimagwiritsidwa ntchito popereka nthawi yayitali ya mankhwala),
mankhwala ophera tizilombo toyambitsa matenda
olimbitsa, chifukwa chomwe acidity yoyenera imasungidwa mu yankho la mankhwalawa.

Kupitiliza Zowonjezera

Pali ma insulin omwe amagwira ntchito kwa nthawi yayitali omwe zochita zake zimakhala kwa maola 8 mpaka 42 (kutengera gulu la mankhwalawo). Izi zimatheka chifukwa cha kuwonjezera pa zinthu zapadera - zotambuzira ku yankho la jakisoni. Nthawi zambiri, imodzi mwamafuta awa imagwiritsidwa ntchito pazolinga izi:

Mapuloteni omwe amalimbitsa nthawi ya mankhwalawa amayeretsedwa mosamalitsa ndipo amakhala otsika kwambiri (mwachitsanzo, protamine). Mchere wamchere wa zinc sukhudzanso zochita za insulin kapena thanzi la munthu.

Madera okhathamiritsa

Tizilombo toyambitsa matenda tomwe timapangira insulini ndikofunikira kuti tizilombo tating'onoting'ono tisachulukane panthawi yosunga ndikugwiritsa ntchito momwemo. Zinthu izi ndizosungirako komanso kuonetsetsa kuti mankhwalawo amasungidwa. Kuphatikiza apo, ngati wodwala amapereka mahandawo kuchokera kwa iye yekha, ndiye kuti mankhwalawo amatha kwa masiku angapo. Chifukwa cha ma antibacterial apamwamba kwambiri, sangakhale ndi mwayi wotaya mankhwala osagwiritsidwa ntchito chifukwa choganiza kuti zitha kubereka mwanjira yankho la ma virus.

Zinthu zotsatirazi zitha kugwiritsidwa ntchito ngati mankhwala ophera majeremusi popanga insulin:

Ngati yankho lake lili ndi ayoni a zinc, amakhalanso ngati chosungirako chifukwa cha antimicrobial

Popanga mtundu uliwonse wa insulini, zinthu zina zoyambitsa matenda zimakhala zoyenera. Kuchita kwawo ndi mahomoni kuyenera kufufuzidwa pamlingo woyeserera koyambirira, popeza osungirako sayenera kusokoneza zochita za insulin kapena kusokoneza katundu wake.

Kugwiritsira ntchito mankhwala osungirako nthawi zambiri kumapangitsa kuti mahomoni azitha kuperekedwa pansi pakhungu popanda kuchitira mankhwala asanakwane ndi mowa kapena antiseptics (wopanga nthawi zambiri amatanthauza izi pamalangizo). Izi zimathandizira kukhazikitsa kwa mankhwalawa ndikuchepetsa kuchuluka kwa mankhwalawa pokonzekera jakisoni wokha. Koma malingaliro awa amangogwira ntchito ngati yankho limaperekedwa pogwiritsa ntchito syringe imodzi ya insulini ndi singano yopyapyala.

Olimbitsa

Olimba amafunika kuti pH yothetsera vutoli ikhalebe yokhazikika. Kusungidwa kwa mankhwalawa, ntchito zake komanso kukhazikika kwa katundu wamafuta zimadalira kuchuluka kwa acidity. Popanga mahomoni a jakisoni kwa odwala matenda ashuga, ma phosphates nthawi zambiri amagwiritsidwa ntchito pazolinga izi.

Kwa insulin yokhala ndi zinc, njira zothetsera kukhazikika sizofunikira nthawi zonse, chifukwa zitsulo zazitsulo zimathandizira kukhalabe koyenera. Ngati agwiritsidwa ntchito, ndiye kuti mitundu ina ya mankhwala imagwiritsidwa ntchito m'malo mwa phosphates, popeza kuphatikiza kwa zinthu izi kumabweretsa kupendekera ndi kusafunika kwa mankhwalawo.Chuma chofunikira chomwe chikuwonetsedwa kwa okhazikika onse ndi chitetezo ndi kulephera kulowa pazomwe zimachitika ndi insulin.

A endocrinologist wokhoza bwino ayenera kuthana ndi kusankha kwa majakisoni obwera ndi shuga kwa wodwala aliyense payekhapayekha. Ntchito ya insulin sikuti kungokhala ndi shuga wambiri m'magazi, komanso osati kuvulaza ziwalo zina ndi machitidwe ena. Mankhwalawa ayenera kukhala osalowerera m'thupi, otsika pang'ono komanso oyenera kugula. Ndiwothekanso kosavuta ngati insulin yosankhidwa ikhoza kusakanikirana ndi mitundu yake malinga ndi nthawi yochitapo kanthu.

Model Clinical-Pharmacological Article 1

Zochita pafamu. Kukonzekera kwa insulini kochepa. Kuyanjana ndi cholandirira kumtundu wakunja kwa maselo, ndikupanga insulini yolandirira. Mwa kukulitsa kaphatikizidwe ka cAMP (m'maselo amafuta ndi maselo a chiwindi) kapena kulowa mwachindunji mu cell (minofu), insulini yolandirira insulin imapangitsa njira zina, kuphatikizira kaphatikizidwe angapo ofunikira a michere (hexokinase, pyruvate kinase, glycogen synthetase, etc.). Kuchepa kwa kuchuluka kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa mayendedwe ake, kuchuluka kwa mayankho, kukondoweza kwa lipogenesis, glycogenogeneis, kaphatikizidwe ka protein, kuchepa kwa kuchuluka kwa shuga ndi chiwindi (kuchepa kwa kufalikira kwa glycogen), etc. mphindi, imafika pazofunikira pambuyo pa maola 1-3 ndipo imatha, kutengera mlingo, maola 5-8. Kutalika kwa mankhwalawa kumatengera mlingo, njira, malo oyendetsera ndipo ali ndi machitidwe ofunikira payekha.

Pharmacokinetics Kukwana kwa mayamwidwe zimatengera njira yoyendetsera (s / c, i / m), malo oyang'anira (pamimba, ntchafu, matako), mlingo, insulin ndende ya mankhwala, etc. Amagawidwa mosiyanasiyana mu minofu. Simadutsana chotchinga ndi mkaka wa m'mawere. Imawonongeka ndi insulinase, makamaka m'chiwindi ndi impso. T 1/2 - kuchokera kwa ochepa mpaka mphindi 10. Amachotsa impso (30-80%).

Zizindikiro. Type 1 shuga mellitus, mtundu 2 shuga mellitus: gawo la kukana mankhwalawa a hypoglycemic, kuperewera kwakumwa kwa mankhwala a hypoglycemic (kuphatikiza mankhwala), matenda a shuga ntchito pafupipafupi kwa odwala omwe ali ndi matenda a shuga ku matenda opatsirana ndimatenda akulu, ndi maopareshoni omwe akubwera, kuvulala, kubala mwana, ndi kuphwanya lamulo Kusinthana kwa zinthu musanafike kuchipatala ndi kukonzekera kwa insulin yayitali.

Contraindication Hypersensitivity, hypoglycemia.

Mlingo Mlingo ndi njira yoyendetsera mankhwalawa imatsimikiziridwa payekhapayekha malinga ndi kuchuluka kwa glucose m'magazi musanadye ndi maola 1-2 mukatha kudya, komanso kutengera ndi kuchuluka kwa glucosuria ndi machitidwe a matendawa.

Mankhwala amatumizidwa s / c, mu / m, mu / mkati, mphindi 15-30 musanadye. Njira yodziwika bwino yoyendetsera ntchito ndi sc. Ndi matenda ashuga ketoacidosis, chikomokere matenda a shuga, pa nthawi ya opaleshoni - mu / mu ndi / m.

Ndi monotherapy, pafupipafupi makonzedwe nthawi zambiri amakhala 3 katatu patsiku (ngati kuli kotheka, mpaka nthawi 5-6 patsiku), tsamba la jakisoni limasinthidwa nthawi iliyonse kupewa chitukuko cha lipodystrophy (atrophy kapena hypertrophy ya subcutaneous mafuta).

Pafupifupi tsiku lililonse 30-30 IU ana - 8 IU, ndiye muyezo tsiku lililonse - 0,5-1 IU / kg kapena 30-40 IU 1-3 pa tsiku, ngati n`koyenera - 5-6 pa tsiku . Pa mlingo wa tsiku ndi tsiku wopitilira 0,6 U / kg, insulin iyenera kuperekedwa ngati ma jakisoni a 2 kapena kuposa m'malo osiyanasiyana a thupi. Ndikotheka kuphatikiza ndi ma insulin omwe amakhala nthawi yayitali.

Njira yothetsera insulini imatengedwa kuchokera ku vial ndi kuboola ndi singano yosalala yotsekera ndi mphira, ndikupukuta mutachotsa kapu ya aluminium ndi ethanol.

Zotsatira zoyipa. Thupi lawo siligwirizana (urticaria, angioedema - malungo, kufupika, kuchepa kwa magazi),

hypoglycemia (pallor of the khungu, thukuta kwambiri, thukuta, pakamwa, kunjenjemera, njala, kusokonezeka, nkhawa, paresthesias mkamwa, kupweteka mutu, kugona, kugona, mantha, kupsinjika, kusakwiya, chikhalidwe chosazolowereka, kusowa kwa kayendedwe, vuto lakulankhula ndi kuyankhula komanso masomphenya), hypoglycemic coma,

hyperglycemia ndi matenda ashuga acidosis (pa Mlingo wochepera, kulumpha jakisoni, kusadya bwino, motsutsana ndi maziko akumatenda ndi matenda): kugona, ludzu, kusowa kudya, kutulutsa nkhope),

kuda nkhawa (mpaka kukula kwa precomatose ndi chikomokere),

kuchepa kwakanthawi kwakanthawi (nthawi zambiri kumayambiriro kwa zamankhwala),

immunological cross-reaction ndi insulin ya anthu, kuwonjezeka kwa gawo la anti-insulin antibodies, kenako kuwonjezeka kwa glycemia,

Hyperemia, kuyabwa ndi lipodystrophy (atrophy kapena hypertrophy of subcutaneous fat) pamalo a jekeseni.

Kumayambiriro kwa mankhwalawa - kutupa ndi kusokonezeka komwekonso (ndizosakhalitsa ndipo kumatha ndikupitilira chithandizo).

Bongo. Zizindikiro: hypoglycemia (kufooka, thukuta lozizira, khungu la pakhungu, palpitations, kunjenjemera, mantha, njala, paresthesia m'manja, miyendo, milomo, lilime, mutu), hypoglycemic coma, kupweteka.

Chithandizo: wodwalayo atha kuyerekezera yekha pakubweretsa shuga kapena zakudya zopatsa mphamvu zophatikizika m'thupi.

Subcutaneous, i / m kapena iv yolowetsa glucagon kapena iv hypertonic dextrose solution. Ndikupanga chikomokere cha hypoglycemic, 20-40 ml (mpaka 100 ml) wa 40% dextrose solution amawayilowetsa mu mtsinje mpaka wodwala atatuluka.

Kuchita. Zosagwirizana ndi mankhwala ena.

Mphamvu ya hypoglycemic imapangidwira ndi sulfonamides (kuphatikizapo mankhwala a hypoglycemic, sulfonamides), ma inhibitors a MAO (kuphatikizapo furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (kuphatikizapo salicylates), anabolic (kuphatikiza stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, phenfluramine, Li + kukonzekera, pyridoxine, quinidine, quinine, etloroquin, etloro.

Zotsatira Hypoglycemic wa kulemala glucagon, kukula timadzi, corticosteroids m'kamwa kulera, estrogens, thiazide ndi kuzungulira okodzetsa, mahomoni BCCI, chithokomiro, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclics, clonidine, calcium muzikangana, diazoxide, morphine, chamba, fodya, phenytoin, epinephrine, blockers a H 1 histamine receptors.

Beta-blockers, reserpine, octreotide, pentamidine imatha kuwongolera ndi kufooketsa mphamvu ya hypoglycemic ya insulin.

Malangizo apadera. Musanatenge insulini kuchokera ku vial, ndikofunikira kuti muwone mawonekedwe a yankho. Matupi achilendo akaonekera, kusefukira kapena kutentha kwa zinthu pagalasi la vial, mankhwalawa sangathe kugwiritsidwa ntchito.

Kutentha kwa insulin yoyenera kuyenera kukhala kutentha kwambiri. Mlingo wa insulin uyenera kusinthidwa matenda opatsirana, matenda a chithokomiro, matenda a Addison, hypopituitarism, kulephera kwaimpso ndi matenda ashuga okonda anthu opitirira zaka 65.

Zomwe zimayambitsa hypoglycemia zimatha kukhala: insulin, mankhwala osokoneza bongo, kudumpha chakudya, kusanza, kutsegula m'mimba, kupsinjika kwa thupi, matenda omwe amachepetsa kufunika kwa insulin (matenda apamwamba a impso ndi chiwindi, komanso hypofunction ya adrenal cortex, pituitary kapena chithokomiro gland), kusintha kwa malo jakisoni (mwachitsanzo, khungu pamimba, phewa, ntchafu), komanso mogwirizana ndi mankhwala ena. Ndikotheka kuchepetsa kuchuluka kwa shuga m'magazi mukachotsa wodwala kuchokera ku insulin ya nyama kupita ku insulin ya anthu.

Kusamutsa wodwala kupita ku insulin yaumunthu kuyenera kukhala kovomerezeka nthawi zonse ndikuyang'aniridwa ndi dokotala. Chizolowezi chokhala ndi hypoglycemia chimatha kuvulaza kuthekera kwa odwala kutenga nawo mbali mokwanira mumsewu, komanso kukonza makina ndi zida zake.

Odwala omwe ali ndi matenda ashuga amatha kuyimitsa pang'ono hypoglycemia mwa iwo kudzera pakudya shuga kapena zakudya zopatsa mphamvu zamafuta (tikulimbikitsidwa kuti nthawi zonse muzikhala ndi shuga osachepera 20 g). About hypoglycemia yosamutsidwa, ndikofunikira kudziwitsa dokotala kuti athetse vuto la kufunika kwa chithandizo chamankhwala.

Mankhwalawa a insulin yocheperako pokhapokha, ndikotheka kuchepetsa kapena kukulitsa kuchuluka kwa minofu ya adipose (lipodystrophy) m'dera la jakisoni. Kwakukulu, izi zimatha kupewedwa ndikusintha malo a jekeseni. Pa nthawi yoyembekezera, ndikofunikira kuganizira kuchepa (I trimester) kapena kuwonjezeka (II-III trimesters) pazofunikira za insulin. Nthawi yobadwa pambuyo pokhapokha ndipo mwayamba kubadwa, zofunika za insulin zimatha kugwa kwambiri. Pa mkaka wa m`mawere, kuwunikira tsiku ndi tsiku kumafunikira kwa miyezi ingapo (mpaka kufunika kwa insulin kukhazikika).

Odwala omwe amalandila insulini yoposa 100 ya insulin patsiku, amasintha mankhwalawa amafunikira kuchipatala.

Kulembetsa boma boma. Kusindikiza kovomerezeka: m'ma 2. M: Medical Council, 2009. - Vol 2, gawo 1 - 568 s., Gawo 2 - 560 s.