INSULIN GLULISIN - malangizo, mtengo, ndemanga ndi analogi ya mankhwala

Glulin insulin ndi analogue yowonjezera ya insulin ya anthu. Insulin glulisin imafanana ndi mphamvu kwa insulin wamba ya anthu. Mothandizidwa ndi insulin, glulisin amayamba kuchita zinthu mwachangu ndipo amakhala ndi nthawi yofupikirapo kuposa insulin ya munthu. Mu insulin glulisin, amino acid asparagine ya insulin yaumunthu pamalo B3 imasinthidwa ndi lysine, ndipo amino acid lysine yomwe ili pamalo B29 imasinthidwa ndi glutamic acid, yomwe imathandizira kuti magazi ayambe kuthamanga. Insulin glulisin, monga insulin ndi ma insulin ena, imayendetsa kagayidwe ka glucose, komwe ndi kofunikira kwambiri. Insulin glulisin imachepetsa kuchuluka kwa shuga m'magazi amwazi ndikulimbikitsa mayamwidwe ake ndi zotumphukira zake, makamaka minyewa yam'mimba ndi minyewa ya adipose, komanso kuletsa mapangidwe ake m'chiwindi. Insulin glulisin imawonjezera kaphatikizidwe kamapulogalamu ndipo amalepheretsa adipocyte lipolysis, proteinolysis. M'maphunziro omwe adachitika pa odzipereka athanzi komanso odwala matenda a shuga, adawonetsedwa kuti insulin glulisin, akapatsidwa mankhwala ochepa, amayamba kuchita zinthu mwachangu komanso amakhala ndi nthawi yofupikirapo kuposa kusungunuka kwa insulin yamunthu. Ndi subcutaneous makonzedwe, mphamvu ya insulin glulisin imayamba pakadutsa mphindi 10 mpaka 20. Zotsatira za hypoglycemic za insulin glulisin ndi sungunulamu wa munthu akapatsidwa mankhwala ochepa amakhala olimba. Gulu limodzi la insulini ya glulisin lili ndi zochitika zofanana za hypoglycemic monga gawo limodzi la insulin la munthu.
Pakafukufuku woyamba wa odwala omwe ali ndi matenda a shuga 1, mapangidwe a hypoglycemic a insulin glulisin ndi insulle human insulin amafanizidwa, omwe amaperekedwa mosavomerezeka panthawi ya 0,15 U / kg panthawi zosiyanasiyana malinga ndi chakudya chokwanira cha mphindi khumi ndi zisanu. Zinawonetsedwa kuti insulin glulisin, yomwe idapangidwira mphindi ziwiri asanadye chakudya, idapereka chiwonetsero chofananira cha glycemic pambuyo pa chakudya monga insulin yamunthu yosungunuka, yomwe idaperekedwa theka la ola lisanadye. Glulisin insulin, yomwe idapangidwira mphindi ziwiri asanadye chakudya, idawongolera glycemic bwino pambuyo paphwando kuposa chakudya chosungunuka cha munthu, adachititsidwanso mphindi ziwiri asanadye. Glulisin insulin, yomwe idapangidwira mphindi 15 chakudya chitayamba, adaperekanso chiwonetsero chofananira cha glycemic pambuyo pa chakudyacho monga insulin ya munthu wosungunuka, yomwe idaperekedwa mphindi ziwiri chakudya chisanachitike.
M'maphunziro a gawo loyamba, omwe amachitidwa ndi insulin glulisin, insulin ya anthu, komanso lyspro insulin pagulu la odwala onenepa kwambiri, zidawonetsedwa kuti mwa odwala a gululi, insulin glulisin imakhalabe ndi machitidwe ake achangu.
Phunziroli, nthawi yoti ifike 20% ya malo onse omwe amapezeka pansi pa pharmacokinetic nthawi yotseka nthawi inali ya 114 mphindi ya insulini glulisin, mphindi 150 kuti insulle yaumine ya anthu, mphindi 121 za inspro insulin, ndi dera lomwe linali pansi pa nthawi ya mapiritsi a pharmacokinetic ), yomwe imawonetsa ntchito yoyambirira ya hypoglycemic, inali 427 mg / kg ya insulin glulisin, 197 mg / kg ya insulin ya insuble ya anthu, 354 mg / kg ya insulin lispro.
Mu gawo 3 la 3 la kuchipatala lomwe limatenga masabata 26 lomwe limafananiza ndi insulin glulisin ndi insulin lispro yomwe idaperekedwa kwa mphindi 0 mpaka 15 musanadye, odwala omwe ali ndi matenda a shuga 1 omwe amagwiritsa ntchito insulin glargine, insulini glulisin ndi insulin anali wofanana ndi kayendetsedwe ka glycemic, kotsimikizika ndi kusintha kwa msambo wa glycosylated hemoglobin panthawi yakumapeto kwa phunziroli poyerekeza ndi zotsatira. Panali zofananira za kuchuluka kwa shuga m'magulu a seramu, zomwe zimatsimikiziridwa ndi kudzipenda pawokha. Mukamagwiritsa ntchito insulin glulisin, mosiyana ndi insulin mankhwala omwe ali ndi lyspro, kuchuluka kwa basal insulin sikunafunikire.
Kuyesedwa kuchipatala kwachitatu, komwe kunatenga milungu 12 kwa odwala omwe ali ndi matenda a shuga 1 omwe amalandira insulin glargine ngati chithandizo choyambira, adawonetsa kuti mphamvu ya insulini glulisin atangodya chakudya ikufanana ndi insulin glulisin ya 0-15 Mphindi musanadye kapena musanadye insulin ya anthu 30 mpaka 45 musanadye.
Mwa kuchuluka kwa odwala omwe adachita kafukufukuyu, pagulu la odwala omwe adalandira insulin glulisin asanadye, kuchepa kwambiri kwa hemoglobin ya glycosylated kumayerekezeredwa poyerekeza ndi gulu la odwala omwe amalandila insulin yaumunthu.
Chiyeso chachipatala cha gawo lachitatu chomwe chimatha masabata 26, ndikutsatiridwa ndi kafukufuku wokhudzana ndi chitetezo cha sabata 26, chinagwiritsidwa ntchito kuyerekezera insulin glulisin (itaperekedwa kwa mphindi 0-15 musanadye) ndi insulin ya anthu (mutaperekedwa kwa mphindi 30 mpaka 45 musanadye), omwe amathandizidwa ndi odwala omwe ali ndi matenda a 2 a shuga ndi chiwindi chambiri cha 34,55 kg / m2, kuwonjezera pa insulin-isophan ngati njira yochizira. Glulisin insulin anali wofanana ndi sungunulin waumunthu polemekeza kusintha kwa glycosylated hemoglobin pambuyo pa miyezi 6 ya mankhwala poyerekeza ndi mtengo woyambira (0.46% wa glulisin insulin ndi 0,30% wa insulle ya anthu sungunuka) komanso pambuyo pa chaka chimodzi chamankhwala ndi mtengo woyambira (0,23% ya insulini glulisin ndi 0,13% ya insulle ya anthu sungunuka). Phunziroli, odwala ambiri (79%) anasakaniza insulin yawo yochepa ndi isulin insulin nthawi isanakwane. Odwala a 58 panthawi ya kusankha kwa phunziroli amagwiritsa ntchito mankhwala amkamwa a hypoglycemic ndipo adalandira malangizo kuti apitilize kayendetsedwe ka mankhwala osasinthika.
Popita mosalekeza kosunthira kwa insulin yogwiritsira ntchito chipangizo cha odwala 59 omwe ali ndi matenda a shuga 1 omwe adalandira insulin glulisin kapena insulini, inshuwaransi yotsika ya catheter imawonedwa m'magulu onse azithandizo (0,88 ma protmenti pamwezi pogwiritsa ntchito insulin glulisin ndi 0, Ma occlusions 15 pamwezi pogwiritsa ntchito insulin aspart), komanso pafupipafupi pamafakisoni omwe amapezeka jakisoni (10,3% mukamagwiritsa ntchito insulin glulisin ndi 13.3% mukamagwiritsa ntchito insulin aspart).
Ana ndi achinyamata omwe ali ndi matenda a shuga 1 amisipito, omwe amalandila chithandizo cham'mawa kawiri m'mawa ndi madzulo insulin isofan kapena kamodzi tsiku lililonse insulin glargine, ndikufanizira chitetezo ndi mphamvu ya insulin glulisin ndi insulin lispro ndi subcutaneous Maminiti 15 asanadye, kunapezeka kuti kuwongolera kwa glycemic, kuchuluka kwa hypoglycemia, komwe kumafunikira kulowererapo kwa anthu ena, zochitika zamasewera a hypoglycemic anali ofanana m'magulu onse awiri mankhwala. Nthawi yomweyo, pakatha milungu 26 ya mankhwala, odwala omwe amagwiritsa ntchito insulin glulisin kuti akwaniritse kuwongolera kwa glycemic kufananizira ndi glycemic control ya insulin lispro amafunikira kuwonjezeka kwakukulu kwa Mlingo wa insulin tsiku lililonse, kulandira insulin mwachangu komanso kuchuluka kwa insulini.
M'mayeso azachipatala olamulidwa mwa odwala akuluakulu, kusiyana pakukwaniritsa ndi chitetezo cha insulini glulisin sikunawonetsedwe mukuwunika kwamagulu omwe anali osiyana ndi jenda komanso mtundu.
Dera la pharmacokinetic ndende ya nthawi yogwiritsira ntchito insulin glulisin mwa odzipereka athanzi komanso odwala omwe ali ndi mtundu woyamba wa 2 ndi 2 mellitus akuwonetsa kuti kuyamwa kwa insulini glulisin poyerekeza ndi insulin yaumunthu yoyambira inali pafupifupi kawiri mwachangu, ndipo kuchuluka kwakukulu kwa plasma komwe kunakwaniritsidwa kunali pafupifupi kawiri kuchuluka. Mu kafukufuku yemwe wachitika pakati pa odwala omwe ali ndi matenda a shuga 1, atatha kulowetsedwa kwa insulin glulisin pa mlingo wa 0,15 U / kg, kuchuluka kwambiri kwa plasma kwamankhwala kumachitika pambuyo pa mphindi 55 ndikuyambira 70.7 mpaka 93, mcED / ml poyerekeza ndi kuchuluka plasma ndende ya sungunuka wa anthu, itafika patadutsa mphindi 82 ndipo imapangidwa kuchoka pa 44.7 mpaka 47.3 mkU / ml. Nthawi yayitali yotsalira ya insulin glulisin mu kufalikira kwazinthu ndi mphindi 98, zomwe ndizofupikitsidwa poyerekeza ndi chizindikiro chomwecho cha insulin yaumunthu ya mphindi 161. Pakafukufuku wa odwala omwe ali ndi matenda a shuga 2 omwe amakhala ndi insulin glulisin pa 0,2 U / kg, pazitsulo zambiri zimachokera ku 78 mpaka 104 mcU / ml. Ndi subcutaneous makonzedwe a insulin glulisin m'chigawo cha anterior m'mimba khoma, phewa (m'chigawo cha minyewa yotsekemera), ndi ntchafu, kuyamwa kwa mankhwalawa kunkachitika mwachangu pamene adayambitsa dera lakhomopo lamkati lam'mimba poyerekeza ndi kayendetsedwe ka mankhwala mu ntchafu. Mlingo wa kunyamulidwa paphewa (dera la minofu yolumikizidwa) unali wapakatikati. Mtheradi wa bioavailability wa insulini glulisin pamene kutumikiridwa subcutaneous anali otsika kusiyanasiyana odwala osiyanasiyana ndipo anali pafupifupi 70% (68% kuchokera ntchafu, 71% kuchokera minofu onyentchera, 73% kuchokera khoma lakunja kwam'mimba. Kutupa ndi kufalitsa kwa insulin glulisin ndi insulle ya insulin yaumunthu pa intravenous makonzedwe akufanana, ndi theka la moyo lomwe liri 13 ndi mphindi 17, motsatana, komanso magawo omwe amagawa 13 ndi 21 malita, motsatana. Ndi subulinane insulin, glulisin imachotsedwa mofulumira kuposa sungunuka wa munthu. Hafu ya moyo wa insulini glulisin wochita kupanikizika ndi mphindi 42, theka la moyo wa munthu wosungunuka wokhala ndi ma subcutaneous makonzedwe ndi mphindi 86. Hafu yodziwikiratu ya moyo inali ya mphindi 37 mpaka 75 posanthula pang'ono za maphunziro a insulin glulisin mwa anthu athanzi komanso odwala omwe ali ndi mtundu woyamba wa 2 ndi matenda a shuga.
Mu kafukufuku wazachipatala omwe amachitika mwa anthu omwe alibe matenda a shuga omwe ali ndi ntchito yambiri ya impso (creatinine chilolezo choposa 80 ml / min, 30 mpaka 50 ml / min, ochepera 30 ml / min), kuyambitsa kwa insulin glulisin nthawi zambiri kumasungidwa. Koma ndikuphwanya magwiridwe antchito a impso, kufunika kwa insulin kungachepe. Odwala omwe ali ndi vuto la chiwindi, mapiritsi a pharmacokinetic a insulin glulisin sanaphunzire. Pali chidziwitso chochepa kwambiri pamapiritsi a pharmacokinetic a insulin glulisin mwa odwala okalamba omwe ali ndi matenda osokoneza bongo. Mankhwala a insulin glulisin amaphunzitsidwa mwa ana (azaka 7 mpaka 11) komanso achinyamata (azaka 12 mpaka 16) omwe amakhala ndi matenda a shuga 1. M'magulu onse awiriwa, insulin glulisin imatengedwa mwachangu ndi nthawi kuti ifike pamtunda wambiri komanso kufunika kwake kofanana ndi kwa akuluakulu (odwala omwe ali ndi matenda a shuga 1 komanso odzipereka athanzi). Monga mwa odwala achikulire, mankhwala akaperekedwa mwachangu musanayesedwe ndi chakudya, insulin glulisin imayendetsa bwino shuga wa magazi mukatha kudya kuposa insulin yaumunthu. Kuwonjezeka kwa seramu glucose mutatha kudya (dera lomwe lili pansi pa pharmacokinetic curve ndiko kugundika kwa glucose m'magazi kwa maola asanu ndi limodzi oyamba) anali 641 mg / (h • dl) kwa insulin glulisin ndi 801 mg / (h • dl) ya insulle yaumunthu.

Matenda a shuga, omwe amafunikira kugwiritsa ntchito insulin, mwa akulu ndi ana opitilira zaka zisanu ndi chimodzi.

Mlingo ndi makonzedwe a insulin glulisin ndi mlingo

Insulin glulisin imayang'aniridwa pang'onopang'ono. Mlingo wa insulin glulisin umakhazikitsidwa payekhapayekha. Glulisin insulin iyenera kuperekedwa kwa mphindi 0-15 musanadye kapena pambuyo chakudya. Insulin glulisin iyenera kugwiritsidwa ntchito pazamankhwala omwe amaphatikiza insulin, kapena insulin yayitali, kapena analog ya insulin yayitali. Insulin glulisin ingagwiritsidwenso ntchito limodzi ndi mankhwala amkamwa a hypoglycemic.
Insulin glulisin imayendetsedwa ngati jekeseni wofunda kapena ngati kulowetsedwa kosalekeza kwa insulini pogwiritsa ntchito chinthu chopukutira chomwe chiri choyenera kuperekera insulin. Subcutaneous jakisoni wa insulin glulisin iyenera kuchitidwa m'chigawo cha anterior m'mimba khoma, ntchafu, ndi phewa, ndipo insulini glulisin iyenera kuyendetsedwa ndi kulowetsedwa kosalekeza kudera lachiberekero cham'mimba khoma. Masamba obayira ndi kulowetsedwa kosalekeza kosakanikirana kuyenera kusinthana m'malo omwe ali pamwambawa ndikuwongolera kwatsopano kwa insulin glulisin. Tsamba la oyang'anira, zochitika zolimbitsa thupi, ndi zina zingakhudze kuchuluka kwa mayamwidwe ndi kuyambika ndi kutalika kwa insulin glulisin. The subcutaneous makonzedwe a insulin glulisin m'chigawo cha anterior m'mimba khoma, poyerekeza ndi mankhwala mankhwala mbali zina za thupi (ntchafu, phewa), amapereka mofulumira mayamwidwe mankhwala. Chenjezo liyenera kuchitika kuti zitsimikizidwe kuti insulini glulisin ilowe mwachindunji m'mitsempha yamagazi. Pambuyo pa mankhwala a insulin, glulisin, ndizosatheka kutikita minofu ya mankhwala. Odwala ayenera kuphunzitsidwa njira yolondola ya jekeseni wa insulini glulisin.
Insulin glulisin imatha kusakanikirana ndi insulin ya anthu, pomwe insulin glulisin imayenera kukokedwa mu syringe yoyamba. Subcutaneous makonzedwe ayenera kuchitidwa atangophatikiza mankhwala. Ma insulin osakanikirana (insulin glulisin ndi insulin-isophan) sangathe kutumikiridwa kudzera m'mitsempha.
Insulin glulisin itha kuperekedwanso ntchito pogwiritsira ntchito pampu popanga insulin mosalekeza. Pankhaniyi, kulowetsedwa ndi chosungira chomwe chimagwiritsidwa ntchito ndi insulin glulisin ziyenera kusinthidwa osachepera masiku awiri alionse molingana ndi malamulo a asepsis ndi antiseptics. Mukamagwiritsa ntchito insulin glulisin yokhala ndi chida chopukutira popitiliza kuperekera insulin, insulin glulisin siyingasakanikirane ndi ma insulin ena kapena ma sol sol. Odwala omwe amalandira insulin glulisin mwakuwongolera mosalekeza mosapumira amayenera kukhala ndi njira zina zoperekera insulin ndipo ayenera kuphunzitsidwa kuperekera insulin mwa kubaya jakisoni wa subcutaneous ngati kuwonongeka kwa chipangizo chomwe chagwiritsidwa ntchito.Mukamagwiritsa ntchito insulin glulisin yokhala ndi zida zama pampu zopitilira insulin, kuperewera kwa kulowetsedwa, kulakwitsa kwa pompo, ndipo zolakwika pakuzisamalira zingayambitse kukula kwa hyperglycemia, ketosis komanso matenda ashuga a ketoacidosis. Ndi chitukuko cha hyperglycemia, ketosis kapena matenda ashuga ketoacidosis, kuzindikiritsa mwachangu ndikuchotsa zomwe zimayambitsa kukula kwawo ndikofunikira.
Musanagwiritse ntchito glulisin mu insulin yankho, ndikofunikira kuyang'ana mawonekedwe, mawonekedwe, kupezeka kwa tinthu tambiri, komanso kusasinthasintha. Njira yothetsera insulini ya glulisin iyenera kukhala yopanda utoto, yowonekera, yopanda zinthu zowoneka komanso kukhala ndi mawonekedwe ofanana ndi madzi. Simungagwiritse ntchito mankhwalawa ngati njira ya insulini ya glulisin ndi yamtambo, yokhala ndi utoto kapena tinthu tachilendo.
Chifukwa cha kufupika kwazomwe zimachitika ndi insulin glulisin mwa odwala omwe ali ndi matenda a shuga, kuti azitha kuyang'anira glycemic yokwanira, ndikofunikira kuyang'anira insulin yayitali kapena kupatsa insulin ndi pampu ya insulin.
Kusintha kulikonse kwa chithandizo cha insulini kuyenera kuchitika mosamala komanso kokha ndikuyang'aniridwa ndi dokotala. Zosintha mu ndende ya insulin, monga insulin (insulin-isofan, solulle human insulin, insulin analogues), wopanga insulin, mitundu ya insulin (insulin ya anthu, insulini yachokera kuchinyama), njira yopanga insulin (insulin yoyambira nyama, insulin, yomwe imapezeka ndi njira ya recombinant deoxyribonucleic acid) ) ingafune kusintha kwa insulin. Zingafunikenso kusintha kusintha kwa mankhwalawa.
Pa matenda opatsirana, chifukwa cha kuchuluka kwa nkhawa kapena kupsinjika, kufunika kwa insulin kungasinthe.
Kugwiritsa ntchito Mlingo wambiri wa matenda a insulin kapena discontinuation osakwanira, makamaka kwa odwala omwe ali ndi matenda a shuga 1, kungayambitse kukula kwa hyperglycemia ndi matenda ashuga a ketoacidosis, omwe ali pachiwopsezo cha moyo.
Hypoglycemia ndiwosadziwika kwambiri chifukwa cha insulin. Nthawi yomwe hypoglycemia imayamba imadalira mphamvu ya mankhwalawa chifukwa amayamba kusintha chifukwa cha kusintha kwa mankhwalawo. Hypoglycemia imatha kukhala ndi milingo yayikulu kwambiri ya insulin yomwe imapitirira kufunikira kwake. Zizindikiro za hypoglycemia nthawi zambiri zimawonekera mwadzidzidzi. Koma nthawi zambiri vuto la neuropsychiatric chifukwa cha neuroglycopenia (kutopa kwachilendo, kumva kutopa, kufooka kwachilendo, kugona, kuchepa kwa chidwi, kusokonezeka kwamaonekedwe, kupweteka mutu, kusokonezeka, kuzindikira, kusakhazikika kwa matenda, chikomokere, nseru) Kuyankha kwa hypoglycemia (adrenergic anti-regulation): kusakhazikika, njala, kusangalala kwamanjenje, nkhawa, kunjenjemera, thukuta lozizira, kutsekemera kwa khungu, ahikardiya anasonyeza kugunda. Ndipo hypoglycemia imakula mwachangu, ndipo ikamakulirakulira, ndizomwe zimatchulidwa ndizizindikiro za kukhazikitsidwa kwa dongosolo lazomvera potsatira hypoglycemia. Ndime za hypoglycemia, makamaka zomwe zimabwerezedwa, zimatha kuwononga dongosolo lamanjenje. Hypoglycemia yayitali komanso yayitali ingasokoneze miyoyo ya odwala, popeza ndi kukula kwa hypoglycemia, zotsatira zakupha ndizotheka. Mikhalidwe yomwe ingapangitse zomwe zimayambira kutsogolo kwa hypoglycemia kusatchulika kapena kusintha zimaphatikizapo kusintha kwakukulu pakuwongolera glycemic, kulimbitsa inshuwaransi, kukula pang'onopang'ono kwa hypoglycemia, kupezeka kwa neuropathy ya dongosolo laumwini la autonomic, wodwala wokalamba, kupitilirabe kwa matenda a shuga, komanso kugwiritsa ntchito mankhwala ena. Zochitika zoterezi zimatha kuyambitsa hypoglycemia yayikulu (mwinanso kuthedwa nzeru) wodwala asanadziwe kuti akupanga hypoglycemia.
Malangizo a insulin Mlingo ungafunikire ngati odwala asintha nthawi yawo yanji kudya kapena kuwonjezera zolimbitsa thupi. Kuchita masewera olimbitsa thupi komwe kumachitika mukangodya kungakulitse chiwopsezo cha hypoglycemia.
Poyerekeza ndi sungunuka wa munthu pambuyo pochita ma insulin analogues (kuphatikizapo insulin glulisin), hypoglycemia imayamba kale.
Kuchuluka kwa ma hyperglycemic osagwiritsidwa ntchito kapena kuwonongeka kwa hypoglycemic kungayambitse kusokonezeka kwa chikumbumtima, chikomokere, kapena kufa.
Systemic hypersensitivity zimachitika insulin glulisin akhoza limodzi ndi kuzungulira, kuyamwa, chifuwa, kukomoka, kuchepa magazi, kuchuluka kwa mtima, ndi thukuta lotupa. Milandu yambiri ya chifuwa chachikulu, kuphatikizapo mawonekedwe a anaphylactic, ikhoza kuwononga moyo wa wodwalayo.
Pamene insulin glulisin ikagwiritsidwa ntchito, hypersensitivity reaction imatha kuchitika (kuphatikizapo hyperemia pamalo a jakisoni, kutupa m'malo a jakisoni, kuyabwa pamalo opukusira jekeseni. Nthawi zambiri, izi zimachitika patatha masiku angapo kapena milungu yambiri yogwiritsa ntchito insulin glulisin. Nthawi zina, izi zimachitika chifukwa cha insulin glulisin, koma zimayamba chifukwa cha khungu, lomwe lingayambike chifukwa cha mankhwala a antiseptic musanalowe kapena jakisoni wolakwika wa insulin glulisin (kuphwanya njira yoyenera yovalira jakisoni).
Monga ndi insulin ina iliyonse, mukamagwiritsa ntchito insulin glulisin, lipodystrophy imatha kupezeka pamalo a jakisoni, omwe angachedwetse kuyamwa kwa insulin glulisin. Kukhazikitsidwa kwa mankhwalawo pamalo omwewo kungathandizire kukulitsa kwa lipodystrophy, motero, kuphwanya kosinthika kwa malo a makonzedwe a insulin glulisin kungathandizire kukulitsa lipodystrophy. Kusinthana kosalekeza kwa malo a jakisoni a insulin glulisin mkati mwa malo amodzi a jekeseni (phewa, ntchafu, kunja kwa khoma lam'mimba) kungathandize kuchepetsa ndikuletsa kutukuka kwa lipodystrophy.
Kukhazikitsidwa kwangozi kwa ma insulin ena molakwika kunanenedwa, makamaka ochita insulin, m'malo mwa insulin glulisin.
Kufunika kwa insulini glulisine, monga zina zonse zotetezera, zitha kuchepa pamene chida cha impso chikukula. Odwala omwe ali ndi vuto la chiwindi, kusowa kwa insulin glulisin kumachepa chifukwa chakuchepa kwa kagayidwe ka insulin glulisin komanso kuchepa kwa mphamvu ya gluconeogeneis m'chiwindi. Ntchito yaimpso yolakwika mu okalamba imatha kubweretsa kuchepa kwa kufunika kwa insulin glulisin. Odwala okalamba amatha kuvutika kuzindikira zizindikiritso ndi hypoglycemia. Insulin glulisin itha kugwiritsidwa ntchito mwa ana opitilira zaka 6. Zambiri zamankhwala pazokhudza kugwiritsa ntchito insulin glulisin mwa ana ochepera zaka 6 ndizochepa. Mankhwala a insulin glulisin amaphunzitsidwa mwa ana azaka zopitilira 6 ndi mtundu wa matenda a shuga. Mwa ana opitirira zaka 6, insulin glulisin idatengedwa mwachangu, ndipo mayamwidwe ake sanasiyane ndi omwe ali ndi akuluakulu (odzipereka athanzi labwino komanso odwala omwe ali ndi matenda a shuga 1). Monga mwa akulu, mwa ana opitirira zaka 6 ndi kuyambitsidwa kwa insulin glulisin musanayesedwe ndi chakudya, mankhwalawa amapereka mphamvu ya shuga pambuyo pakudya kuposa kusungunuka kwa insulin yaumunthu.
Kutha kuganizira kwambiri komanso kuthamanga kwa zochitika zama psychomotor mwa odwala omwe ali ndi matenda osokoneza bongo amatha kuchepa chifukwa cha hypoglycemia, hyperglycemia, kusokonezeka kowoneka, komwe kumatha kukhala pachiwopsezo m'malo omwe maluso ndi ofunikira (mwachitsanzo, mukamachita ntchito zowopsa, kuyendetsa magalimoto machitidwe). Pogwiritsa ntchito insulin glulisin, odwala ayenera kulangizidwa kuti asamale ndi kupewa hypoglycemia akamagwira ntchito zoopsa zomwe zimafuna kuti azikhala ndi chidwi komanso kuthamanga kwa zochitika zama psychomotor (kuphatikizapo magalimoto oyendetsa, maginito). Izi ndizofunikira kwambiri kwa odwala omwe akukhalapo kapena wochepetsedwa kuti azindikire zizindikiro zomwe zikuwonetsa kukula kwa hypoglycemia, kapena zochitika zapafupipafupi za hypoglycemia. Mwa odwalawa, ndikofunikira kuti aliyense payekha aganizirepo za momwe angachitire zoopsa zomwe zimafunikira chidwi chochulukirapo komanso kuthamanga kwa zochitika zama psychomotor (kuphatikiza magalimoto oyendetsa, machitidwe).

Mimba komanso kuyamwa

Palibe mayesero azachipatala omwe amayesedwa pakugwiritsira ntchito insulin glulisin mwa amayi nthawi yapakati. Zambiri zomwe zimapezeka pakugwiritsa ntchito insulin glulisin mwa amayi panthawi yomwe ali ndi pakati (zotsatira zosakwana 300 zapakati) sizikuwonetsa kuwonongeka kwa mankhwalawa pakukula kwa intrauterine kwa mwana wosabadwayo, pakati, mwana wakhanda. Kafukufuku wolera nyama sanawonetse kusiyana kulikonse pakati pa insulin glulisin ndi insulin yaumunthu pokhudzana ndi kukula kwa embryonic, kukula kwa fetal, pakati, kubereka ndi kubereka. Kugwiritsa ntchito insulin glulisin mwa amayi nthawi yapakati kuyenera kuchitika mosamala. Kuwunikira mosamala kuchuluka kwa shuga wa seramu ndikuwongolera glycemic kuyenera. Amayi omwe adadwala matenda ashuga asanabadwe kapena omwe adayamba kudwala matenda ashuga amayenera kusamala nthawi yonse yomwe ali ndi pakati. Mu trimester yoyamba ya kubereka, kufunika kwa insulin kumatha kuchepa, munthawi yachiwiri ndi yachitatu, kufunika kwa insulin kumatha kuchuluka. Kufunika kwa insulin mukangobadwa nthawi zambiri kumachepetsa msanga. Sizikudziwika ngati insulin glulisin yachotsedwa mkaka wa m'mawere. Mwa akazi, poyamwitsa, zingakhale zofunika kusintha mankhwalawa a insulin ndi / kapena zakudya.

Zotsatira zoyipa za insulin glulisin

Machitidwe amsempha, ma psyche ndi ziwalo zam'maganizo: kusachedwa, kusokonezeka kwamanjenje, kuda nkhawa, kunjenjemera, kutopa kwachilendo, kumva kuti watopa, kufooka mosadziwika bwino, kugona, kuchepa kwa chidwi, kupweteka mutu, kusokonezeka, kusazindikira, kuwononga dongosolo lamanjenje, kusokonezeka kwa mawonekedwe.
Matenda a mtima: tachycardia, palpitations kwambiri, chifuwa cholimba, kuchepa kwa magazi, kuthamanga kwa mtima.
Matumbo: nseru
Machitidwe opatsirana: kutsutsika.
Metabolism: hypoglycemia (kusokonezeka, kugona, chisangalalo, nkhawa, kugwedezeka, thukuta, kuzizira kwa khungu, tachycardia, palpitations, kutopa kwachilendo, kumva kutopa, kufooka kwachilendo, kugona, kuchepa mphamvu yakuya, kusokonezeka kowoneka, kupweteka mutu, kusokonezeka) chikumbumtima, kulephera kudziwa, kupweteka mtima, nseru, kuwonongeka kwamitsempha, chikomokere, kufa nkotheka).
Chitetezo cha mthupi: Hypersensitivity reaction (kuphatikizapo hyperemia pamalo a jakisoni, kutupa pamalo omwe jakisoni, kuyamwa pamalo opaka jekeseni), systemic hypersensitivity reaction (kuphatikizapo kuzizira, kuyanika, chifuwa, kuperewera, kuchepa kwa kuthamanga kwa magazi, kuchuluka kwa mtima, kutuluka thukuta, chifuwa; anaphylactic zochita.
Khungu komanso minyewa yolumikizira: lipodystrophy, thukuta lozizira, khungu la pakhungu, zotupa, kuyabwa, Hyperemia, kutupira pamalowo.
Zina: njala, makonzedwe mwangozi a mankhwala ena a insulin.

Kuchita kwa insulin glulisin ndi zinthu zina

Kafukufuku wokhudzana ndi kuphatikizana kwa mankhwala a insulin glulisin ndi mankhwala ena sanachitike. Kutengera chidziwitso chopezeka cha mankhwala ena aliwonse, kupangika kwokhudzana kwambiri ndi zamankhwala zamatenda a insulin glulisin ndi mankhwala ena ndizokayikitsa.
Mankhwala ena angakhudze kagayidwe ka glucose, kamene kamayambitsa kusintha kwa insulin glulisin makamaka kuwunika mosamala chithandizo. Mankhwala omwe amatha kuonjezera mphamvu ya hypoglycemic ya insulin glulisin ndikuwonjezera kudziwikiratu kwa hypoglycemia akuphatikiza ma angiotensin-kutembenuza ma enzyme, ma processor a hypoglycemic, fibrate, disopyramide, fluoxetine, pentoxifylline, monoamine oxidase inhibitors, mankhwala a sulphonamidobenamycin insulin glulisin. Mankhwala omwe amachepetsa hypoglycemic zotsatira za insulin glulisin amaphatikizapo danazol, diazoxide, diuretics, glucocorticosteroids, glucagon, phenothiazine zotumphukira, isoniazid, somatropin, sympathomimetics (mwachitsanzo, epinephrine (adrenaline), terbutaline, terbutamine contraceplication ya mahomoni), mahomoni a chithokomiro, ma protein a inhibitors, atypical antipsychotic (mwachitsanzo, clozapine, olanzapine), zingakhale zofunika kusintha Mlingo wa insulin glulisin. Beta-blockers, saltamu, clonidine, ethanol amatha kukulitsa kapena kufooketsa mphamvu ya hypoglycemic ya insulin glulisin, pangafunike kusintha mlingo wa insulin glulisin. Pentamidine akagwiritsidwa ntchito limodzi ndi insulin glulisin ingayambitse hypoglycemia ndi hyperglycemia, zingakhale zofunika kusintha Mlingo wa insulin glulisin. Mothandizidwa ndi mankhwala omwe ali ndi vuto la chisoni, monga clonidine, beta-blockers, reserpine, guanethidine, zizindikiro za adrenergic activation poyankha hypoglycemia atha kukhalapo, komanso osatchulidwa pang'ono.
Chifukwa cha kuchepa kwa maphunziro, insulin glulisin sayenera kusakanikirana ndi mankhwala ena onse kupatula insulin-isophan ya anthu. Pamene insulini imayendetsedwa ndi glulisin pogwiritsa ntchito chipangizo cha kulowetsedwa, mankhwalawa sayenera kusakanikirana ndi sol sol kapena mankhwala ena aliwonse (kuphatikiza kukonzekera kwa insulin).

Bongo

Palibe zambiri zachidziwikire zokhudzana ndi bongo za insulin ndi glulisin.Ndi kuchuluka kwa insulin glulisin poyerekeza ndi kufunika kwake, komwe kumatsimikiziridwa ndi kuchuluka kwa mphamvu ya thupi ndi kudya, hypoglycemia imatha kukhazikika (yomwe ikuwonetsedwa ndi zizindikiro zotsatirazi: kusakhazikika, njala, kusangalala kwamanjenje, nkhawa, kunjenjemera, thukuta lakuthwa, khungu lotuwa, tachycardia kugunda kwamtima kwambiri, kutopa kosazolowereka, kumva kutopa, kufooka kwachilendo, kugona, kuchepa kwa mphamvu yoganizira, kusokonezeka kowoneka, kupweteka mutu, s utan, kukomoka, khunyu, nseru, kuwonongeka kwa wamanjenje dongosolo, chikomokere, imfa) n'zotheka.
Hypoglycemia yofatsa imatha kuyimitsidwa pakumwa shuga kapena zakudya zomwe zimakhala ndi shuga. Chifukwa chake, tikulimbikitsidwa kuti odwala matenda ashuga nthawi zonse azikhala ndi maswiti, ma cookie, ma cubes a shuga kapena msuzi wa zipatso wokoma. Matenda oopsa a hypoglycemia okhala ndi chikomokere, kukomoka komanso matenda amitsempha amatha kuyimitsidwa ndi kuperewera kwa njira ya glucose yokhazikika (dextrose) kapena subcutaneous kapena intramuscular management ya 0.5-1 mg ya glucagon ndi akatswiri azachipatala. Pambuyo pakupezanso chikumbumtima, wodwalayo akulangizidwa kuti apereke chakudya cham'mimba mkati kuti aletse kukonzanso kwa hypoglycemia, zomwe zimatheka pambuyo pakuwoneka bwino kwachipatala. Kuti adziwitse zomwe zimayambitsa hypoglycemia yayikulu ndikulepheretsa kukula kwa zochitika zina zofananira, wodwalayo ayenera kuyang'aniridwa kuchipatala.

Zochizira

Glulin insulin ndi analogue (recombinant) ya insulin ya anthu. Mphamvu ya chochita chake ndiofanana ndi insulin wamba ya anthu. Glulisin amayamba mwachangu, koma amakhala ndi nthawi yofupikitsa kuposa insulin yaumunthu.

Insulin glulisin jekeseni pansi pakhungu pambuyo mphindi 10-20.

Njira makonzedwe a insulin glulisin ndi subcutaneous jakisoni kapena mosalekeza kulowetsedwa mu subcutaneous mafuta am'mimba kudzera pampu. Insulin imayendetsedwa posachedwa (0-15min.) Isanachitike, kapena mutangodya.

Matenda a shuga odwala matenda a insulin.

Njira yogwiritsira ntchito

Glulisin insulin iyenera kutumikiridwa posachedwa (0-15min.) Asanayambe kudya kapena atangomaliza kudya.

Insulin iyi imagwiritsidwa ntchito pama regimens othandizira omwe amaphatikizapo insulin yapakatikati kapena yayitali, kuphatikizapo analogue ya basal insulin. Insulin glulisin imagwiritsidwanso ntchito limodzi ndi othandizira a hypoglycemic monga mapiritsi.

Thupi limayendetsedwa ndi jekeseni wa subcutaneous kapena kulowetsedwa kosalekeza m'mimba (m'mafuta oyenda) pogwiritsa ntchito pampu.

Jakisoni wotsekemera umachitika m'mimba, ntchafu kapena phewa, kulowetsedwa kosalekeza kungachitike kokha m'mimba.

Zotsatira zoyipa

Hypersensitivity zimachitika (redness, kutupa kapena kuyabwa pa malo jakisoni). Maganizo ngati amenewa nthawi zambiri amakhala osakhalitsa, amawonongeka pomapitilira chithandizo. Nthawi zina pamakhala zochitika za lipodystrophy (kuphwanya kusinthana kwa malo a jakisoni m'dera lomwelo).

Thupi lawo siligwirizana (urticaria, kupuma movutikira, bronchospasm, kuyabwa, dermatitis), kuphatikizapo milandu ikuluikulu ya chiwonetsero cha thupi lawo (kuphatikizapo anaphylactic), yomwe ingawononge moyo.

Malangizo apadera

Akaphatikizidwa ndi othandizira a hypoglycemic othandizira, ACE inhibitors, disopyramide, fluoxetine, fibrate, mao inhibitors, pentoxifylline, salicylates, propoxyphene ndi sulfanilamide antimicrobials, insulin glulisin imatha kuwonjezera hypoglycemic komanso kuonjezera chiwopsezo.

Akaphatikizidwa ndi GCS, diazoxide, danazole, diuretics, somatropin, isoniazids, phenothiazine ,ivitomimetics (mwachitsanzo, epinephrine, terbutaline, salbutamol), mahomoni a chithokomiro, estrogens ndi progestins (mwachitsanzo, zoletsa zam'kamwa, komanso zoletsa. mankhwala (mwachitsanzo, olanzapine ndi clozapine) insulin glulisin itha kuchepetsa zotsatira za hypoglycemic.

Beta-blockers, clonidine, komanso maamuamu amchere ndi ethanol amatha kuyambitsa kapena kufooketsa zochita za insulin. Pentamidine imayambitsa hypoglycemia ndi hyperglycemia yotsatira.

Kugwiritsa ntchito mankhwala a sympatholytic (beta-blockers, clonidine ndi guanethidine, komanso reserpine) kutseka zizindikiro za adrenergic Reflex activation.

Mukasamutsa wodwala ku mtundu wina wa insulin kapena insulin ya wopanga watsopano, ndikofunikira kuyang'aniridwa mosamala kwambiri chifukwa chofunikira pakuwongolera. Mlingo wosakwanira wa insulin kapena kusiya chithandizo kumabweretsa chitukuko cha hyperglycemia, komanso matenda ashuga a ketoacidosis, mikhalidwe yomwe ikhoza kukhala pangozi.

Nthawi yakutukuka kwa hypoglycemia kumatha kutengera kuchuluka kwa magwiritsidwe a insulin omwe angagwiritsidwe ntchito ndipo amatha kusintha, ndikusintha kwa regimen yothandizira. Mikhalidwe yomwe imasintha kapena kuchepetsa zomwe zimatchulidwa zakutsogolo kwa hypoglycemia ikuphatikizapo: kutalika kwa matenda a shuga, kulimbitsa insulin mankhwala, matenda ashuga, kugwiritsa ntchito mankhwala ena (mwachitsanzo, beta-blockers), kapena kusamutsa wodwala kuchokera ku insulin ya nyama kupita kwa anthu.

Malangizo a insulin Mlingo wofunika pakuwathandiza kusintha kwa zakudya kapena kusintha zolimbitsa thupi. Kuchita masewera olimbitsa thupi mukangotha ​​kudya kumatha kukhala pachiwopsezo cha hypoglycemia. Ndi kukhazikitsidwa kwa ma analogi olimbitsa thupi a insulin ya anthu, hypoglycemia imatha kuyamba mwachangu kuposa kugwiritsa ntchito insulin yaumunthu.

Kuchuluka kwa hypoglycemic kapena hyperglycemic komwe sikunachitike kungayambitse chikumbumtima, chikomokere, komanso ngakhale kufa.

Kugwiritsa ntchito insulin glulisin mwa amayi apakati kuyenera kuchitika pang'onopang'ono kuwunika kwamisempha yamagazi.

Insulin glulisin simalowa mkaka wa m'mawere, motero imagwiritsidwa ntchito mkaka wa m'mawere.

Pa yoyamwitsa, mkazi angafunike kusintha mlingo wa insulin kutumikiridwa.
Kusintha kwa mankhwala a insulini kungafunikenso kwa matenda oyanjananso, komanso nkhawa kwambiri.

Sungani insulini glulisin m'malo amdima mpaka kutentha 8 mpaka C popanda kuzizira. Alumali moyo mpaka zaka 2.

CHOKONZEDWA MALO OGULITSA

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Kufotokozera za mankhwalawa

Mankhwala "Insulin glulisin" ndi chinthu chomwe chimakhala ndi khungu loyera. Mankhwalawa amapakidwa pansi pa khungu la m'mimba, ntchafu kapena phewa. Ndikofunika kusintha mawebusayiti obayira. Ngati ndi kotheka, ndikotheka kugwiritsa ntchito mankhwala osokoneza bongo mosalekeza m'mimba mwa maselo am'mimba pogwiritsa ntchito pampu. Kukhazikitsidwa kwa mankhwala "Insulin glulisin" uyenera kuchitidwa mukatha kudya, nthawi yayitali, asanadye.

Momwe mungatenge INSULIN GLULISINE

Dokotalayo amapereka mankhwala a insulin glulisin aliyense payekhapayekha. Panthawi yapakati kapena yoyamwitsa, kuchuluka kwa mankhwalawa kuyenera kusinthidwa pafupipafupi kutengera mtundu wa mkazi. Kugwiritsira ntchito pamodzi kwa mankhwalawo limodzi ndi mankhwala ena ogwira ntchito kumatha kuchepetsa kapena kuwonjezera mphamvu yake.

Kusintha mulingo wa mankhwala "Insulin glulisin" kwa wodwala ndikofunikira ngati:

• Khalidwe limasintha
• kusintha zakudya
• kusintha kwamphamvu pamthupi,
• matenda opatsirana komanso matenda ena
• kupsinjika kwamalingaliro ndi zochuluka

Zotsatira zoyipa

Mankhwala "Insulin glulisin" ali ndi zovuta zina zomwe muyenera kukhala nazo pakukonzekera: redness, kupuma movutikira, thupi lawo ndi zina, zovuta zina. Kugwiritsa ntchito mankhwala osokoneza bongo ochulukirapo kungayambitse kuchepa kwakukuru ndi kwakukulu kwa shuga wamagazi popanda kuyambitsa zovuta zina mthupi. Mutha kubwezeretsa shuga m'magulu mwa kudya zakudya zokhala ndi shuga.

Ngati wodwala wasamutsidwa kuchokera ku Insulin Glulisin kupita ku mankhwala ena, kuyang'anira wodwalayo kumafunikira kwakanthawi kokwanira kuti thupi lizisintha. Njira yosinthira sikutanthauza kuonedwa kwapadera ndi dokotala.

Makhalidwe

Mankhwala Chochita chachikulu cha insulin ndi mitundu yake yonse (insulin-glulisin sichili choncho) ndi kusintha kwa shuga m'magazi.

Chifukwa cha insulin, gluzulin, kuchuluka kwa glucose m'magazi kumachepa ndipo mayamwidwe ake amalimbikitsidwa ndi zotumphukira zama minofu, makamaka mafuta, mafupa komanso minofu. Kuphatikiza apo, insulin:

• amalepheretsa kupanga shuga mu chiwindi,
• kumawonjezera kapangidwe kazakudya zomanga thupi,
• timaletsa proteinol,
• amalepheretsa lipolysis mu adipocytes.

Kafukufuku wochitidwa pa odzipereka athanzi komanso odwala matenda a shuga a mellitus awonetsa bwino kuti kulowetsedwa kwa insulin-glulisin sikuti kumangochepetsa nthawi yodikirira, komanso kumachepetsa nthawi yovutikira mankhwalawo. Izi zimasiyanitsa ndi insulin ya anthu osungunuka.

Ndi subcutaneous makonzedwe, kutsitsa-shuga kutsika kwa insulin-glulisin m'magazi kumayamba pakatha mphindi 15 mpaka 20. Ndi jakisoni wamkati, mphamvu ya insulin ya anthu sungunuka komanso zotsatira za insulin-glulisin pamagazi a glucose ali ofanana.

Gawo lokonzekera kwa Apidra lilinso ndi zochitika zofanana za hypoglycemic monga gawo la insulin ya anthu sungunuka. M'maphunziro a zamankhwala odwala omwe ali ndi matenda a shuga 1, zotsatira za hypoglycemic za insuble insulin ndi Apidra zimayesedwa.

Onsewa adawonetsedwa ndi mlingo wa 0,15 U / kg mosasunthika mosiyanasiyana panthawi yokhudzana ndi chakudya champhindi 15, zomwe zimawerengedwa kuti ndi zofunikira.

Zotsatira za kafukufukuyu zikuwonetsa kuti insulini-glulisin yoyendetsedwa mphindi ziwiri asanadye chakudya chinapereka chiwonetsero chofananira cha glycemic pambuyo chakudya pambuyo pake insulin ya munthu yosungunuka idalowetsedwa mphindi 30 asanadye.

Ngati insulin-glulisin imayang'aniridwa 2 mphindi musanadye, mankhwalawa amapereka kuwunika koyenera glycemic mukatha kudya. Kuposa kupaka insulin ya anthu sungunuke pakadutsa mphindi ziwiri musanadye.

Insulin-glulisin, yomwe idapangidwira mphindi 15 chakumayambiriro kwa chakudyacho, idapereka kuwunika kwa glycemic pambuyo paphwando lofanana ndi lomwe limaperekedwa ndi insulin ya anthu osungunuka, kuyambitsa kwake komwe kumachitika pakadutsa mphindi 2 chakudya chisanayambe.

Kafukufuku wa gawo loyamba, wopangidwa ndi Apidra, insulin ya insulle ndi insulin-lyspro pagulu la odwala omwe ali ndi kunenepa kwambiri komanso matenda a shuga, adawonetsa kuti mwa odwala insulin-glulisin sataya machitidwe ake othamangira.

Phunziroli, kuchuluka kwa 20% ya malo onse omwe amapezeka pansi pa insulin-glulisin anali maminiti 114, kwa insulin-lispro -121 mphindi ndi insulin ya anthu osungunuka - mphindi 150.

Ndipo AUC (maola 0-2), yowonetsanso ntchito yoyambirira ya hypoglycemic, inali 427 mg / kg ya insulin-glulisin, 354 mg / kg ya insulin-lispro ndi 197 mg / kg ya insulin ya sungunuka ya anthu.

Mtundu woyamba wa shuga

Maphunziro azachipatala. Mtundu woyamba wa shuga wambiri, insulin-lyspro anayerekezera ndi insulin-glulisin.

Mu gawo lachitatu lazachipatala lomwe limatenga milungu 26, anthu omwe ali ndi matenda a shuga 1 amapatsidwa insulin glulisin atatsala pang'ono kudya (insulin glargine imakhala ngati insulin insulin mwa odwalawa).

Mwa anthu awa, insulin-glulisin pokhudzana ndi kayendedwe ka glycemic adayerekeza ndi insulin-lyspro ndipo adayesedwa ndikusintha ndende ya glycosylated hemoglobin (L1L1c) kumapeto kwa phunziroli ndi poyambira.

Odwala adawonetsa ofanana, odziletsa, ofanana ndi shuga m'magazi. Kusiyana pakati pa insulini-glulisin ndi kukonzekera kwa insulin-lyspro ndikuti pomwe zomwe kale zimaperekedwa, palibe chifukwa chowonjezera kuchuluka kwa insulin.

Kuyesedwa kwamankhwala kwa gawo lachitatu, masabata 12, (mtundu 1 wa matenda ashuga wogwiritsa ntchito insulin-glargine monga chithandizo chachikulu adayitanidwa ngati odzipereka) kunawonetsa kuti nzeru zakujambulira insulin-glulisin mukangodya chakudya ndizofanana ndi kubaya insulin-glisin nthawi yomweyo musanadye (0-16 mphindi). Kapena mphindi 30-45 musanadye insulin yaumunthu.

Odwala omwe adachita mayeso adagawika m'magulu awiri:

1. Gulu loyamba lidamwa insulin apidra musanadye.
2. Gulu lachiwiri lidapatsidwa insulin ya anthu osungunuka.

Omwe adalandira gulu loyamba adawonetsa kuchepa kwakukulu mu HL1C kuposa odzipereka a gulu lachiwiri.

Type 2 shuga

Choyamba, zoyesa zamankhwala za gawo lachitatu zinachitika sabata zoposa 26. Adatsatiridwa ndi maphunziro a chitetezo cha 26-sabata, zomwe zinali zofunikira kuyerekezera zotsatira za Apidra (mphindi 0-15 musanadye) ndi insulin yaumunthu (30-45 mphindi musanadye).

Mankhwalawa amagwiritsidwa ntchito mosadukiza kwa odwala omwe ali ndi matenda a shuga 2 (anthuwa adagwiritsa ntchito insulin-isophan monga insulin yayikulu). Mlozera wapakati wamagulu omaliza a maphunziro anali 34,55 kg / m².

Pokhudzana ndi kusintha kwa kuzama kwa HL1C, patatha miyezi isanu ndi umodzi ya chithandizo, insulin-glulisin adawonetsa kufananizidwa kwake ndi insulin ya madzi sungunuka poyerekeza ndi mtengo woyambira motere:

• insulin-0.30% ya sungunuka wa anthu,
• kwa insulin-glulisin-0.46%.

Ndipo patatha chaka chimodzi cha chithandizo, chithunzicho chidasintha monga chonchi:

1. insulin ya madzi sungunuka - 0,13%,
2. insulin-glulisin - 0,23%.

Ambiri mwa odwala omwe akuchita nawo phunziroli, atangolowa jakisoni, wosakanikirana wa insulin-isophan wokhala ndi insulin yochepa. Panthawi yodziwika, 58% ya odwala amagwiritsa ntchito mankhwala a hypoglycemic ndipo adalembera malangizo kuti apitirize kumwa nawo chimodzimodzi.

M'mayeso azachipatala olamulidwa mwa akulu, panalibe kusiyana pakukhazikika ndi chitetezo cha insulini-glulisin pofufuza magulu omwe adadziwika ndi jenda komanso mtundu.

Ku Apidra, kulowa kwa ampinogine wa amino acid pamalo a B3 a insulin yaumunthu, komanso, lysine pamalo a B29 ndi glutamic acid, amalimbikitsa kuyamwa mwachangu.

Magulu Opatsa Odwala

• Odwala aimpso kuwonongeka. Mu kafukufuku wazachipatala omwe amapangidwa mwa anthu athanzi labwino omwe ali ndi mitundu yayitali yogwira ntchito yaimpso (creatinine clearance (CC)> 80 ml / min, 30¬50 ml / min, Zizindikiro ndi Mlingo

Mtundu wa 1 wodwala matenda a insulin 1 atatha zaka 6, achinyamata ndi akulu.

Insulin-glulisin iyenera kuperekedwa mwachangu kapena nthawi yomweyo ndi chakudya.Apidra iyenera kugwiritsidwa ntchito pazinthu zamankhwala, zomwe zimaphatikizapo ma insulin a nthawi yayitali, apakati, okhala ndi insulin kapena mawonekedwe awo.

Kuphatikiza apo, Apidra ikhoza kugwiritsidwa ntchito limodzi ndi mankhwala a pakamwa a hypoglycemic. Mlingo wa mankhwalawa nthawi zonse umasankhidwa payekha.

Njira Zoyang'anira

Mankhwala amathandizidwa ndi subcutaneous jakisoni kapena kulowetsedwa mosalekeza mafuta a subcutaneous pogwiritsa ntchito insulin pump. Jekeseni wovomerezeka wa mankhwalawa amapangidwa m'mimba, ntchafu kapena phewa. Jekeseni wa pampu imachitidwanso pamimba.

Malo a kulowetsedwa ndi jakisoni ndi jakisoni watsopano aliyense wa insulin ayenera kusintha. Kumayambiriro kwa kuchitapo kanthu, kutalika kwake komanso kuchuluka kwa adsorption, zochitika zolimbitsa thupi komanso dera lotsogolera zimatha kusintha. Kukhazikitsidwa kwam'mimba kumimba kumapereka mofulumira adsorption kuposa jakisoni wa ziwalo zina za thupi.

Pofuna kupatula mankhwalawa kuti asalowe mwachindunji m'mitsempha yamagazi, muyenera kusamala kwambiri. Mukangomwa mankhwala, jakisoniyo sayenera kutenthedwa.

Amaloledwa kusakaniza Apidra kokha ndi insulin-isophan yamunthu.

Pampu ya insulin yopitiliza kulowetsabe mosalekeza

Ngati Apidra imagwiritsidwa ntchito ndi dongosolo la pampu kuti lipitirire kulowetsedwa kwa insulin, ndizoletsedwa kusakaniza ndi mankhwala ena.

Kuti mudziwe zowonjezereka pakugwirira ntchito kwa mankhwalawa, ndikofunikira kuti muphunzire malangizo omwe aphatikizidwe nawo. Pamodzi ndi izi, malingaliro onse okhudzana ndi zolembera zodzaza majakisoni ayenera kutsatiridwa.

Magulu apadera a odwala akuphatikizapo odwala omwe:

• ntchito yaimpso yoyipa (ndi matenda otere, kufunika kwa jakisoni wa insulin kungachepe),
• ntchito ya chiwindi hepatic (monga momwe zinalili kale, kufunika kwa kukonzekera kwa insulin kumatha kuchepa chifukwa kuchepa kwa kuthekera kwa gluconeogeneis ndi kuchepa kwa insulin metabolism).

Zambiri zamaphunziro a pharmacokinetic a mankhwalawa kwa anthu okalamba sizikwanira. Kufunika kwa insulin kwa odwala okalamba kumatha kuchepa chifukwa cha vuto losakwanira la impso.

Mankhwalawa amatha kuperekedwa kwa ana atatha zaka 6 ndi achinyamata. Zambiri pazokhudza mankhwalawa kwa ana osakwana zaka 6 sizipezeka.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zimachitika pakumwa mankhwala a insulin pamene mlingo wadutsa ndi hypoglycemia.

Pali zovuta zina zomwe zimagwirizanitsidwa ndikugwiritsa ntchito mankhwalawa ndipo zimawonedwa pakupimidwa kwamankhwala, pafupipafupi momwe zimachitikira pagome.

Kusokonezeka kwa kagayidwe ndi khungu

Nthawi zambiri hypoglycemia imayamba. Zizindikiro za mkhalidwewu nthawi zambiri zimachitika mwadzidzidzi. Mawonetsero otsatirawa ndi amodzi mwa zizindikiro za neuropsychiatric:

1. Kutopa, kumva kuti watopa, kufooka.
2. Kuchepetsa mphamvu yoganizira.
3. Zosokoneza.
4. Kugona.
5. Mutu, nseru.
6. Kusokonezeka kwa chikumbumtima kapena kuwonongeka kwathunthu.
7. Matenda opatsirana.

Koma nthawi zambiri, zizindikiro za neuropsychiatric zimayambitsidwa ndi zizindikiro za adrenergic anti-regulation (poyankha hypoglycemia ya dongosolo la chisoni):

1. Mtsempha wodabwitsa, wosakwiya.
2. Kutopa, nkhawa.
3. Kumva njala.
4. Kukongola kwa khungu.
5. Tachycardia.
6. Thukuta lakuzizira.

Zofunika! Kubwerezabwereza kwambiri kwa hypoglycemia kumatha kuwononga dongosolo lamanjenje. Zolemba za hypoglycemia yayikulu komanso yayitali imasokoneza moyo wa wodwalayo, chifukwa ngakhale zotsatira zakupha ndizotheka ndi dziko lomwe likukula.

Pamavuto a jakisoni wa mankhwala, mawonetseredwe am'deralo a hypersensitivity amapezeka nthawi zambiri:

Kwenikweni, izi zimachitika mosakhalitsa ndipo nthawi zambiri zimazimiririka ndi mankhwala ena.

Kuyankha kotereku kuchokera ku minofu yaying'ono, monga lipodystrophy, ndikosowa kwambiri, koma kumatha kuwonekera chifukwa cha kuphwanya kusintha kwa malo a jakisoni (simungathe kulowa insulin m'dera lomwelo).

Mavuto ambiri

Mawonetsedwe achilengedwe a hypersensitivity ndi osowa, koma ngati akuwoneka, ndiye zotsatirazi:

1. urticaria
2. kutsutsika
3. chifuwa cholimba
4. kuyabwa
5. dermatitis ya mziwindi.

Milandu yapadera yokhudzana ndi chifuwa chachikulu (izi zimaphatikizapo mawonetseredwe a anaphylactic) amaopseza moyo wa wodwalayo.

Mimba

Zambiri pazakugwiritsira ntchito insulin-glulisin ndi amayi apakati sizipezeka. Kuyesa kwachilengedwe kwa zinyama sikunawonetse kusiyana kulikonse pakati pa insulle ya insulle ya munthu ndi insulin-glulisin pokhudzana ndi pakati, kukula kwa fetal, kubereka mwana ndi chitukuko cha pambuyo pake.

Komabe, amayi apakati amayenera kupereka mankhwalawa mosamala kwambiri. Munthawi ya chithandizo, kuwunika shuga kumayang'aniridwa pafupipafupi.

Odwala omwe anali ndi matenda ashuga asanabadwe kapena omwe adayambitsa matenda a shuga kwa amayi apakati ayenera kukhalabe ndi vuto la glycemic nthawi yonseyi.

Munthawi yoyamba kubereka, kufunikira kwa wodwala insulin kumatha kuchepa. Koma, monga lamulo, mu trimesters wotsatira, zimawonjezeka.

Pambuyo pobereka, kufunikira kwa insulin kumacheperanso. Amayi omwe akukonzekera kutenga pakati ayenera kudziwitsa woyang'anira wawo zaumoyo za izi.

Sizikudziwikabe ngati insulin-glulisin imatha kudutsa mkaka wa m'mawere. Amayi pa nthawi yoyamwitsa angafunikire kusintha kuchuluka kwa mankhwalawa ndi zakudya.