Momwe mungagwiritsire ntchito mankhwala Biosulin N?

Insulin Biosulin amandia munthu insulinzopezeka ndi tekinoloje yobwerezabwereza DNA. Pali mitundu itatu bioinsulin: 30/40 (biphasic), wochita zinthu wapakati komanso wosungunuka-pang'ono. Mitundu yonse jinijini insulin mogwirizana ndi cell membrane receptor ndikupanga zovuta. Zimathandizira njira zamkati komanso kapangidwe kazinthu zazikulu. Kutsika kwa shuga kumalumikizidwa ndi kuwonjezeka kwa mayamwidwe ake ndi kuyamwa.

Biosulin N amakhala ndi nthawi yokwanira kuchitapo kanthu. Mbiri yamachitidwe ake imatha kusinthasintha kwakukulu ngakhale mwa munthu yemweyo. Ndi subcutaneous jakisoni, kuyamba kwa zochita kumawonedwa pambuyo pafupifupi maola 1-2, pambuyo pa maola 5 ndi 12 mphamvuyo imatheka, ndipo nthawi yokwanira imasiyana mkati mwa maola 19-24.

Biosulin P imakhala yochepa. Ndi jekeseni wa subcutaneous, imagwira pambuyo pa mphindi 30, mphamvu yayikulu imakhala mkati mwa maola 2-4, ndipo nthawi yake ndi maola 7-8.

Zizindikiro zogwiritsidwa ntchito

wodwala insulin matenda ashuga (mtundu 1)
insulin yodziyimira payokha matenda ashuga (lembani 2) kukana othandizira pakamwa, munthawi ya kuphatikiza mankhwala komanso matenda amodzi.

Kugwiritsa ntchito Biosulin P kumawonetsedwanso pazochitika zadzidzidzi ndi shuga wowonjezera.

Zotsatira zoyipa

thukuta kwambiri, mutu, palpitations, njala, kunjenjemera, paresthesiachisangalalo
hypoglycemic chikomokere,
Edema wa Quinckezotupa pakhungu anaphylactic mantha,
kutupa,
mavuto obwezera
Hyperemia pamalo opangira jekeseni lipodystrophy (pogwiritsa ntchito nthawi yayitali).

Biosulin, malangizo ogwiritsira ntchito (Njira ndi Mlingo)

Biosulin N amagwiritsidwa ntchito ngati subcutaneous makonzedwe. Kugwiritsidwa ntchito nokha kapena kuphatikiza ndi ena. insulin. Mlingo watsimikiza ndi dokotala. Pafupifupi tsiku lililonse 0,5 kuti 1 IU pa kg iliyonse ya kulemera. Nthawi zambiri, jakisoni amachitidwa mu ntchafu kapena kunja kwamimba khoma. Popewa kuwoneka kwa lipodystrophy, muyenera kusintha tsamba la jakisoni.

Biosulin P imayang'aniridwa mosiyanasiyana, kudzera m'mitsempha ndi m'mitsempha. Pafupifupi tsiku lililonse tsiku lililonse amawerengedwa. Yambitsani mphindi 30 chakudya chisanafike.

Ndi monotherapy, mankhwalawa amatumizidwa katatu patsiku (nthawi zina 6). Wodwalayo amadzibaya jakisoni wamkati, ndipo jakisoni wamkati ndi wamkati amachitika kokha m'malo azachipatala moyang'aniridwa ndi dokotala. Kusintha kwa Mlingo kumachitika chifukwa cha matenda opatsirana, malungo, musanachite opareshoni, komanso ndi kuwonjezeka kwakukulu kwa zolimbitsa thupi. Kusintha kuchokera ku mankhwala kupita kwina kumachitika motsogozedwa ndi shuga.

Mankhwalawa onse amaphatikizidwa ndi ma insulin, ndipo cholembera cha biosulin chimakulolani kuti mugwiritse ntchito makatoniji atatu okha. Poterepa, muyenera kugwiritsa ntchito cholembera Cholemba Chamoyo ndi kutsatira mosamalitsa malangizo ogwiritsa ntchito. Katoniyo adapangira kuti azigwiritsa ntchito payekha ndipo sayenera kuzazidwanso.

Bongo

Imawonekera ngati dziko la hypoglycemic: kutuluka thukuta, pallor, palpitations, njala, kunjenjemera, paresthesiachisangalalo mutu. Nthawi zina amakula hypoglycemic chikomokere.

Chithandizo chophweka hypoglycemia imakhala ndi kutenga shuga, tiyi wokoma kapena zakudya zamatumbo (maswiti, makeke, maswiti). M'mavuto akulu (chikomokere) jekeseni 40% yankho dextrose kudzera m'mitsempha, komanso modzitchinjiriza - glucagon. Wodwalayo akayambanso kudziwa, amalimbikitsa kudya chakudya chamagulu.

Kuchita

Mphamvu ya mankhwalawa imatheka ndi: pakamwa hypoglycemic agents, zoletsa monoamine oxidasekaboni anhydrase angiotensin akatembenuka enzymesulfonamides, osasankha opanga beta, octreotide, bromocriptineanabolic steroids onjezerani, manzeru, ketoconazole, pyridoxine, cyclophosphamide, theofylline, fenfluramine, kukonzekera kwa lithiamu, ethanol.

Mphamvu ya mankhwalawa imafooka ndi: glucocorticosteroidskulera kwamlomo heparinthiazide okodzeya, tridclic antidepressants, danazol, clonidine, sympathomimetics, calcium blockers blockers, morphine, phenytoin, diazoxide, chikonga. Mukamagwiritsa ntchito yotsalira ndi salicylates onse kufooka ndi kukweza mphamvu zimadziwika.

Ndemanga za biosulin

Mankhwala kusankha pa mankhwala a odwala SD ndi genetic engineering insulin munthu yemwe ali wofanana mu kapangidwe ka mankhwala kwa munthu. Malinga ndi International Diabetes Federation, awa okha insulin gwiritsani ntchito padziko lonse lapansi. Ubwino wawo ndi kuchita bwino komanso chitetezo, mogwirizana ndi momwe Unduna wa Zaumoyo ku Russia umalimbikitsa kugwiritsa ntchito achinyamata, ana ndi amayi apakati kuti apatsidwe mankhwala. Zotsatira za kafukufuku wa mankhwalawa zimawonetsa kuti zomwe zili ndi michere ya chiwindi, lipids, nitrogen yotsalira, creatinine ndipo urea idakhalabe yokhazikika pazomwe amagwiritsa ntchito. Palibe amene anali ndi vuto lililonse.

Ubwino wina (izi zikugwira ntchito pokonzekera kwanthawi yayitali) ndikuti mapuloteni amagwiritsidwa ntchito ngati chowonjezera. protamine (otchedwa NPH insulin), osati zinc. NPH insulin itha kusakanikirana ndi mankhwala omwe amangokhala osokoneza bongo mu syringe imodzi ndipo izi sizingapangitse kusintha kwa ma pharmacokinetics. Ngakhale zabwino zonse, pali ndemanga zoyipa ndipo odwala ambiri amakonda mankhwala omwe atengedwera kunja (Chichewa, NovoRapid).

«... Ndakhala ndikumubaya kwa miyezi ingapo. Chilichonse ndichabwino, koma ndikuganiza kuti palibe chabwino kuposa Humalog».
«... Agogo pa Biosulin. Shuga akhoza kulipidwa, koma kuwona kumatsika ndi phazi la matenda ashuga».
«... kwa masiku angapo ndili pamenepo. Kuchokera mu chipatala. Zidafika poipa - shuga kwa 20! Sizothandiza!».
«... Inemwini, Biosulin N sichindithandiza, ndipo Biosulin P ndiyabwino».

Kutulutsa mawonekedwe ndi kapangidwe kake ka mankhwala

Mankhwala Biosulin N akupezeka mu mawonekedwe a kuyimitsidwa anaikira subcutaneous makonzedwe mu 5 ndi 10 ml galasi mbale.

Chofunikira chachikulu pa mankhwalawa ndi chibadwa cha anthu 100% IU. Mankhwalawa amakhalanso ndi zigawo zothandiza: madzi a jakisoni, zinc oxide, sodium hydrogen phosphate, glycerol.

Pharmacological zimatha mankhwala

Biosulin H ndi insulin yaumunthu, yomwe imapangidwa ndi ukadaulo wa majini ogwiritsira ntchito DNA ya anthu. Chida ichi chili ndi achire zotsatira za nthawi yayitali. Kulowa pazomwe zimachitika, mankhwalawa amapanga insulini-receptor yofunikira kulimbikitsa njira zamagawo. Mothandizidwa ndi mankhwalawa, kuchuluka kwa shuga m'magazi komanso kuchuluka kwa shuga m'magazi kumachepa.

The achire kutalika kwa mankhwala amatsimikiza ndi kuyamwa kwa mankhwala, amenenso zimatengera njira ya mankhwala ndi jakisoni malo.

Pambuyo pa kukhazikitsidwa kwa Biosulin N pansi pa khungu, kuyamba kwake kwa kuchiritsika kumawonedwa pambuyo pa ola limodzi, mphamvu yayikulu imachitika pambuyo pa maola 5-10, nthawi yonse yochita ndi pafupifupi maola 18-20.

Kuchuluka kwa kuyamwa kwa mankhwalawa komanso chiyambi cha njira zake zochizira kumadalira malo a makonzedwe a insulin (ntchafu, m'mimba, matako), mlingo wa mankhwalawa komanso kuchuluka kwa insulin mu botolo. Pambuyo makonzedwe pansi pa khungu, mankhwalawa sagawanidwa monseponse. Insulin siyidutsa chotchinga china kupita kwa mwana wakhanda. Imafufutidwa kudzera mu impso mwachilengedwe.

Zizindikiro zogwiritsidwa ntchito

The mankhwala Biosulin N zotchulidwa kwa odwala milandu:

Mtundu woyamba wa matenda a shuga
Type 2 yosagwirizana ndi insulin - matenda a shuga - ndikupanga mkhalidwe wama mankhwala ena omwe amachepetsa kuchuluka kwa shuga m'magazi kuti agwiritse ntchito pakamwa.

Mlingo ndi makonzedwe

Mankhwala Biosulin N adapangira makonzedwe pansi pa khungu. Kwa wodwala aliyense payekha, dokotala amasankha muyezo wogwira mosiyanasiyana. Zimatengera kuchuluka kwa shuga m'magazi, kuopsa kwa njira yodutsamo, kulemera kwa thupi, zaka komanso mawonekedwe a thupi la wodwalayo. Pakati pa mankhwalawa tsiku lililonse odwala omwe ali ndi matenda ashuga amachokera ku 0,5 mpaka 1 IU / kg thupi.

Musanayambitse mankhwalawo pansi pa khungu, vial amayenera kuzitenthetsera kutentha kwa chipinda, atasungitsa valayo kwa mphindi zingapo m'manja mwanu.

Mwambiri, mankhwalawa amapaka jekete pansi pa ntchafu, koma pazifukwa izi, mutha kugwiritsanso ntchito khoma lakumbuyo kapena matako. Nthawi zina mankhwalawa amapakidwa paphewa. Malinga ndi malangizo, malo omwe jekeseni pansi pa khungu amayenera kusinthidwa nthawi zonse, chifukwa jakisoni wa insulin m'malo omwewo angayambitse kufooka kwa mafuta osaneneka. Biosulin N itha kugwiritsidwa ntchito ngati mankhwala odziyimira pawokha kapena kuphatikiza ndi Biosulin P - mankhwala osakhalitsa.

Malangizo apadera

Kuyimitsidwa Biosulin N sikungagwiritsidwe ntchito jakisoni ngati, mutagwedeza botolo mopepuka, zomwe zili mkati mwake siziyera kukhala zoyera kapena zamtambo. Munthawi yogwiritsira ntchito mankhwalawa, odwala ayenera kuyang'anira kuchuluka kwa shuga m'magazi.

Ndi kudziyimira pawokha kwa mankhwalawa ndi mawonekedwe ake, wodwalayo amatha kukhala ndi vuto la hypoglycemia (kuchepa kwa shuga wamagazi). Mankhwala osokoneza bongo kwambiri a insulin, kudumpha chakudya, kutsekula m'mimba kapena kusanza kwina, kuchita masewera olimbitsa thupi mopitirira muyeso kapena kupsinjika kwambiri kungayambitsenso kukula kwa chikhalidwe chotere. Hypoglycemia imatha kudwala mwa omwe ali ndi malo osankhidwa bwino jakisoni kapena akaphatikizidwa ndi mankhwala ena.

Mlingo wosankhidwa bwino wa insulin pokonzekera odwala omwe ali ndi matenda a shuga 1, komanso nthawi yayitali pakati pa jakisoni wa Biosulin, angayambitse kukula kwa matenda a hyperglycemia (kuchuluka kwa shuga m'magazi). Ndi kukula kwa matendawa, wodwalayo amapanga zizindikiro zotsatirazi patangotha maola ochepa:

Kuchulukitsa ludzu
Kuchulukitsa kwamikodzo komanso kuchuluka kwamkodzo tsiku lililonse (mwa odwala ena mpaka malita 10 patsiku),
Chizungulire
Pakamwa pakamwa
Kuchulukitsa chilakolako
Fungo la maapulo akhathamiritsa ochokera mkamwa (kununkhira kwa acetone).

Kukula kwa hyperglycemia kwa odwala omwe ali ndi matenda a shuga 1 kungayambitse matenda ashuga kwambiri a ketoacidosis ndi hyperglycemic.

Mlingo wa tsiku ndi tsiku wa mankhwalawa umayenera kusinthidwa kwa odwala azaka zopitilira 65, komanso kwa odwala omwe ali ndi vuto la chithokomiro. Mlingo kusintha kwa mankhwalawa amafunikanso kwa odwala omwe akuwonjezera kuchuluka kwa zolimbitsa thupi kapena kukula kwa zovuta kuchokera ku chiwindi ndi impso.

Panthawi ya matenda opatsirana komanso mkhalidwe wofinya, wodwalayo ayenera kuwunika mlingo wa tsiku ndi tsiku wa Biosulin N, kutengera kuyesedwa kwa magazi.

Kusintha kuchokera ku kukonzekera kwa insulin kupita ku kwina kuyenera kuchitika kokha moyang'aniridwa ndi dokotala!

Zotsatira zoyipa ndi mankhwala osokoneza bongo

Ndi mlingo woyenera, mankhwalawa amavomerezedwa ndi odwala. Ngakhale kuwonjezeka pang'ono pa mlingo, wodwalayo atha kudwala:

Thukuta lozizira
Kufooka ndi chizungulire,
Kukomoka
Palpitations
Kudzanja kwamanja
Kukongola kwa khungu
Njala
Kumverera kwa "zokwawa."

Ndi mankhwala osokoneza bongo, wodwalayo amatha kudwala matendawa.

Nthawi zina, ndi munthu hypersensitivity wa mankhwala, wodwalayo angadwale matupi awo sagwirizana ndi urticaria, zidzolo, edema ya Quincke. Ndi kuyambitsa insulin nthawi yomweyo, wodwalayo amapanga lipodystophia.

Kugwiritsa ntchito mankhwalawa panthawi yapakati komanso poyamwitsa

Mankhwala Biosulin N angagwiritsidwe ntchito pochiza matenda a shuga mwa amayi apakati komanso amayi oyamwitsa. Ndi kuyambika kwa pakati, mkazi safunikira kusiya kuperekera mankhwalawa, koma ndikulimbikitsidwa kukaonana ndi dokotala kuti athe kukonza mlingo wa tsiku ndi tsiku, womwe ungafunikire kuwonjezeka pang'ono chifukwa cha kuwonjezeka kwa katundu pa ziwalo zonse ndi machitidwe a wodwala.

Zoyenera kugawa ndikusunga mankhwalawo

Biosulin N imagawidwa m'mafakisoni ndi mankhwala. Mankhwalawa amayenera kusungidwa mufiriji pa kutentha kosaposa 8 digiri. Kuzizira kwa Mbale sikuloledwa.

Botolo lotseguka liyenera kusungidwa kutentha osapitirira 20 madigiri osaposa miyezi 1.5. Sungani mbale mumalo amdima, kutali ndi ana. Alumali moyo wa mankhwalawa ndi zaka 2 kuyambira tsiku lopanga.

Njira yogwiritsira ntchito biosulin N mu mawonekedwe a kuyimitsidwa

Cholinga cha shuga m'magazi, insulin ikukonzekera kugwiritsidwa ntchito, njira ya insulin dosing (mlingo ndi nthawi ya makonzedwe) iyenera kutsimikizika ndikusintha payekhapayekha kuti mugwirizane ndi chakudya, mulingo wakuchita zolimbitsa thupi komanso moyo wa wodwalayo.

Mankhwala Biosulin® N adapangidwa kuti azigwiritsa ntchito poyambira. Mlingo wa mankhwalawa amadziwitsidwa ndi dokotala aliyense payekhapayekha malinga ndi kuchuluka kwa shuga m'magazi. Pafupifupi, tsiku lililonse mlingo wa mankhwalawa umachokera ku 0,5 mpaka 1 IU / kg thupi (kutengera umunthu wa wodwalayo komanso kuchuluka kwa shuga).

Dokotala amayenera kupereka malangizo ofunikira kuti azindikire kuchuluka kwa shuga m'magazi, komanso apereke malangizo oyenera pazosintha zilizonse m'zakudya kapena muyezo wa insulin.

Mankhwalawa kwambiri hyperglycemia kapena, makamaka ketoacidosis, insulin makonzedwe ndi gawo limodzi la machitidwe azachipatala omwe amaphatikiza njira zoteteza odwala ku zovuta zazikulu chifukwa cha kuchepa kwambiri kwa ndende yamagazi. Malangizo a mankhwalawa amafunika kuwunika mosamalitsa m'chipinda chopangira chisamaliro (kudziwa kagayidwe kazinthu, acid-base olimba ndi electrolyte bwino, kuwunika zofunikira za thupi).

Kusintha kuchokera ku mtundu wina wa insulin kupita ku Biosulin® N

Posamutsa wodwala kuchokera ku mtundu wina wa insulini kupita ku ina, angafunikire kuwongolera mtundu wa insulin: mwachitsanzo, pakusintha kuchokera ku insulin yochokera ku nyama kupita ku insulin yaumunthu, kapena mukasintha njira ina yopangira insulin yaumunthu kupita ku ina. , kuphatikizapo insulin.

Pambuyo pakusintha kuchokera ku insulin yochokera ku nyama kupita ku insulin ya anthu, mwina pangafunike kuchepetsa kuchuluka kwa insulin, makamaka kwa odwala omwe kale anali ndi zovuta zamagazi, odwala omwe ali ndi chizolowezi chokhala ndi hypoglycemia, mwa odwala omwe kale amafuna kuchuluka kwa insulin yayikulu chifukwa cha ndi kukhalapo kwa ma antibodies a insulin.

Kufunika kosinthira kwa mlingo (kuchepetsa) kumatha kuchitika mukangosintha mtundu watsopano wa insulin kapena kuyamba pang'onopang'ono milungu ingapo.

Mukasintha kuchokera ku mtundu wina wa insulini kupita ku wina kenako m'milungu yoyamba yotsatira, kuyang'aniridwa mosamala kwa shuga wamagazi ndikulimbikitsidwa.Odwala omwe amafuna kwambiri Mlingo wa insulin chifukwa cha antibodies, tikulimbikitsidwa kusinthana ndi mtundu wina wa insulin moyang'aniridwa ndi achipatala kuchipatala.

Kusintha kowonjezera kwa insulin

Kuwongolera kagayidwe ka metabolic kumatha kuyambitsa chidwi cha insulini, zomwe zingapangitse kuchepa kwa kufunika kwa insulin.

Kusintha kwa mlingo kungafunikenso ngati: kusintha kwa thupi la wodwalayo, kusintha kwa moyo (kuphatikizapo zakudya, kuchuluka kwa zolimbitsa thupi, ndi zina) kapena muzochitika zina zomwe zingakulitse chiwopsezo cha hypo- kapena hyperglycemia (onani gawo "Malangizo apadera" ").

Mlingo wampingo wodwala aliyense

Odwala okalamba

Mwa okalamba, kufunika kwa insulini kumatha kuchepa (onani magawo "Mosamala", "Malangizo apadera"). Ndikulimbikitsidwa kuti kuyambitsidwa kwa chithandizo, kuchuluka kwa mankhwalawa ndikusankhidwa kwa odwala okalamba omwe ali ndi matenda osokoneza bongo kuchitike mosamala kuti asagwiritsidwe ntchito.

Odwala omwe ali ndi chiwindi kapena aimpso kulephera

Odwala omwe ali ndi vuto la hepatic kapena aimpso, kufunika kwa insulin kungachepe.

Kutentha kwa insulin yoyenera kuyenera kukhala kutentha kwambiri.

Mankhwala Biosulin® N nthawi zambiri amaperekedwa mwachangu pa ntchafu. Jakisoni amathanso kuchitika mkati mwa khoma lakunja, matako kapena paphewa pang'onopang'ono.

Ndikofunikira kusintha malo a jekeseni mkati mwa anatomical dera kuti muchepetse kukula kwa lipodystrophy.

Ndi subulinaneous ya insulin, chisamaliro chimayenera kumwedwa kuti musalowe m'mitsempha yamagazi pakubaya. Pambuyo pa jakisoni, tsamba la jakisidwe siliyenera kutenthedwa. Odwala ayenera kuphunzitsidwa bwino kugwiritsa ntchito insulin yobereka.

Kukonzekera mawu oyamba

Mukamagwiritsa ntchito mankhwala Biosulin® N m'makalata

Makatoni okhala ndi Biosulin® N amayenera kukukhira pakati pa manja m'manja mozungulira maulendo 10 musanagwiritse ntchito ndikugwedezeka kuti apatsenso insulin mpaka itakhala mafuta osungunuka kapena mkaka. Foam sayenera kuloledwa kuchitika, zomwe zingasokoneze mlingo woyenera. Makatoni amayenera kufufuzidwa mosamala. Osagwiritsa ntchito insulini ngati ili ndi masamba mutasakaniza, ngati ma cell oyera olimba amatsatira pansi kapena makoma a cartridge, kuwapatsa mawonekedwe "mawonekedwe achisanu".

Chipangizo cha ma cartridge sichimalola kusakanikirana ndi zomwe zili ndi insulini zina mwachindunji mu cartridge lokha. Makatoniwo sanapangidwe kuti adzazitsidwe.

Mukamagwiritsa ntchito makatoni okhala ndi cholembera cholinganiranso, malangizo a wopanga kuti akwaniritse katoni mu syringe cholembera ndikuyika singano akuyenera kutsatiridwa. Mankhwalawa amayenera kuperekedwa molingana ndi malangizo a wopanga a cholembera.

Mukamagwiritsa ntchito mankhwala Biosulin® N mu cholembera cha biomatikPen ®2

Mukamagwiritsira ntchito zolembera zanthawi zonse za jakisoni wambiri, ndikofunikira kusakaniza kuyimitsidwa kwa kukonzedwa kwa Biosulin® N mu syringe yomweyo musanagwiritse ntchito. Kuyimitsidwa kophatikizidwa bwino kuyenera kukhala kofanana ndi oyera komanso mitambo.

Mankhwala a Biosulin® N mu cholembera sangathenso kugwiritsidwa ntchito ngati atawundana.

Mukamagwiritsa ntchito zolembera zanthawi zonse zanthawi zonse, ndikofunikira kuchotsa cholembera mufiriji musanagwiritse ntchito ndikulola kukonzekera kuti mufike kutentha kwa firiji. Malangizo enieni ogwiritsira ntchito cholembera chomwe amaperekedwa ndi mankhwalawa ayenera kutsatiridwa.

Mankhwala Biosulin® N mu syringe cholembera ndi singano amapangidwira kuti azigwiritsa ntchito okha. Osadzazitsanso katoni katemera. Singano sayenera kugwiritsidwanso ntchito. Kuteteza kuchokera ku kuwala, cholembera cha syringe chikuyenera kutsekedwa ndi chipewa. Osasunga cholembera chogwiritsidwa ntchito mufiriji.

Mankhwala a Biosulin® N amatha kuthandizidwa yekha kapena osakanikirana ndi insulin yochepa (mankhwalawa Biosulin® P).

Makhalidwe wamba. Zopangidwa:

Zogwira pophika: 100 IU ya insulin ya anthu.

Omwe amathandizira: zinc oxide, sodium hydrogen phosphate, protamine sulfate, metacresol, crystalline phenol, glycerol, madzi a jekeseni.

Zindikirani Kusintha pH, njira ya 10% ya sodium hydroxide kapena 10% hydrochloric acid imagwiritsidwa ntchito.

Katundu

Mankhwala Biosulin® N - insulin yaumunthu yomwe idagwiritsidwa ntchito pogwiritsa ntchito ukadaulo wa DNA. Ndi kukonzekera kwa insulin. Imalumikizana ndi cholandilira chapadera pa cell ya cytoplasmic cell ndipo imapanga insulini-receptor zovuta zomwe zimapangitsa njira zamkati mwake, kuphatikizapo kaphatikizidwe kazinthu zingapo za enzymes (hexokinase, pyruvate kinase, glycogen synthetase, ndi zina). Kutsika kwa shuga m'magazi kumachitika chifukwa cha kuchuluka kwa kayendedwe ka intracellular, kuchuluka kwa minofu, kukondoweza kwa lipogenesis, glycogenogeneis, kuchepa kwa kuchuluka kwa shuga ndi chiwindi, etc.

Kutalika kwa nthawi ya kukonzekera kwa insulin makamaka chifukwa cha kuchuluka kwa mayamwidwe, zomwe zimatengera zinthu zingapo (mwachitsanzo, pa mlingo, njira ndi malo oyang'anira), chifukwa chake zochitika za insulin zimasinthasintha kwambiri, mwa anthu osiyanasiyana komanso m'modzi munthu yemweyo.

Mbiri yakuchitapo kanthu kwa jakisoni wamphepo (pafupifupi chiwerengero): kuyambika kwa maola 1-2, kuchuluka kwakukulu pakatikati pa maola 6 ndi 12, nthawi yayitali ndi maola 18-24.

Pharmacokinetics Kukwanira kwathunthu ndi kuyambika kwa mphamvu ya insulin kumadalira malo a jakisoni (m'mimba, ntchafu, matako), mlingo (kuchuluka kwa insulin), kuchuluka kwa insulin, mankhwalawa. Amawonongedwa ndi insulinase makamaka m'chiwindi ndi impso. Amachotsa impso (30-80%).

Zomwe Mungagwiritse Ntchito:

Gwiritsani ntchito panthawi yoyembekezera komanso mkaka wa m`mawere. Palibe choletsa kuchiza matenda osokoneza bongo a shuga ndi insulin pa nthawi yomwe ali ndi pakati, popeza insulin siyidutsa chotchinga. Mukakonzekera kukhala ndi pakati komanso panthawi imeneyi, ndikofunikira kulimbikitsa chithandizo cha matenda ashuga. Kufunika kwa insulin nthawi zambiri kumachepera mu trimester yoyamba ya kutenga pakati ndipo kumawonjezeka pang'onopang'ono kwachiwiri komanso kachitatu.

Nthawi yobadwa pambuyo pokhapokha ndipo mwayamba kubadwa, zofunika za insulin zimatha kugwa kwambiri. Pambuyo pobadwa, kufunika kwa insulin kumabweranso pamlingo womwe unali usanakhale ndi pakati.

Palibe choletsa pa chithandizo cha matenda osokoneza bongo a shuga ndi insulin panthawi yoyamwitsa. Komabe, zingakhale zofunikira kuchepetsa mlingo wa insulini, chifukwa chake, kuwunikira mosamala ndikofunikira miyezi ingapo mpaka kufunika kwa insulin kumakhala kokhazikika.

Osagwiritsa ntchito Biosulin® N ngati, mutagwedezeka, kuyimitsidwa sikusintha kukhala koyera komanso kwamitambo.

Poyerekeza ndi maziko a mankhwala a insulin, kuyang'anira kuchuluka kwa shuga m'magazi ndikofunikira.

Zomwe zimayambitsa hypoglycemia, kuwonjezera pa insulin yochulukirapo, imatha kukhala: kusintha kwa mankhwala, kudumpha chakudya, kusanza, kutsegula m'mimba, kuchuluka kwa zochitika zolimbitsa thupi, matenda omwe amachepetsa kufunikira kwa insulin (chiwindi ndi matenda a impso, hypofunction ya adrenal cortex, pituitary kapena chithokomiro cha chithokomiro), kusintha kwa malo jakisoni, komanso kucheza ndi mankhwala ena.

Kulephera kapena kusokoneza kwa insulin makonzedwe, makamaka kwa odwala omwe ali ndi matenda amtundu wa 1, angayambitse matenda a hyperglycemia. Nthawi zambiri, zizindikiro zoyambirira za hyperglycemia zimayamba pang'onopang'ono kwa maola angapo kapena masiku. Izi zimaphatikizapo ludzu, kukodza kwambiri, kusanza, kusanza, chizungulire, khungu ndi kuwuma pakhungu, pakamwa pouma, kusowa chilimbikitso, kununkhira kwa acetone mu mpweya wotuluka. Ngati sanalandire, hyperglycemia mu mtundu 1 wa shuga angayambitse kukula kwa matenda ashuga a ketoacidosis.

Mlingo wa insulin uyenera kukonzedwa kuti matenda a chithokomiro asokonekera, matenda a Addison, hypopituitarism, chiwindi ndi impso ntchito ndi anthu odwala azaka zopitilira 65.

Kuwongolera mlingo wa insulin kungafunikenso ngati wodwala akuwonjezera kuchuluka kwa zolimbitsa thupi kapena asintha zakudya zomwe amakonda.

Matenda onga, makamaka matenda ndi machitidwe omwe amatsatana ndi malungo, amalimbikitsa kufunika kwa insulini.

Kusintha kuchokera ku mtundu wina wa insulin kupita ku wina kuyenera kuchitika mothandizidwa ndi misempha yamagazi.

Mankhwala amachepetsa kulolera kwa mowa.

Chifukwa cha kuthekera kwanyengo m'matumba ena, kugwiritsa ntchito mankhwalawa m'mapampu a insulin sikulimbikitsidwa.

Kukopa pa kuyendetsa magalimoto ndi kayendedwe kazinthu. Pokhudzana ndi cholinga choyambirira cha insulin, kusintha kwa mtundu wake kapena kukhalapo kwa kupanikizika kwakukulu kwakuthupi kapena kwamalingaliro, ndizotheka kuchepetsa kuyendetsa galimoto kapena kuwongolera njira zosiyanasiyana, komanso kuchita zochitika zina zowopsa zomwe zimafuna chidwi chochulukirapo komanso kuthamanga kwa malingaliro ndi magalimoto.

Malo osungira:

Lembani B. M'malo amdima pa kutentha 2 2 C mpaka 8 ° C. Osamawuma. Sungani vala wogwiritsidwa ntchito kutentha kwa 15 ° C mpaka 25 ° C kwa milungu 6. Sungani bokosi logwiritsidwa ntchito pa kutentha kwa 15 ° C mpaka 25 ° C kwa milungu 4. Pewani kufikira ana. Moyo wa alumali ndi zaka 2. Osagwiritsa ntchito tsiku lotha ntchito likusonyezedwa pa phukusi.

Malo opumulira:

Kuyimitsidwa kwa subcutaneous makonzedwe a 100 IU / ml.

5 ml kapena 10 ml pa botolo lililonse lagalasi lopanda utoto, lokometsedwa ndi kapu.

3 ml iliyonse mu katoni yopangidwa ndi galasi lopanda utoto, losindikizidwa ndi chidindo chophatikizika, kuti mugwiritse ntchito ndi cholembera cha Biomatic Pen® kapena cholembera cha biosulin® cholembera. Mpira wopangidwa ndi galasi la borosilicate umalowetsedwa m'bokosi.

Vala imodzi ya 5 ml kapena 10 ml pa paketi iliyonse, pamodzi ndi malangizo ogwiritsira ntchito. Mbale 2.3 kapena 5 za 5 ml kapena 10 ml pa chithupsa chilichonse.

Pa 1, 3 kapena 5 makatoni ojambula pamtunda wa blister.

Phukusi limodzi la mabotolo ndi mabotolo kapena makatiriji pa paketi limodzi ndi malangizo ogwiritsa ntchito.

Zizindikiro, contraindication ndi mavuto

Chizindikiro chogwiritsa ntchito mankhwala ndi kupezeka kwa thupi la wodwalayo la mtundu 1 shuga.

Mankhwalawa amagwiritsidwa ntchito ngati mtundu wa matenda a shuga 2, omwe ali pakanthawi kosagwirizana ndi mankhwala a hypoglycemic omwe atengedwa pakamwa, pa nthawi yokana kukana mankhwalawa pakamwa pogwiritsa ntchito zovuta, komanso pa matenda a matenda a shuga a mtundu wachiwiri.

Zoyeserera zazikulu zogwiritsidwa ntchito ndizopezeka kwa kukhudzika kwa chidwi cha insulin kapena chinthu china chomwe ndi gawo la chipangizo chachipatala ndikukula kwa zizindikiro za wodwala wokhala ndi hypoglycemic state.

Maonekedwe owonongera chifukwa chogwiritsa ntchito mankhwala othandizira amakhudzana ndi mphamvu yomaliza ya chakudya.

Zotsatira zoyipa zomwe zimapezeka mthupi la wodwala mukamagwiritsa ntchito mankhwalawa ndi izi:

Kukula m'thupi la dziko la hypoglycemic, komwe kumadziwoneka ngati khungu, khungu limakulitsa thukuta, kuwonjezeka kwa mtima komanso kuwoneka kwamanjala. Kuphatikiza apo, chisangalalo cha dongosolo lamanjenje ndi paresthesia mkamwa zimawonekera; Hypoglycemia yayikulu imatha kupha.
Thupi lawo siligwirizana mukamagwiritsa ntchito mankhwalawa limawonekera kawirikawiri ndipo nthawi zambiri limapezeka pakhungu pakhungu, kakulidwe ka edema la Quincke komanso m'malo osowa kwambiri anaphylactic amayamba.
Momwe zimachitika zoyipa zam'deralo, hyperemia, kutupa ndi kuyabwa m'malo a jekeseni. Ndi kugwiritsa ntchito mankhwalawa kwa nthawi yayitali, kukulira kwa lipodystrophy m'malo a jakisoni ndikotheka.

Kuphatikiza apo, maonekedwe a edema, komanso zolakwika zokonzanso. Nthawi zambiri, zotsatira zoyipa zotsiriza zimachitika koyambirira kwa mankhwalawa.

Malangizo ogwiritsira ntchito mankhwalawa

Mankhwala ndi njira yothandizirana ndi ma subcutaneous. Kuchuluka kwa mankhwala ofunikira jakisoni kuyenera kuwerengedwa ndi adokotala.

Ndi endocrinologist wokhayo amene amatha kuwerengetsa mlingo wake, yemwe amayenera kuganizira za momwe thupi limayendera komanso zotsatira za mayeso ndi mayeso a wodwalayo. Mlingo wogwiritsidwa ntchito pochizira ayenera kuganizira kuchuluka kwa shuga m'thupi la wodwalayo. Nthawi zambiri, mankhwalawa amagwiritsidwa ntchito muyezo wa 0,5 mpaka 1 IU / kg wa wodwala thupi.

Kutentha komwe kumagwiritsidwa ntchito kumayambitsa thupi kumayenera kukhala kutentha.

Mlingo wowerengera wa mankhwalawa uyenera kuperekedwa m'dera la ntchafu. Kuphatikiza apo, mankhwalawa amatha kuthandizidwa mosadukiza m'chigawo cha khomo lachiberekero lamkatikati, matako, kapena dera lomwe minofu yolumikizira imakhalapo.

Pofuna kupewa lipodystrophy mu shuga mellitus, ndikofunikira kusintha tsamba la jakisoni.

Biosulin N itha kugwiritsidwa ntchito ngati chida chodziyimira panokha pa mankhwala a insulin komanso monga gawo la mankhwala osakanikirana molumikizana ndi Biosulin P, omwe ndi insulin yochepa.

Mankhwalawa sayenera kugwiritsidwa ntchito ngati mankhwalawa atapukusidwa, kuyimitsidwa sikupeza tint yoyera ndipo sikukhala ngati mitambo.

Pankhani yogwiritsa ntchito mankhwalawa, kuyang'anira kuchuluka kwa shuga wa m'magazi kuyenera kuchitika.

Zomwe zimayambitsa kukula kwa hypoglycemic state m'thupi la wodwalayo zitha kukhala, kuwonjezera pa bongo, zifukwa zotsatirazi:

m'malo mankhwala
kuphwanya dongosolo lazakudya,
kusanza,
kupezeka kwa matenda am'mimba,
chakudya kwa wodwala pakuchita zolimbitsa thupi,
matenda omwe amakhudza kufunika kwa insulin,
kusintha kwa jekeseni,
mogwirizana ndi mankhwala ena.

Ndi cholinga choyambirira cha insulin, kuyang'anira magalimoto sikuyenera kuchitika, popeza pali kuthekera kwakukulu kotsika kachitidwe ka anthu komanso kuchepa kwa maonedwe acuity.

Mikhalidwe yosungirako, mtengo wake ndi mawonekedwe a mankhwala

Mankhwalawa amayenera kusungidwa pamalo otetezedwa ku kuwala, kutentha kwa madigiri 2 mpaka 8 Celsius. Sizoletsedwa kuyimitsa chipangizo chachipatala.

Botolo lotseguka ndikugwiritsa ntchito chipangizo chachipatala liyenera kusungidwa pamatenthedwe osiyanasiyana kuyambira 15 mpaka 25 digiri Celsius. Malangizo a insulin awa ogwiritsira ntchito akuti moyo wa alumali wa mankhwalawa ndi miyezi isanu ndi umodzi. Mukamagwiritsa ntchito mankhwalawa katiriji, moyo wa alumali wa cartridge wogwiritsidwa ntchito suyenera kupitirira masabata anayi.

Mankhwalawa amayenera kusungidwa m'malo osavomerezeka ndi ana.

Moyo wa alumali wa chipangizo chachipatala chokhazikitsidwa ndi zaka ziwiri. Pambuyo pa nthawi imeneyi, chipangizo chachipatala sichiyenera kugwiritsidwa ntchito pakumwa mankhwala a insulin.

Mankhwalawa amagawidwa m'mafakisoni mosamalitsa.

Malinga ndi odwala omwe amagwiritsa ntchito insulin yamtunduwu, ndi njira yothandiza kwambiri kuwongolera mulingo wa shuga m'thupi la wodwala yemwe ali ndi matenda ashuga.

The fanizo la mankhwala ndi:

Gansulin N.
Insuran NPH.
Humulin NPH.
Humodar.
Rinsulin NPH.

Mtengo wa botolo limodzi ku Russia ndi pafupifupi ma ruble 500-510, ndipo ma cartridge 5 okhala ndi voliyumu ya 3 ml iliyonse amakhala ndi mtengo wokwanira ma ruble a 1046-1158.

Kanemayo munkhaniyi akukamba za zomwe amachita ndi insulin.

Pharmacokinetics

Mlingo wa mayamwidwe ndi isanayambike chitukuko cha zotsatira za insulin zimadalira kuchuluka kwa insulin yomwe imayendetsedwa, kuyika kwake pakukonzekera ndi malo a jekeseni (ntchafu, pamimba, matako).

Homoni imafalitsidwa mosiyanasiyana. Simadutsana chotchinga ndi mkaka wa m'mawere.

Isulin insulin imapangidwa makamaka mu chiwindi ndi impso mothandizidwa ndi insulinase. Amatulutsidwa mu mkodzo wokwanira 30 mpaka 80% ya mlingo.

Contraindication

achina,
Hypersensitivity insulin kapena chinthu chilichonse chothandiza pakuyimitsidwa Biosulin N.

Mosamala, mankhwalawa ayenera kugwiritsidwa ntchito potsatira milandu:

kuwonongeka kwaimpso,
chiwindi ntchito,
kupezeka kwa matenda wamba,
stenosis yamphamvu yam'mimba komanso yam'mimba
Matenda a chithokomiro,
Matenda a Addison
hypopituitarism,
proliferative retinopathy, makamaka kwa odwala omwe sanalandire chithandizo cha laser (chithandizo cha Photocoagulation),
zaka zopitilira 65.

Biosulin N, malangizo ake: njira ndi mlingo

Chowerengera cha glucose, dosing regimen (mlingo ndi nthawi ya makonzedwe) zimatsimikiziridwa ndikusinthidwa mosamalitsa ndi dokotala aliyense payekhapayekha kwa wodwala aliyense m'njira zofanana ndi zomwe akukhala ndi moyo wa wodwalayo, kuchuluka kwa zochitika zolimbitsa thupi ndi zakudya.

Kuyimitsidwa Biosulin N imayendetsedwa mosavuta, nthawi zambiri ntchafu. Majekiseni amathanso kuchitidwa paphewa (pang'onopang'ono kwa minofu yolimba), khoma lakunja lam'mimba kapena matako. Pofuna kupewa kukula kwa lipodystrophy, tikulimbikitsidwa kusinthana malo omwe jakisoni uli mkati mwa anatomical dera. Kuyimitsidwa kuyenera kuperekedwa mosamala kuti isalowe mumtsempha wamagazi. Palibenso chifukwa chokwanira kutikirira jakisoni.

Dokotalayo amamulembera kuchuluka kwa glucose m'magazi ndi zomwe wodwalayo ali nazo. Pafupifupi tsiku lililonse mlingo umasiyana pakati pa 0.5-1 IU / kg.

Wodwala aliyense ayenera kulangizidwa ndi katswiri wazachipatala za pafupipafupi momwe angadziwire kuchuluka kwa shuga ndi malingaliro pazokhudza kusintha kwa mankhwala a insulini pakachitika kusintha kulikonse m'moyo kapena zakudya, ayeneranso kuphunzitsidwa momwe angagwiritsire ntchito chipangizocho kuperekera Biosulin N.

Mu kwambiri hyperglycemia (makamaka, ndi ketoacidosis), kugwiritsa ntchito insulin ndi gawo limodzi la chithandizo chokwanira, kuphatikizapo njira zotetezera odwala ku zovuta zomwe zingachitike chifukwa cha kuchepa msanga kwa magazi m'magazi. Malangizo othandizira oterewa amafunika kuwunika mosamalitsa m'chipinda choperekera chisamaliro chokwanira, chomwe chimaphatikizapo kuyang'anira zofunikira za thupi, kudziwa kuchuluka kwa electrolyte, acid-base usawa, ndi metabolic level.

Kutentha kwa kuyimitsidwa kuyenera kukhala kutentha kwa chipinda.

Sizoletsedwa kuyambitsa kuyimitsidwa, ngati kusakaniza sikukhala kopanda pake, kwamtambo, koyera. Osagwiritsa ntchito ngati, mutasakaniza, muli ndi ma flakes, kapena tinthu tating'ono tomwe timatirira pansi / makhoma a botolo (zotsatira za "mawonekedwe achisanu").

Kusintha kupita ku Biosulin N kuchokera ku mtundu wina wa insulin

Posamutsa wodwala kuchokera ku mtundu wina wa insulin kupita ku wina, njira yodulira imafunikira kusinthidwa, mwachitsanzo, posintha insulin yochokera ku nyama ndi munthu, posintha kuchokera ku insulin yaumunthu kupita ku imzake, pochotsa insulin ya insulle yaumunthu kupita ku insulin yotalikirapo, etc.

Mukasintha kuchokera ku insulin yochokera ku nyama kupita ku insulin yaumunthu, zingakhale zofunikira kuchepetsa mlingo wa mankhwalawa, makamaka kwa odwala omwe ali ndi vuto la hypoglycemia, m'mbuyomu omwe anali ndi kutsika kwa shuga m'magazi, m'mbuyomu amafunikira insulini yayikulu chifukwa cha kukhalapo kwa ma antibodies kwa iwo.

Kufunika kuchepetsa mlingo wa mankhwalawa kumatha kuchitika pokhapokha atasamukira ku mtundu watsopano wa insulin, ndikupanga pang'onopang'ono milungu ingapo.

Pakusintha kwa wodwalayo kukonzekera kwina kwa insulin komanso m'milungu yoyamba yogwiritsidwa ntchito, kuchuluka kwa shuga wamagazi kuyenera kuyang'aniridwa mosamala. Odwala omwe kale amafuna kwambiri Mlingo wa insulin chifukwa cha kupezeka kwa ma antibodies akulimbikitsidwa kusamukira ku mtundu wina wa insulin kuchipatala moyang'aniridwa ndi achipatala.

Kusintha kowonjezera kwa insulin

Ndi bwino kagayidwe kachakudya, kuwonjezeka kwa insulin sensitivity ndikotheka, chifukwa chomwe kufunika kwake kumatha kuchepetsedwa.

Kusintha kwa magazi kungakhale kofunikira posintha thupi, wodwala, kapena zochitika zina zomwe zingakulitse chiwonetsero chakukula kwa hyper- kapena hypoglycemia.

Kufunika kwa insulin nthawi zambiri kumachepetsedwa mwa okalamba. Pofuna kupewa kutengeka kwa hypoglycemic, tikulimbikitsidwa kuti muyambe kugwiritsa ntchito mankhwala mosamala, kuwonjezera kuchuluka kwa mankhwalawa ndikusankha Mlingo wokonza.

Zofunikira za insulini zochepetsedwa zimawonekanso nthawi zambiri chifukwa cha kulephera kwaimpso / chiwindi.

Kugwiritsa ntchito Biosulin N m'mbale

Kugwiritsa ntchito mtundu umodzi wokha wa insulin:

Patulani khungu pa mphira.
Sungani mpweya mu syringe mu voliyumu yomwe ikufanana ndi insulin yofunika. Zilowetseni mu botolo ndi mankhwala.
Tembenuzani botolo (pamodzi ndi syringe) mozungulira ndikujambulitsa muyeso womwe mukufuna kuyimitsidwa mu syringe. Chotsani syringe mu vial ndikuchotsa mpweya kuchokera pamenepo. Onani kulondola kwa mlingo.
Lowetsani nthawi yomweyo.

Kuphatikiza mitundu iwiri ya insulin:

Tizilombo toyambitsa matenda a mphira m'mabotolo awiri.
Pereka botolo la insulin (yamtambo) yayitali pakati pama manja mpaka mankhwala atakhala ofanana komanso oyera.
Sungani mpweya mu syringe wofanana ndi mlingo wa insulin yamitambo, ikanikeni mu vial yoyenera ndikutenga singano (simufunikanso kusonkhanitsa mankhwalawa).
Sungani mpweya mu syringe mu gawo lofanana ndi mlingo wa insulin (yoonekera mwachidule) ndikuyiyika mu vial yoyenera. Popanda kuchotsa syringe, tembenuzani botolo mozama ndikuyimba muyeso womwe mukufuna. Chotsani syringe mu vial ndikuchotsa mpweya kuchokera pamenepo. Onani kulondola kwa mlingo.
Ikani singano mu mitambo ya insulin. Popanda kuchotsa syringe, itembenuleni mozondoka ndikuyimba muyeso womwe mukufuna. Chotsani mpweya, onetsetsani kuchuluka kwa mankhwalawo.
Lowetsani osakaniza nthawi yomweyo.

Kulemba mitundu yosiyanasiyana ya insulin nthawi zonse kumayenera kukhala m'njira zomwe tafotokozazi.

Kugwiritsa ntchito Biosulin N m'makalata

Katirijiyo adapangira kuti azigwiritsa ntchito cholembera cha biosulin ndi ma syringes a biomatic.

Asanayambe kuperekera chithandizo, wodwala ayenera kuonetsetsa kuti katiriji sikuwonongeka (mwachitsanzo, ming'alu), apo ayi sangagwiritsidwe ntchito.

Kuyimitsaku kuyenera kusakanikirana nthawi yomweyo musanabayidwe (ndikuyika makatiriji mu cholembera): tembenuza katiriji mpaka magawo 10 kuti galasi la galasi lisunthe kuchokera kumapeto mpaka kumapeto kwa cartridge mpaka madzi onse atasakanizika. Ngati katiriji waikapo kale cholembera, mutembenuzire pamodzi ndi cartridge. Njirayi iyenera kuchitidwa musanayambe makonzedwe a Biosulin N.

Mukayika makatoni mu syringe cholembera, Mzere wachikuda udzaonekera pawindo la wogwirizira.

Bokosi lirilonse la Biosulin N ndi logwiritsa ntchito payekha. Osadzaza makatoni.

Pamaso jakisoni, muyenera kusamba m'manja ndikupukuta khungu pamalo opukutira jakisoni ndi misozi, koma pambuyo poti mulingo wa insulin waikidwa mu cholembera ndipo mulore kuti mowa uume.

Ndondomeko ya jakisoni wa Biosulin N ndi cholembera:

Sonkhanitsani khola ndi zala ziwiri ndikulowetsa singano m'munsi mwake pamalo a 45 °, kupanga jakisoni wa insulin.
Mukugwira batani pansi, siyani singano pansi pa khungu kwa masekondi osachepera 6 kuti muwonetsetse kuti mupeze yoyenera ya mankhwalawo ndikuchepetsa kulowa kwa magazi / lymph mu singano / katoni.
Chotsani singano. Ngati magazi athawa pamalo a jakisoni, pofinyani jakisoniyo ndi swab ya thonje wothinitsidwa ndi njira yotsatsira (monga mowa).

Yang'anani! Singano ndi yopanda chonde, osakhudza. Wopanda singano yatsopano uyenera kugwiritsidwa ntchito pobayira iliyonse.

Wodwala amayenera kutsatira mosamala malangizo omwe angagwiritse ntchito cholembera china, chomwe chimafotokoza mwatsatanetsatane momwe angakonzekere, kusankha mlingo, kupereka mankhwala.