Isofan insulin malonda dzina, mbali, analogs, limagwirira, contraindication, zikuonetsa, ndemanga ndi mtengo wapakati

U.S. Food and Drug Administration (FDA) idavomereza Tresiba / Tresiba (insulin degludec ya jekeseni) ndi Ryzodeg / Ryzodeg 70/30 (insulin degludec / insulin aspart ya jekeseni) pa Seputembara 25 kuti apititse patsogolo magazi a shuga mwa akulu omwe ali ndi matenda ashuga.

Malinga ndi Centers for Disease Control and Prevention, anthu pafupifupi 21 miliyoni ku United States ali ndi matenda a shuga. Popita nthawi, matenda ashuga amawonjezera mwayi wamavuto akulu, kuphatikizapo matenda amtima, khungu, kuwonongeka kwamanjenje, komanso matenda a impso. Kupititsa patsogolo kayendedwe ka shuga m'magazi kungathandize kuchepetsa chiopsezo cha zovuta zotere.

«Kuchita insulin nthawi yayitali amagwira ntchito yayikulu pakuwathandiza odwala omwe ali ndi matenda ashuga a mtundu woyamba komanso matenda a shuga a II, ”atero Dr. Jean-Marc Gettyer, Director of Metabolic and Endocrinological Division of FDA's Center for Drug Evaluation and Research. "Nthawi zonse timalimbikitsa kukhazikitsa ndi kukhazikitsa mankhwala othandizira kulimbana ndi matenda ashuga."

Mankhwala a Tresiba Kodi ndi anulin insulin yolembedwa kale kuti ipangitse kusintha kwa glycemic control mwa akulu omwe ali ndi matenda amtundu wa II komanso mtundu II. Mlingo wa mankhwalawa amasankhidwa payekhapayekha. Tresiba imayendetsedwa kamodzi kamodzi tsiku lililonse nthawi iliyonse.

Kuchita bwino ndi chitetezo Tresiba yogwiritsidwa ntchito ndi odwala omwe ali ndi matenda a shuga a Type I kuphatikiza ndi insulin ya pakamwa pakudya, adayesedwa m'masabata awiri a 26 komanso sabata limodzi la 52 lomwe limayang'aniridwa mwachangu ndi odwala 1 102.

Kuchita bwino ndi chitetezo Tresiba yogwiritsidwa ntchito ndi odwala omwe ali ndi matenda amtundu wa II osakanikirana ndi mankhwala othandizira odwala matenda a shuga adayesedwa m'masabata anayi a 26 komanso masabata awiri 52 adawongolera mwachangu mayeso azachipatala omwe amakhala ndi odwala 2 702. Ophunzira onse adatenga mankhwala oyesera.

Odwala omwe ali ndi matenda amtundu wa I komanso a Type II omwe anali ndi vuto losakwanira la shuga kumayambiriro kwa phunziroli, kugwiritsa ntchito Treshiba kunapangitsa kuchepa kwa HbA1c (hemoglobin A1c kapena glycogemoglobin, chizindikiro cha shuga wamagazi), komanso machitidwe ena okonzekera insulin. adavomerezedwa kale.

Mankhwala Ryzodeg 70/30 ndi mankhwala ophatikiza: insulin-degludec, anulinue insulin-insulin, wothamanga wa insulin, wothamanga kwambiri. Ryzodeg adapangidwa kuti apititse patsogolo chiwongolero cha glycemic mwa akulu omwe ali ndi matenda ashuga.

Kuchita bwino ndi chitetezo Ryzodeg 70/30, kuti agwiritsidwe ntchito ndi odwala omwe ali ndi matenda a shuga a I kuphatikiza ndi insulin ya pakamwa pakudya, adayesedwa mu kafukufuku wolamulidwa mwachangu wa sabata la 262 mwa odwala 362.

Kuchita bwino ndi chitetezo cha Ryzodeg 70/30 kwa makonzedwe 1-2 kawiri pa tsiku ndi odwala omwe ali ndi matenda amtundu wa II adayesedwa m'mayesero anayi azachipatala a 268 omwe anali ndi odwala 998. Ophunzira onse adatenga mankhwala oyesera.

Odwala omwe ali ndi matenda amtundu wa I komanso a Type II omwe anali ndi vuto losakwanira la shuga kumayambiriro kwa phunziroli, kugwiritsa ntchito Raizodeg 70/30 kunapangitsa kuchepa kwa HbA1c yofanana ndi yomwe idapezedwa ndi insulin yolembedwa kale kapena insulin yosakanikirana.

Kukonzekera Tresiba ndi Ryzodeg contraindicated odwala ndi okwera misempha ya matupi a ketone m'magazi kapena mkodzo (matenda ashuga ketoacidosis). Madokotala ndi odwala ayenera kuwunika bwino kuchuluka kwa shuga m'magazi nthawi yonse ya chithandizo cha insulin. Tresiba ndi Ryzodeg angayambitse kuchepa kwa shuga wamagazi (hypoglycemia) - mkhalidwe wowopsa. Kuwunikira mosamala kwambiri kuyenera kuchitika posintha kuchuluka kwa insulin, kugwiritsa ntchito mankhwala ena omwe amachepetsa shuga, kusintha pakudya, kuchita masewera olimbitsa thupi komanso odwala omwe ali ndi vuto la impso kapena hepatic kapena insensitivity hypoglycemia.

Kugwiritsa ntchito insulin iliyonse zimatha kuyambitsa zovuta zomwe zimawopsa m'moyo, kuphatikiza anaphylaxis, zochitika pakhungu, angioedema, bronchospasm, hypotension komanso thupi lawo siligwirizana.

Zotsatira zoyipa kwambiri za mankhwala a Tresiba ndi Risedeg omwe apezeka pa mayesero azachipatala anali hypoglycemia, matupi awo sagwirizana, zomwe zimachitika jekeseni, lipodystrophy (kuchepa kwamafuta onunkhira) pamalo opangira jekeseni, kuyabwa pakhungu, zotupa, kutupa komanso kunenepa kwambiri.

Pharmacodynamics ndi pharmacokinetics

Insulin ndi mahomoni ofunikira omwe, limodzi ndi glucagon, amakhudza shuga. Hormoni imapangidwa mu ß-cell (beta cell) kapamba - zisumbu za Langerhans. Ntchito yayikulu ya insulin ndikuwongolera glycemic.

Kusakhalapo kwathunthu kwa insulin kumabweretsa chitukuko cha mtundu 1 shuga mellitus - matenda a autoimmune. Ngakhale ali ndi vuto lodalira insulin, kusowa kwathunthu kwa insulin kumawonedwa, matenda osagwirizana ndi insulin amadziwika chifukwa cha kuchepa kwa mahomoni.

Chomwe chimapangitsa kuti mamasulidwe a insulini amasulidwe ndi shuga wamagazi a 5 mmol glucose pa lita imodzi ya magazi. Komanso ma amino acid osiyanasiyana komanso mafuta achilengedwe omasuka amatha kupangitsa kuti maholidi amasulidwe: secretin, GLP-1, HIP ndi gastrin. Glucose wodalira insulinotropic polypeptide amathandizira kupanga insulin mutatha kudya.

Analog ya insulini imamangirira zigawo zina za insulini ndipo imalowetsa mamolekyulu am'magazi kulowa m'maselo a chandamale. Ma cell a minofu ndi chiwindi ali ndi kuchuluka kwakukulu kwama receptor. Chifukwa chake, amatha kuyamwa glucose wambiri munthawi yochepa kwambiri ndikuisunga ngati glycogen kapena kusintha mphamvu.

Zizindikiro ndi contraindication

Zotsatira zamankhwalazi zaphunziridwa mwa anthu oposa 3,000. Maphunziro ambiri anali ochepa koma adangofalitsidwa pang'ono.

Pakufufuza kwakukulu, kosasankhidwa, kwamitundu yambiri, insulin ya lyspro inayerekezedwa ndi isophan. Anthu 1,008 omwe ali ndi matenda a shuga omwe amadalira insulin anali m'fukufukuyu, yemwe adatenga miyezi isanu ndi umodzi. Onse anali kuthandizidwa molingana ndi mfundo yoyambira ya bolus. Mankhwalawa anali kuperekedwa musanadye, nthawi zonse musanadye mphindi 30-45 musanadye. Mukamagwiritsa ntchito lyspro, mulingo wa ma monosaccharides m'magazi unakula kwambiri mutatha kudya kusiyana ndi insulin yofananira, kuchuluka kwa glucose m'magazi mutatha kudya anali 11.15 mmol / L ndi insulin yofananira, 12.88 mmol / L yokhala ndi lyspro. Ponena za glycosylated hemoglobin (HbA c) ndi kutsata kwa glucose, panalibe kusiyana kwakukulu pakati pa njira ziwirizi.

Pakafukufuku waposachedwa, kugwiritsa ntchito mankhwalawa kunaphunziranso mwa anthu 722 omwe ali ndi matenda osokoneza bongo omwe amadalira insulin. Panalinso kuchepa kwakukulu kwa shuga m'magazi mutatha kudya. Pamapeto pa phunziroli, kuchuluka kwa glucose anali 1.6 mmol / L kutsika ndi isofan 2 maola atatha kudya kusiyana ndi lyspro. Glycated hemoglobin inachepa chimodzimodzi magulu onse azachipatala.

Mlandu wina wosasinthika unanena kuti anthu 336 omwe ali ndi matenda a shuga a mtundu wa I ndi 295 omwe ali ndi matenda osokoneza bongo omwe amadalira insulin. Odwala amatenga ama lispro kapena isofan. Apanso, mankhwalawa amaperekedwa musanadye, ndipo lispro mphindi 30-45 musanadye. Komanso mu kafukufukuyu, yemwe adakhala miyezi 12, isofan adawonetsa kuchepa kwa glucose wa postprandial poyerekeza ndi mankhwala ena. Mtundu woyamba wa matenda a shuga, mtundu wa isofan nawonso umakwaniritsidwa ndi kuchuluka kwa hemoglobin wa glycated (mpaka 8.1%). Mwa anthu omwe ali ndi matenda amtundu wa II, palibe kusiyana pakati pa magulu azamankhwala pankhaniyi.

Zotsatira zoyipa

Hypoglycemia ndiye vuto lofunika kwambiri la insulin. Kafukufuku ambiri adagwiritsa ntchito zizindikiritso za hypoglycemic kapena saccharides am'munsi mwa 3.5 mmol / L kuti adziwe kugwidwa kwa hypoglycemic. M'maphunziro awiri akulu, a hypoglycemia ofunikira komanso asymptomatic anali ochepa pa odwala omwe adatenga isofan, kusiyana kumeneku kunatchulidwa kwambiri usiku.

Pakufufuza kwa anthu odwala matenda a shuga omwe amadalira insulin, hypoglycemia imachitika kangapo pa 6 mwezi. Poyerekeza ma khungu awiri pakati pa lispro ndi isophane, palibe kusiyana komwe kunapezeka mwa pafupipafupi kwambiri mwa ma hypoglycemia. Mukamagwiritsa ntchito mankhwala oyamba, chiopsezo cha hypoglycemia chinali chokwanira patatha pafupifupi maola atatu pambuyo pa jekeseni, komanso ndikuyambitsa kwa insulin ya anthu atatha maola 3-12.

Popeza lyspro imalumikizidwa mwapadera ndi insulin-like grow factor I (IGF-I), imamangiriza ku IGF-I receptors kuposa insulin yokhazikika. Mwachidziwitso, zotsatira za IGF-I-ngati zimathandizira kukulira kwa zovuta za microvascular kapena, chifukwa chodziwa ndi insulin yofanana ndi insulin, imayambitsanso zotsatira za carcinogenic.

Hypoglycemia imachitika ngati wodwala atamwa kwambiri mankhwala, amamwa mowa, kapena akudya pang'ono. Kuchita masewera olimbitsa thupi nthawi zina nthawi zina kumayambitsa vuto lalikulu la hypoglycemic.

Zizindikiro zodziwika bwino ndi izi:

• Hyperhidrosis,
• Kutentha
• Kuchulukitsa chilakolako
• Kuwona koperewera.

Hypoglycemia ikhoza kulipiriridwa msanga ndi dextrose kapena chakumwa chokoma (msuzi wa apulosi). Chifukwa chake, aliyense wodwala matenda ashuga ayenera kumatenga shuga nthawi zonse. Pokhala ndi hypoglycemia pafupipafupi komanso matenda a shuga omwe amakhala nawo kwa nthawi yayitali, pamakhala ngozi yoti wodwalayo angagwe. Mankhwala, makamaka a beta blockers, amatha kufinya zizindikiro za hypoglycemia.

Hyperglycemia imayamba ngati kuchuluka kwa chakudya ndi insulin sikumawerengeredwa bwino. Matenda komanso mankhwala ena amathanso kuyambitsa hyperglycemia. Mtundu woyamba wa odwala matenda ashuga, kuperewera kwa insulini kumatsogolera ku otchedwa ketoacidosis - kuchuluka kwa thupi. Izi zitha kuchititsa kuti musakhale ndi chikumbumtima chokwanira (matenda a shuga), ndipo vuto lalikulu kwambiri ndi imfa. Ketoacidosis ndi vuto lachipatala mwadzidzidzi ndipo ayenera kuthandizidwa ndi dokotala nthawi zonse.

• Kusanza ndi kusanza
• Kukodza pafupipafupi
• Kutopa
• Acetone

Mlingo ndi bongo

Malinga ndi malangizo ogwiritsira ntchito, mankhwalawa nthawi zambiri amaperekedwa mwachangu - m'matumbo a adipose. Madera omwe amakonda kubayidwa ndi m'mimba ndi ntchafu zotsika. Mankhwalawa amapaka jekeseni ndi singano yopyapyala komanso yochepa kwambiri pakhungu lotukuka. Ubwino wa cholembera ndikuti wodwalayo amatha kuwona kuchuluka kwake kwa mankhwalawa omwe amaperekedwa. Mlingo wa tsiku ndi tsiku umatsimikiziridwa ndi dokotala.

Zolembera za insulin zimakhala ndi singano yochepa thupi. Pamwamba pa chogwirizira pali chipangizo chozungulira. Chiwerengero chomwe chimasinthidwa chimatsimikizira kuchuluka kwa insulin yomwe imabayidwa panthawi ya jakisoni.

Mapampu a insulini ndi ochepa, amalamulira pakompyuta ndipo amatha kupakidwa omwe amavala thupi ndikupereka mlingo wa insulin kuti utulutse minofu kudzera pa chubu la pulasitiki.

Pampu ya insulin ndi yoyenera makamaka kwa anthu odwala matenda ashuga omwe ali ndi mtundu wina wa moyo. Ngati glycemia imasinthasintha ngakhale ndi jakisoni wambiri wa insulin, pampu ya insulini ndi yothandiza komanso yotetezeka.

Kuchita

Mankhwala amatha kuyanjana ndi mankhwala onse omwe ali ndi chiwonetsero cha glycemia mwachindunji.

Mofanizira waukulu wa mankhwala:

Maganizo a adotolo komanso odwala.

Mtundu wa insulin wa munthu ndi mankhwala otetezeka komanso otsimikizika omwe agwiritsidwa ntchito mu shuga kwazaka zambiri. Komabe, musanagwiritse ntchito ndikofunikira kusintha mlingo wa mankhwalawa.

Kirill Alexandrovich, katswiri wa matenda ashuga

Ndakhala ndikumwa mankhwalawa kwa zaka 5 ndipo sindimva zoyipa zilizonse zoyipa. Ngati simukudya, amanjenjemera, mutu wanu umapindika ndipo mtima wanu umayamba kugunda mwachangu. Bokosi la shuga limapulumutsa vutoli. Zovuta sizimachitika kawirikawiri, chifukwa ndine wokondwa ndimankhwala.