Insulin Degludec: Kodi mtengo wowonjezera wa mankhwala ndimatenga nthawi yayitali bwanji?

Philadelphia, PA June 2012 Insulin degludec, mankhwala atsopano omwe amapezeka kwa nthawi yayitali a Novo Nordisk, adawonetsa kuchepa kwakukulu kwa zochitika za nocturnal hypoglycemia * mwa odwala akulu omwe ali ndi matenda a shuga a 2, pomwe nthawi yomweyo amawongolera kuwongolera kwa shuga wamagazi poyerekeza ndi insulin glargine pa milungu 52 milungu. Zotsatira za phunziroli, gawo 3a, zidaperekedwa pamsonkhano wa 72nd Sayansi ya American Diabetes Association (ADA) 1.

Kafukufukuyu adawonetsanso kuti insulini ya insulin poyerekeza ndi insulin glargine imachepetsa kwambiri zochitika za hypoglycemia 1.

"Nocturnal hypoglycemia, kapena hypoglycemia nthawi yogona, ndivuto lalikulu kwa anthu omwe ali ndi matenda ashuga, chifukwa milandu ngati imeneyi nthawi zambiri imalephera kuneneratu komanso chitukuko chawo chimavuta kuzindikira," atero a Bernard Zinman, mtsogoleri wamaphunziro ndi mutu wa likulu la Dokotala wothandizira odwala matenda a shuga ku Mount Sinai komanso pulofesa wa zamankhwala ku University of Toronto.

Munthawi ya kusinthaku, kafukufuku wowonekera kuti atsimikizire kuperewera kwa kuyerekezera kwapamwamba pa mankhwala osanthula, ndikukonzanso mtengo wa glycemic, phindu ndi chitetezo cha insulin degludec ndi insulin glargine poyerekeza. Kukonzekera kwa insulin konseko kunaperekedwa kamodzi patsiku kwa odwala akuluakulu 1030 omwe ali ndi matenda a 2 omwe anali asanaledzeretse kale, omwe anali ndi vuto loyipa la glycemic panthawi yamankhwala othandizira pakamwa.

Zotsatira 1

· Zotsatira za nocturnal hypoglycemia zinali kwambiri - 36% - kutsika pogwiritsa ntchito insulin dehydlude poyerekeza ndi insulin glargine (0.25 milandu poyerekeza ndi milandu ya 0.39 pa wodwala pachaka, tsa =0.04).

· Kuchuluka kwa milandu yotsimikizika ya hypoglycemia inali 1.52 milandu poyerekeza ndi 1.85 milandu kwa wodwala pachaka pogwiritsira ntchito insulin deglyudec ndi insulin glargine, ( tsa =0.11).

· Kuchuluka kwa matenda oopsa a hypoglycemia kunali kochepa m'magulu onse awiri azachipatala, koma anali otsika kwambiri ndi ma cell a insulin kuposa ma insulin glargine (0.003 milandu poyerekeza ndi milandu ya 0.023 pa wodwala pachaka, tsa =0.02).

Chaka chimodzi pambuyo pake, kafukufukuyu adawonetsa kuchepa kwakukulu kwa milingo ya HbA. _1c mukamagwiritsa ntchito insulin, achigudec wachibale ndi insulin glargine (-1.06% poyerekeza -1.19%). **

Kuthamanga kwa shuga m'magazi kunachepa kwambiri mukamagwiritsa ntchito insulin gllgek poyerekeza ndi insulin glargine (-67.7 mg / dl motsutsana -59,5 mg / dl, kuyerekezera kwa zotsatizana zamankhwala (EDT) -7.7 mg / dl , p = 0.005).

Zomwe zimachitika pazochitika zoyipa zinali zochepa komanso chimodzimodzi m'magulu onse awiri.

* Amatanthauzira ngati shuga ochepa magazi nthawi yayitali kuyambira 00:01 mpaka 05:59.

Pharmacology

Mfundo za zomwe Degludek insulin imachita ndi zofanana ndi zomwe zimachitika m'thupi la munthu. Kutsitsa kwa shuga kumachitika chifukwa chopangitsa kuti shuga agwiritsidwe ntchito ndi matupi atamangidwa ku mafuta ndi ma cell cell receptors ndipo nthawi yomweyo amachepetsa kuchuluka kwa shuga ndi chiwindi.

Pambuyo pobayira limodzi yankho mkati mwa maola 24, imakhala ndi zotsatira zofanana. Kutalika kwa zotsatirazi ndi maola opitilira 42 mkati mwa njira yothandizira. Ndizofunikira kudziwa kuti ubale wotsogola unakhazikitsidwa pakati pakuwonjezeka kwa kuchuluka kwa mankhwalawo komanso zotsatira zake zonse za hypoglycemic.

Kusiyana kwakukulu pamankhwala omwe amapezeka mu mankhwala a Degludec insulin pakati pa odwala ndi achinyamata sikunawonekere. Komanso, kupanga ma antibodies kupita ku insulin sikunapezeke pambuyo pa chithandizo cha Deglyudec kwa nthawi yayitali.

Zotsatira zazitali za mankhwalawa zimachitika chifukwa cha mamolekyu ake. Pambuyo pazoyang'anira sc, mankhwala osokoneza bongo osungunuka amapangidwa, omwe amapanga mtundu wa "depot" wa insulin m'matumbo a subipaneous adipose.

Ma Multihexamers amadzipatula pang'onopang'ono, zomwe zimapangitsa kuti amasulidwe a ma monmors apangidwe. Chifukwa chake, kuyenda pang'onopang'ono komanso kotenga nthawi yayitali kulowa mumtsinje wamagazi kumachitika, komwe kumatsimikizira mawonekedwe osachedwa, okhalitsa komanso zotsatira zokhazikika za shuga.

Mu plasma, CSS imatheka patadutsa masiku awiri kapena atatu jekeseni. Kugawidwa kwa mankhwalawa ndi motere: ubale wa Degludek ndi albin -> 99%. Ngati mankhwalawa amaperekedwa pang'onopang'ono, ndiye kuti magazi ake onse amakhala olingana ndi Mlingo womwe umaperekedwa pakachiritsi.

Kusweka kwa mankhwalawa ndikofanana ndi zomwe zimapangitsa insulin ya anthu. Ma metabolites onse omwe adapangidwa munjira imeneyi sagwira ntchito.

Pambuyo pa sc makonzedwe a T1 / 2 amatsimikiza ndi nthawi ya mayamwidwe kuchokera subcutaneous minofu, yomwe ili pafupifupi maola 25, mosasamala kanthu.

Gender ya odwala sichikhudza pharmacokinetics ya insulin Degludec. Kuphatikiza apo, palibe kusiyana kwakanthawi kachipatala ka insulini mu achinyamata, odwala okalamba komanso odwala matenda ashuga omwe ali ndi vuto la chiwindi ndi impso.

Ponena za ana (azaka 6 mpaka 11) ndi achinyamata (azaka 12-18) omwe ali ndi matenda a shuga 1, ma pharmacokinetics a insulin Degludec ndiwofanana ndi odwala achikulire. Komabe, ngati jakisoni imodzi ya mankhwalawa odwala omwe ali ndi matenda amtundu wa 1, kuchuluka kwa mankhwalawa kwa odwala omwe ali ndi zaka zosaposa 18 ndi akulu kuposa a odwala matenda ashuga okalamba.

Ndizofunikira kudziwa kuti kugwiritsidwa ntchito kosalekeza kwa Degludec insulin sikukhudza ntchito yobereka komanso sikukuwononga thupi.

Ndipo chiŵerengero cha mitogenic ndi metabolic zochita za Degludek ndi insulin ya anthu ndizofanana.

Pharmacological gulu la zinthu Insulin degludec

Human insulin analogue, a insulin ya nthawi yayitali yochita kupanga yaukadaulo yama DNA pogwiritsa ntchito kupopera Saccharomyces servisiae.

The pharmacological mphamvu ya insulin degludec amadziwikanso chimodzimodzi ndi mphamvu ya munthu insulin kudzera mwachindunji chomangiriza ndi mogwirizana ndi zolandilira anthu amkati insulin.

Mphamvu ya hypoglycemic ya degludec insulin imachitika chifukwa cha kugwiritsidwa ntchito kwa glucose pogwiritsa ntchito minofu pambuyo pomangiriza minofu ndi ma cell cell receptors komanso kutsika kwamtundu womwewo kwa kuchuluka kwa shuga mwa chiwindi.

Munthawi ya kuwunika kwa maola 24 a hypoglycemic zotsatira za insulin degludec mwa odwala omwe amalandira mlingo wa 1 patsiku, zotsatira zoyipa zimawonedwa nthawi yoyamba komanso yachiwiri ya maola 12.

Kutalika kwa nthawi ya insulin degludec ndi maola opitilira 42 mkati mwa njira ya mankhwalawa.

Ubwenzi wapakati pa kuchuluka kwa kuchuluka kwa insludec insulin ndi zotsatira zake zazikulu za hypoglycemic kwatsimikiziridwa.

Panalibe kusiyana kwakukulu kachipatala mu pharmacodynamics ya insulin degludec pakati pa odwala okalamba ndi achinyamata achinyamata odwala.

Palibe kupangika kwofunikira kwambiri kwa ma antibodies kwa insulin komwe kumapezeka pambuyo pothandizidwa ndi insludec insulin kwa nthawi yayitali.

Mafuta Kuchititsidwa kwanthawi yayitali kwa insulin degludec kumachitika chifukwa cha kupangidwa kwake molekyu. Pambuyo pa jekeseni wa subcutaneous, mahesi angapo osungunuka amasungunuka amapangidwa kuti apange depot ya insulin mu minofu ya subcutaneous adipose. Multihexamers pang'onopang'ono amadzisiyanitsa, ndikumasulidwa kwa zipludec insulin monomers, zomwe zimapangitsa kuti mankhwalawo atulutsidwe pang'onopang'ono komanso motalika, ndikuwonetsa pang'onopang'ono zochitika komanso kudziwika bwino kwa hypoglycemic.

C_SS mu madzi am`magazi zimatheka patatha masiku 2-3 pambuyo makonzedwe a insulin degludec.

Kugawa. Kulumikizana kwa insulin degludec ndi mapuloteni a plasma (albumin) ndi> 99%. Ndi sc makonzedwe, okwana plasma woipa ndi wofanana mlingo kutumikiridwa mu osiyanasiyana achire Mlingo.

Kupenda. Kuwonongeka kwa insulin degludec ndikufanana ndi insulin yamunthu, ma metabolites onse omwe amapangidwa satha ntchito.

Kuswana. T_1/2 pambuyo pa jekeseni wa insulin, degludec imatsimikiza ndi mayamwidwe ake kuchokera kuzinthu zowerengeka, pafupifupi maola 25, ndipo osadalira mlingo.

Magulu apadera a odwala

Palibe kusiyana komwe kunapezeka mu pharmacokinetic katundu wa insludec insulin malinga ndi jenda la odwala.

Okalamba okalamba, odwala mafuko osiyanasiyana, odwala omwe ali ndi vuto laimpso kapena kwa chiwindi. Palibe kusiyana kwakukulu mwachipatala komwe kunapezeka mu pharmacokinetics ya degludec insulin pakati pa odwala okalamba ndi achinyamata, pakati pa odwala amitundu yosiyanasiyana, pakati pa odwala omwe ali ndi vuto laimpso ndi kwa chiwindi, komanso odwala athanzi.

Ana ndi achinyamata. The pharmacokinetic katundu wa insulin degludec mu kuphunzira mu ana (6-11 wazaka) ndi achinyamata (12-18 wazaka) ndi mtundu 1 matenda a shuga ndi ofanana ndi odwala achikulire. Poyerekeza ndi kukhazikitsidwa kamodzi kwa mankhwalawa kwa odwala omwe ali ndi matenda a shuga 1, zimawonetsedwa kuti kuwonetsa kwa mankhwalawa kwa ana ndi achinyamata ndi kwapamwamba kwambiri poyerekeza ndi kwa odwala akuluakulu.

Zambiri kuchokera ku maphunziro oyang'anira chitetezo. Zambiri zam'mbuyo zokhudzana ndi maphunziro a chitetezo chamatsenga, kuwopsa kwa Mlingo wobwereza, kuchuluka kwazowopsa, zotsatira zakupha pakubala, sizinawonetse vuto lililonse la insludec insulin kwa anthu. Chiŵerengero cha metabolic ndi mitogenic zochita za insludec insulin kwa insulin yaumunthu ndizofanana.

Matenda a shuga mwa akulu.

Kuchulukitsa kwa chidwi cha munthu wokhudzana ndi insludec insulin, ana osaposa zaka 18, nthawi yomwe ali ndi pakati komanso kuyamwitsa (palibe zovuta zamankhwala zokhudzana ndi kugwiritsa ntchito mankhwalawa kwa ana, azimayi omwe ali ndi pakati komanso poyamwitsa).

Kugwiritsa ntchito insulin degludec panthawi yoyembekezera komanso yoyamwitsa kumatsutsana, chifukwa Palibe zovuta zamankhwala ndi kugwiritsa ntchito kwake nthawi izi.

Sizikudziwika ngati insulin degludec imachotsedwa mkaka wa amayi.

FDA Fetal Action Gulu - C.

Zotsatira zoyipa zomwe zimanenedwa nthawi ya mankhwala a insludec insulin ndi hypoglycemia, ndipo matupi awo amakhudzidwa, kuphatikizapo mtundu wapa, kuphatikizapo wodwala owopsa.

Zotsatira zonse zoyipa zomwe zaperekedwa pansipa, kutengera za mayesero azachipatala, zimagawidwa malinga ndi MedDRA ndi machitidwe a ziwalo. Zomwe zimayambitsa zovuta zimayesedwa nthawi zambiri (> 1/10), nthawi zambiri (> 1/100 mpaka 1/1000 mpaka 1/10000 kupita ku ®

Insulin Degludec: Kodi mtengo wowonjezera wa mankhwala ndimatenga nthawi yayitali bwanji?

Kugwira kwathunthu kwa thupi la munthu ndikosatheka popanda insulini. Ichi ndi mahomoni ofunikira pokonza shuga, yemwe amabwera ndi chakudya, mu mphamvu.

Pazifukwa zosiyanasiyana, anthu ena ali ndi vuto la insulin. Poterepa, pali zofunika zakukhazikitsa mahomoni opanga thupi. Chifukwa chaichi, insulin Degludek imagwiritsidwa ntchito nthawi zambiri.

Mankhwala ndi insulin yaumunthu yomwe imakhala ndi zotsatira zowonjezera zazitali. Chogulitsacho chimapangidwa kudzera mu mitundu iwiri ya michere ya DNA pogwiritsa ntchito Saccharomyces cerevisiae.

Mfundo za zomwe Degludek insulin imachita ndi zofanana ndi zomwe zimachitika m'thupi la munthu. Kutsitsa kwa shuga kumachitika chifukwa chopangitsa kuti shuga agwiritsidwe ntchito ndi matupi atamangidwa ku mafuta ndi ma cell cell receptors ndipo nthawi yomweyo amachepetsa kuchuluka kwa shuga ndi chiwindi.

Pambuyo pobayira limodzi yankho mkati mwa maola 24, imakhala ndi zotsatira zofanana. Kutalika kwa zotsatirazi ndi maola opitilira 42 mkati mwa njira yothandizira. Ndizofunikira kudziwa kuti ubale wotsogola unakhazikitsidwa pakati pakuwonjezeka kwa kuchuluka kwa mankhwalawo komanso zotsatira zake zonse za hypoglycemic.

Kusiyana kwakukulu pamankhwala omwe amapezeka mu mankhwala a Degludec insulin pakati pa odwala ndi achinyamata sikunawonekere. Komanso, kupanga ma antibodies kupita ku insulin sikunapezeke pambuyo pa chithandizo cha Deglyudec kwa nthawi yayitali.

Zotsatira zazitali za mankhwalawa zimachitika chifukwa cha mamolekyu ake. Pambuyo pazoyang'anira sc, mankhwala osokoneza bongo osungunuka amapangidwa, omwe amapanga mtundu wa "depot" wa insulin m'matumbo a subipaneous adipose.

Ma Multihexamers amadzipatula pang'onopang'ono, zomwe zimapangitsa kuti amasulidwe a ma monmors apangidwe. Chifukwa chake, kuyenda pang'onopang'ono komanso kotenga nthawi yayitali kulowa mumtsinje wamagazi kumachitika, komwe kumatsimikizira mawonekedwe osachedwa, okhalitsa komanso zotsatira zokhazikika za shuga.

Mu plasma, CSS imatheka patadutsa masiku awiri kapena atatu jekeseni. Kugawidwa kwa mankhwalawa ndi motere: ubale wa Degludek ndi albin -> 99%. Ngati mankhwalawa amaperekedwa pang'onopang'ono, ndiye kuti magazi ake onse amakhala olingana ndi Mlingo womwe umaperekedwa pakachiritsi.

Kusweka kwa mankhwalawa ndikofanana ndi zomwe zimapangitsa insulin ya anthu. Ma metabolites onse omwe adapangidwa munjira imeneyi sagwira ntchito.

Pambuyo pa sc ya T1 / 2, imatsimikiziridwa ndi nthawi yakupezeka kuchokera kuzinthu zowononga, zomwe zimakhala pafupifupi maola 25, mosasamala kanthu.

Gender ya odwala sichikhudza pharmacokinetics ya insulin Degludec. Kuphatikiza apo, palibe kusiyana kwakanthawi kachipatala ka insulini mu achinyamata, odwala okalamba komanso odwala matenda ashuga omwe ali ndi vuto la chiwindi ndi impso.

Ponena za ana (azaka 6 mpaka 11) ndi achinyamata (azaka 12-18) omwe ali ndi matenda a shuga 1, ma pharmacokinetics a insulin Degludec ndiwofanana ndi odwala achikulire. Komabe, ngati jakisoni imodzi ya mankhwalawa odwala omwe ali ndi matenda amtundu wa 1, kuchuluka kwa mankhwalawa kwa odwala omwe ali ndi zaka zosaposa 18 ndi akulu kuposa odwala matenda ashuga okalamba.

Ndizofunikira kudziwa kuti kugwiritsa ntchito insulini ya Degludek mosasamala sikukhudza ntchito yoberekera ndipo sikukuwononga thupi.

Ndipo chiŵerengero cha mitogenic ndi metabolic zochita za Degludek ndi insulin ya anthu ndizofanana.

Insulin yokhala nthawi yayitali - Glargin kapena Degludek

Wolemba Alla pa Novembala 7, 2017. Yolembedwa mu News News

Mu thupi lathanzi, insulini imasungidwa mosalekeza (chofunikira chachikulu) ndipo imayamba kupangidwa pakafunika kutsika shuga m'magazi (mwachitsanzo, mutatha kudya). Ngati kusowa kwa insulin kupezeka m'thupi la munthu, amafunika kupaka insulin ndi jakisoni, ndiko kuti, insulin.

Udindo wa insulin wa nthawi yayitali (wokhala nthawi yayitali), womwe umapezeka mwa zolembera, umawonetsera kubisalira kwapadera (kosalekeza) kwapancreatic.

Cholinga chachikulu cha mankhwalawa ndikukhalabe ndi chidwi chofunikira cha mankhwalawa m'magazi kwanthawi yayitali. Chifukwa chake, amatchedwa basal insulin.

Hormoni iyi imagawidwa m'magulu awiri: mankhwala osokoneza bongo (NPH) omwe amakhala ndi nthawi yayitali komanso analogue.

Kwa anthu odwala matenda ashuga, inshuwaransi ya anthu ya NPH komanso zochitika zake zazitali zomwe zilipo. Gome ili pansipa likuwonetsa kusiyana kwakukulu pakati pa mankhwalawa.

Mu Seputembara 2015, insulin yatsopano ya Abasaglar idayambitsidwa, yomwe imafanana ndi Lantus yubiquitous.

Food and Drug Administration (FDA, US FDA) - Bungwe la boma lomwe lachita pansi pa dipatimenti ya zaumoyo ku U.S. mu 2016 linavomerezanso mtundu wina wa insulin. Izi zimapezeka pamsika wapanyumba ndipo zimatsimikizira kuyenera kwake pochiza matenda ashuga.

Uwu ndi mtundu wa ma insulin opangira momwe amapangira mapangidwe a insulin yaumunthu, koma olemeretsedwa ndi protamine (protein protein) kuti achepetse. NPH ndi mitambo. Chifukwa chake, isanayambe makonzedwe, iyenera kuzunguliridwa bwino kusakaniza bwino.

NPH ndi mtundu wotsika mtengo kwambiri wa insulin. Tsoka ilo, imakhala ndi chiopsezo chachikulu cha hypoglycemia ndi kulemera kwakukulu, popeza imakhala ndi chiwonetsero chokwanira pantchito (ngakhale zimachitika pang'onopang'ono osati mwachangu ngati insulin pamabowo).

Odwala omwe ali ndi matenda amtundu woyamba 1 amapatsidwa kawiri kawiri la NPH insulin patsiku. Ndipo odwala omwe ali ndi matenda a shuga a 2 amatha jekeseni kamodzi patsiku. Zonse zimatengera kuchuluka kwa shuga m'magazi ndi malingaliro a dokotala.

Insulin, zomwe zimapangidwa ndi mankhwala omwe amasinthika kotero kuti amachedwetsa kuyamwa ndi mphamvu ya mankhwalawo, amadziwika kuti ndi insulin yopanga anthu.

Lantus, Abasaglar, Tujeo ndi Tresiba ali ndi zochitika zodziwika bwino - nthawi yayitali yogwirira ntchito komanso chiwonetsero chochepa kwambiri cha ntchito kuposa NPH. Mwanjira iyi, kudya kwawo kumachepetsa chiopsezo cha hypoglycemia ndi kulemera. Komabe, mtengo wa analogues ndiwokwera.

Abasaglar, Lantus, ndi Tresiba insulin amatengedwa kamodzi patsiku. Odwala ena amagwiritsanso ntchito Levemir kamodzi patsiku. Izi sizikugwira ntchito kwa odwala matenda ashuga 1 omwe mankhwalawa ndi ochepera maola 24.

Tresiba ndiye mtundu watsopano kwambiri ndipo tsopano ndi wotchipa kwambiri wa insulin pamsika. Komabe, ili ndi mwayi wofunikira - chiopsezo cha hypoglycemia, makamaka usiku, ndizotsika kwambiri.

Udindo wa insulin yayitali ndikuwimira chinsinsi chachikulu cha insulini kudzera m'mapapo. Chifukwa chake, muyezo wofanana wa timadzi tomwe timagazi timatsimikizika pantchito yake yonse. Izi zimathandizira kuti maselo a thupi lathu agwiritse ntchito shuga wosungunuka m'magazi kwa maola 24.

Ma insulini onse omwe akhala akuchita kwa nthawi yayitali amalowetsedwa pansi pa khungu m'malo omwe mumakhala mafuta. Gawo lotsatira la ntchafu ndilabwino kwambiri pazolinga izi. Malowa amalola kuti kulowetsedwa pang'onopang'ono, kwa yunifolomu. Kutengera ndi nthawi ya endocrinologist, muyenera kuchita jakisoni imodzi kapena iwiri patsiku.

Ubwino ndi kuipa kwa insulin

Mtundu wa insulin yomwe mumasankha imadalira zinthu zingapo, kuphatikizapo mbiri yanu yakuchipatala, chiwopsezo cha hypoglycemia, komanso kuchuluka kwa kuwongolera pa insulin yanu ya tsiku ndi tsiku.

Ngati cholinga chanu ndikusunga ma jakisoni a insulin otsika mtengo, gwiritsani ntchito Abasaglar, Lantus, Toujeo kapena Tresiba analogues. Jakisoni m'modzi (m'mawa kapena madzulo, koma nthawi zonse nthawi yomweyo) amatha kupereka insulin yofananira ndi wotchi.

Mungafunike jekeseni awiri patsiku kuti mukhale ndi mahomoni azambiri zamagazi posankha NPH. Izi, zimakupatsirani kusintha kwa mankhwalawa kutengera nthawi yatsiku ndi zochitika - zapamwamba masana komanso zochepa pogona.

Kuchita ndi mankhwala ena

Zomwe zili patsamba lino zinatsimikiziridwa ndi katswiri wazachipatala Vasilieva E.I.

Momwe mungasankhire analog yoyenera
Mu pharmacology, mankhwala nthawi zambiri amagawidwa m'magulumagulu ndi ma analogi. Kapangidwe kazofananira kameneka kamaphatikizira amodzi kapena angapo amomwe omwewo omwe ali ndi mphamvu yothandizira thupi. Ndi ma analogi amatanthauza mankhwala okhala ndi zinthu zosiyanasiyana zogwira ntchito, koma zochizira matenda omwewo.

Kusiyana pakati pa matenda a ma virus ndi bakiteriya
Matenda opatsirana amayambitsidwa ndi ma virus, mabakiteriya, bowa ndi protozoa. Njira ya matenda oyambitsidwa ndi ma virus ndi ma bacteria nthawi zambiri imakhala yofanana. Komabe, kusiyanitsa chomwe chimayambitsa matendawa kumatanthauza kusankha njira yoyenera yomwe ingathandize kuthana ndi misala komanso sikuvulaza mwana.

Chifuwa ndi chomwe chimayambitsa chimfine pafupipafupi
Anthu ena amadziwa zomwe zimachitika nthawi zambiri ngati mwana ali ndi chimfine. Makolo amamutengera kwa madotolo, kukamuyeza mayeso, kugwiritsa ntchito mankhwala osokoneza bongo, ndipo monga chotulukapo chake, mwana amalembetsa kale ndi dotolo wa ana monga nthawi zambiri amadwala. Zoyambitsa zenizeni za kupuma pafupipafupi sizidziwika.

Urology: mankhwalawa a chlamydial urethritis
Chlamydial urethritis nthawi zambiri imapezeka pochita urologist. Amayamba chifukwa cha majeremusi a chlamidia trachomatis, omwe ali ndi mphamvu ya mabakiteriya komanso mavairasi, omwe nthawi zambiri amafunikira njira yothandizira antibacterial. Imatha kuyambitsa kutupa kosakhudzana ndi urethra mwa amuna ndi akazi.

Rp. Insulini degludecumi 100 MITUNDU / 3 ml - Na. 5
D.S. Subcutaneally 1 nthawi patsiku.

Hypoglycemic. The pharmacological mphamvu ya insulin degludec amadziwikanso chimodzimodzi ndi mphamvu ya munthu insulin kudzera mwachindunji chomangiriza ndi mogwirizana ndi zolandilira anthu amkati insulin. Mphamvu ya hypoglycemic ya degludec insulin imachitika chifukwa cha kugwiritsidwa ntchito kwa glucose pogwiritsa ntchito minofu pambuyo pomangiriza minofu ndi ma cell cell receptors komanso kutsika kwamtundu womwewo kwa kuchuluka kwa shuga mwa chiwindi.

Subcutaneous 1 nthawi patsiku, makamaka nthawi imodzi. Mlingo amawerengedwa payekhapayekha malinga ndi zomwe zili m'magazi a m'magazi. Odwala omwe ali ndi matenda amtundu wa shuga I amafunika jakisoni wowonjezera wa insulin yokonzekera kuti atsimikizire kufunika kwa insulin.

- matenda ashuga mwa akulu.

- kuchuluka kwa chidwi cha munthu kuti adye insulin
- ana osakwana zaka 18
- nthawi ya pakati komanso yoyamwitsa (palibe chidziwitso chazachipatala chokhudzana ndi kugwiritsa ntchito mankhwalawa kwa ana, amayi panthawi yoyembekezera komanso yoyamwitsa).

Yothetsera d / p / kukhazikitsa kwa 100 PIECES / 1 ml: makatoni 3 ml 5 ma PC.
Njira yothetsera utsogoleri wa sc ndi yowonekera, yopanda utoto.
1 ml:
osakaniza wa insulin degludec ndi insulin aspart mu 70%
(ofanana ndi 2.56 mg wa insulin degludec ndi 1.05 mg wa insulini aspart) 100 IU *
Omwe amathandizira: glycerol - 19 mg, phenol - 1.5 mg, metacresol - 1.72 mg, zinc 27.4 μg (monga zinc acetate 92 μg), sodium chloride 0.58 mg, hydrochloric acid kapena sodium hydroxide (pakusintha kwa pH), madzi d / ndi. - mpaka 1 ml.

3 ml (300 PIECES) - makatoni amtundu wagalimoto a Penfill® (5) - matumba a Al / PVC (1) - mapaketi a makatoni.
pH ya yankho 7.4.
* 1 PIECE imakhala ndi 0,25256 mg ya insulin ya insulin wopanda insuludec ndi 0,105 mg wa mankhwala osokoneza bongo, omwe amafanana ndi 1 IU ya insulin yaumunthu, 1 unit ya insulin, insulin glargine kapena biphasic insulin.

Zomwe zili patsamba lomwe mukuwona zimapangidwa kuti zidziwitso zokha komanso sizimalimbikitsa kudzipatsa mankhwala mwanjira iliyonse. Chidacho chimapangidwa kuti chizolowere akatswiri azachipatala kuti awonjezere zambiri zamankhwala ena, potero amawonjezera luso lawo. Kugwiritsa ntchito mankhwala osokoneza bongo "Insulin degludec" mosakayikira limapereka mwayi wofunsana ndi katswiri, komanso malingaliro ake pa njira yogwiritsira ntchito ndi kuchuluka kwa mankhwala omwe mumasankha.

Matenda a shuga, mtundu 1, mtundu 2, matenda, shuga, magazi, shuga kwa ana

Takulandirani, alendo okonda tsambali! Lero m'masamba athu tikambirana za chinthu chofunikira kwambiri kwa odwala matenda ashuga omwe ali ndi vuto lililonse. Posachedwa (Marichi 2014), m'modzi wa opanga kwambiri a ma novo Nordisk opanga ma novoue Nordisk adayambitsa njira yatsopano yowonjezera - Reflyutek. Ndi nkhani zofunika kwambiri zochizira matenda ashuga mu 2014.

Poyamba, kufunikira kwa mankhwala a insulin kumatha kuchitika ndi mtundu uliwonse wa matenda ashuga. Komanso, odwala omwe ali ndi T2DM nthawi zambiri amagwiritsa ntchito ma "insulin" atali. Mpaka posachedwapa, glargin (Lantus) ndi detemir (Levemir) anali atachitapo kanthu motalika kwambiri. Ntchito yawo yabwino idatenga pafupifupi tsiku limodzi.

Deglutec ndi mnzake wapamwamba kwambiri. Kutalika kwa ntchito nthawi yantchito ndi maola 36-42. Komabe, imakhalabe yopanda mankhwala, ili ndi adsorption komanso kuyambiranso kuchitapo kanthu. Pakadali pano, kugwiritsa ntchito mankhwalawa kumaphunziridwa kokha pochiza odwala akuluakulu. Ana ndi amayi apakati sanatenge nawo mbali pazoyeserazo!

Kafukufuku wambiri (USA, Japan, Canada, India, EU) adawonetsa kuti kubwezeretsa matendawa kuchokera kumbuyo kwa kuyendetsa zinthu zatsopano sikungokhala kotsika mtengo wa matenda a shuga panthawi yamankhwala othandizira glargine, koma ngakhale kupitirira pang'ono kwa omwe akupikisana nawo. Kusiyanitsa kwakukulu ndi chiopsezo chochepa cha hypoglycemia chifukwa chokhala paphiri.

Amakhulupirira kuti kuyendetsa bwino matenda a shuga kumatheka pogwiritsa ntchito njira yatsopano katatu kokha pa sabata. Kuchita njirayi kumachepetsa kwambiri kuchuluka kwa jakisoni watsiku ndi tsiku, ndipo odwala omwe ali ndi matenda amtundu wa 2 komanso mitundu ina yovuta ya matendawa atha kusintha kwambiri moyo wawo, kuchepetsa zotsatira za chithandizo cha matenda ashuga.

Pakadali pano, kugwiritsa ntchito mankhwalawa kumaloledwa ku EU, USA, Canada ndi mayiko ena. Modabwitsa, omaliza adalola kugulitsa mankhwalawa ndi omwe adayambitsa - Britain. Amaganiza kuti mtengo wamankhwala ndiwokwera kwambiri, motero sikuli koyenera kuti mulimbikitse mahomoni ambiri odwala.

Analogue idzawonekeranso ku Russia pansi pa dzina la malonda a Tresiba, mankhwalawa adzathiridwa pa fakitale mumzinda wa Kaluga. Zachidziwikire, tikuyembekeza kuti, malinga ndi malangizo aulere, odwala matenda ashuga amawalandira posachedwa kwambiri, mpaka pano. Koma chifukwa cha iwo okha, mogwirizana ndi adotolo, ndizotheka kuyamba chithandizo chamtsogolo mtsogolo.

Tsamba lathu liziwunikira kwambiri nkhani zaposachedwa kwambiri pothana ndi matenda ashuga ndipo lidzakudziwitsani ngati zidzadziwika kuti gawo lachitatu la kuyesedwa kwa mankhwala atsopano latha, i. ipezeka kwa aliyense.

Adawonjezera Epulo 17, 2015: Chifukwa chake machitidwe oyamba opereka Treshiba m'makliniki azachipamba adawonekera. Pakadali pano, pansi pa pulogalamu yoyesera, odwala matenda ashuga omwe kale adalandila Lantus asamutsidwa. Ngati angafune, mankhwalawa atha kugulidwa pamankhwala ambiri mwakamodzi. Monga ananenera wopanga, zotsatira zake zimakhala mpaka maola makumi atatu ndi limodzi, jekeseni wa mgonero pafupi ndi omwe amapezeka pa Lantus amachitika kamodzi pakatha masiku 1.5 ndikusuntha kwa ola limodzi kapena awiri m'mbuyomu.

Insulin degludec - momwe mungagwiritsire ntchito mtundu 1 wa shuga

Majakisoni onse a insulin amawerengedwa ndi kutalika kwa zochita m'magulu awiri.

Mankhwala osakanikirana akupangidwa, akugwira ntchito m'magawo awiri.

Degludec ndi insulin yochita kupanga kwa nthawi yayitali, yomwe imagwiritsidwa ntchito pa mtundu 1 ndi matenda ashuga a 2.

Zimapangidwa chifukwa cha matekinoloje amakono aubwino wa majini.

Tresiba FlexTouch (dzina la malonda a insulin iyi) pakali pano ndi mankhwala okhawo omwe ali ndi ntchito yogwira - insulin degludec.

Ndikulimbikitsidwa kuti mugwiritse ntchito matenda amtundu wa shuga mu odwala akuluakulu.

Madokotala nthawi zina amakakamizidwa kupereka mankhwala pazinthu zotere:

• wopanda mphamvu ya mankhwala amkamwa, kulephera kukhalabe ndi shuga yochepa,
• kutsutsana pa kugwiritsa ntchito mankhwala amkamwa,
• wapezeka ndi matenda a shuga omwe ali ndi shuga ambiri komanso ndizovuta kudziwa,
• myocardial infaration
• angiography
• matenda am'mimba,
• pachimake matenda opatsirana
• atandichita opareshoni.

Chithandizo cha matenda ashuga amtundu wa 2 chimayamba ndi kudya komanso kugwiritsa ntchito mapiritsi.

Makalata ochokera kwa Owerenga

Agogo anga akhala akudwala matenda a shuga kwa nthawi yayitali (mtundu 2), koma posachedwapa mavuto atuluka pamiyendo ndi ziwalo zamkati.

Mwangozi ndidapeza nkhani pa intaneti yomwe idapulumutsa moyo wanga. Zinali zovuta kuti ndione chizunzo, ndipo fungo loipa m'chipindacho linali kundiyambitsa misala.

Kupyolela pa zamankhwala, agogo aja adasinthanso momwe akumvera. Ananenanso kuti miyendo yake sikupweteka komanso zilonda zake sizinayende; sabata yamawa tidzapita ku ofesi ya dotolo. Falitsa ulalo wa nkhaniyo

Ganizirani zabwino za mankhwalawa:

• wolekeredwa ndi thupi,
• mulingo wabwino woyeretsa
• achalandir.

Mankhwala amakongoletsa glycemia maola 24 mpaka 40. Chiwopsezo chowonjezera kuchuluka kwa shuga ndi mulingo woyenera imachepetsedwa.

Momwe mungasungire shuga kukhala wabwinobwino mu 2019

Ichi ndi mankhwala okwera mtengo omwe amayambitsa mavuto. Zotsatira zoyipa nthawi zambiri zimachitika pambuyo pophwanya malamulo oyendetsera, kusintha kwa mlingo, makina osankhidwa a mankhwala.

Ichi ndi mahomoni opanga ochita zinthu mopitilira muyeso. Amabayidwa pakhungu 1 nthawi patsiku, ndikofunikira kuti mupeze jekeseni nthawi yomweyo, muzitsatira regimen. Mu mtundu wa 2 pathology, umagwiritsidwa ntchito ngati monotherapy komanso kuphatikiza ndi PHGP kapena ndi bolus insulin.

Pankhani ya matenda amtundu wa 1, amagwiritsidwa ntchito limodzi ndi mahomoni opanga ma fupi ndi ultrashort kanthu kuti akwaniritse kufunikira kwa prandial insulin. Mlingo wa mankhwalawa umatsimikiziridwa ndi katswiri, poganizira zosowa za wodwala. Kuti achepetse kuchuluka kwa glycemia, mutha kusintha mlingo wa mankhwalawa poganizira kuchuluka kwa shuga pamimba yopanda kanthu.

Mlingo ukusintha pamene wodwala ayamba kuchita zolimbitsa thupi, amasintha kadyedwe kapena ngati ali ndi zovuta zina.

• Kwa odwala matenda ashuga amtundu wa 2 - magawo 10 patsiku, pakapita nthawi, endocrinologist amasintha payekhapayekha.
• Kwa odwala matenda ashuga a mtundu 1 - amagwiritsidwa ntchito kamodzi patsiku limodzi ndi insulin, yomwe imabayidwa ndi chakudya. Dokotala amayang'anira momwe thupi limayankhira mankhwala, ndikusankha kuchuluka kwake.

Mukamasintha mankhwala okhala ndi insulin, kuchuluka kwa shuga kumawongoleredwa mosamala m'milungu ingapo yoyambirira yogwiritsa ntchito mankhwala atsopano.

Mfundo yosinthika ya dosing imagwiritsidwa ntchito molingana ndi zosowa za odwala matenda ashuga. Mankhwalawa amatha kuperekedwa nthawi zosiyanasiyana masana ndi maola ochepa a 8. Anthu omwe amaiwala kubaya mahomoni owumba munthawi yake adzafunika apereke mlingo akangomaliza kukumbukira izi, ndiye kuti abwezeranso njira zawo zakale.

Palibe kusiyana mu pharmacokinetic mawonekedwe a Degludec insulin, kutengera jenda. Okalamba odwala matenda ashuga omwe ali ndi matenda amkati amayenera kugwiritsa ntchito mankhwalawa mosamala. Palibe kusiyana kwakanema kofunikira mu pharmacokinetics ya insulin Degludek pakati pa okalamba ndi achinyamata odwala matenda ashuga.

Insulin imakhudza thupi la ana ndi achinyamata, monga akulu. Ndi muyezo womwewo wa mankhwalawa, mitundu 1 ya odwala ashuga adatha kudziwa kuti kuchuluka kwa mankhwalawa kwa ana ndi akulu kuposa akulu.

Timapereka kuchotsera kwa owerenga tsamba lathu!

Osagwiritsa ntchito mosaloleza ku zigawo za mankhwala, ana osakhwima, amayi oyembekezera komanso oyembekezera. Palibe zovuta zamankhwala pogwiritsira ntchito mankhwalawa mu ana ndi akazi omwe ali ndi bere ndi mkaka wa m`mawere. Madokotala sakudziwa ngati mankhwalawa amaperekedwa kudzera mkaka wa m'mawere.

Degludec ndi mahomoni opanga osinthidwa omwe amagwiritsidwa ntchito pochiza odwala omwe ali ndi matenda osiyanasiyana a shuga. Kapangidwa pamaziko amakono amakono opanga ma genetic engineering. Chifukwa cha mankhwalawa, kuchuluka kwa shuga kumakhazikika, komwe kumatha kusintha kwambiri moyo wa odwala. Kupewa kwabwino kumatheka ngakhale mutakhazikika shuga mumagazi popanda kusintha kwakukulu.

Matenda a shuga nthawi zonse amayambitsa zovuta zakupha. Mwazi wamagazi ochulukirapo ndi woopsa kwambiri.

A Alexander Myasnikov mu Disembala 2018 adapereka chidziwitso chokhudza chithandizo cha matenda ashuga. Werengani kwathunthu

1. 
   Onipko, V.D. Buku la odwala matenda a shuga mellitus / V.D. Onipko. - Moscow: Nyali, 2001 .-- 192 p.
2. 
   Radkevich V. Matenda a shuga: kupewa, kuzindikira, chithandizo. Moscow, 1997.
3. 
   Balabolkin M.I., Klebanova E.M., Kreminskaya V.M. Funderalal and clinical thyroidology, Medicine - M., 2013. - 816 p.

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

Zogwira ntchito

Insulin degludec + Insulin aspart

subcutaneous yankho

1 ml ya mankhwala ali:

ntchito: 100 magawo a insulini wa insuludec / insulini mu 70/30 (ofanana ndi 2.56 mg wa insulin degludec / 1.05 insulin aspart),

zokopa: glycerol 19.0 mg, phenol 1.5 mg, metacresol 1.72 mg, nthaka 27.4 μg (monga zinc acetate 92.0 μg), sodium chloride 0.58 mg, hydrochloric acid / sodium hydroxide (kusintha pH ), madzi a jakisoni mpaka 1 ml.

pH ya yankho ndi 7.4.

Cholembera chimodzi ili ndi 3 ml ya yankho lofanana ndi 300 PIECES.

Gawo limodzi la insulin Ryzodeg limakhala ndi 0,0256 mg wa insulin wopanda insulin komanso 0,105 mg wa mankhwala osapanda insulin.

Gawo limodzi la insulin Ryzodeg (U) limafanana ndi gawo limodzi lapadziko lonse lapansi (ME) ya insulin yaumunthu, gawo limodzi la insulin glargine, gawo limodzi la insulin detemir kapena gawo limodzi la insulin aspart iwiri.

Transparent colorless solution.

Mankhwala:

Kukonzekera kwa Ryzodeg FlexTouch ndi kuphatikiza kosakanikirana komwe kumapangidwa ndi insulin ya anthu osungunuka kwambiri (insulin degludec) ndi njira yolimbira yolimbikira ya insulin (insulin aspart), yopangidwa ndi recombinant DNA biotechnology yogwiritsa ntchito Saccharomyces cerevisiae.

Insulin degludec ndi insulin aspart makamaka imamangiriza ku cholandilira cha anthu amkati a insulin ndipo, kumayanjana nawo, amazindikira pharmacological awo chimodzimodzi ndi mphamvu ya insulin yaumunthu. Mphamvu ya insoglycemic ya insulin imachitika chifukwa cha kugwiritsidwa ntchito kwa glucose pogwiritsa ntchito minofu pambuyo pomangiriza insulini kupita ku minofu ndi ma cell cell receptors, komanso kutsika kwamtundu womwewo kwa kuchuluka kwa shuga ndi chiwindi.

Zotsatira zamankhwala monga mankhwala a Ryzodeg FlexTouch ndizosiyana bwino (Chithunzi 1) ndipo mbiri yantchito ya mankhwalawa imawonetsa mbiri ya zomwe munthu akuchita: kuthamanga kwambiri kwa insulini ndi insulin degludec yapamwamba kwambiri.

Gawo loyambira la mankhwala a Ryzodeg FlexTouch, lomwe limakhala ndi chowonjezera (insulin degludec), pambuyo pa njira yodutsira panjira yolumikizira ma cellhexamers mu subcutaneous depot, pomwe pali kulowetsa pang'onopang'ono kwa insulin degludec kuzungulira kwa magazi, kupatsirana kwapangidwe kantchito yokhazikika komanso kupindika kwa hypoglycemic. Izi zimasungidwa limodzi ndi insulini ndipo sizikhudza kuchuluka kwa mayamwidwe olimbikira a insulin.

Mankhwala a Ryzodeg® FlexTouch ® amayamba kugwira ntchito mwachangu, ndikupereka chofunikira cha insulin posachedwa, pomwe gawo loyambira lili ndi mawonekedwe osasunthika komanso osasunthika omwe amapereka zofunikira za insulin insulin. Kutalika kwa gawo limodzi la Ryzodeg FlexTouch ndi maola opitilira 24.

Onani Chithunzi 1. Mbiri ya kulowetsedwa kwa glucose ndi mawonekedwe ofanana a Ryzodeg pambuyo pa utsogoleri umodzi wa 0,8 U / kg wa mtundu 1 wa matenda a shuga (kuphunzira 3539).

Ubale wolimba pakati pakuwonjezereka kwa Ryzodeg FlexTouch ndi zotsatira zake zazikulu komanso zapamwamba za hypoglycemic zimatsimikiziridwa. Kuyanjana kofanana kwa Ryzodeg FlexTouch kumatheka pambuyo pa masiku awiri ndi atatu a mankhwalawa.

Panalibe kusiyana mu pharmacodynamics ya Ryzodeg FlexTouch kukonzekera mwa okalamba komanso odwala a senile.

Kuchita Mwachipatala ndi Chitetezo

Mayeso asanu apadziko lonse lapansi, otsogola, otseguka, kuchipatala mayeso a Ryzodeg mu njira ya "Chithandizo cha Goal" adachitidwa kwa masabata 26 kapena 52 ndi odwala 1360 omwe ali ndi matenda a shuga a mellitus (odwala 362 omwe ali ndi matenda amtundu 1 komanso odwala 998 omwe ali ndi matenda a shuga a 2).

Kafukufuku awiri wofanana wofanana ndi makonzedwe amodzi a Ryzodeg osakanikirana ndi mankhwala osokoneza bongo a hypoglycemic (PHGP) komanso makonzedwe amodzi a insulin glargine osakanikirana ndi PHGP mwa odwala omwe ali ndi mtundu wa 2 mellitus.

Kukhazikitsidwa kwa Ryzodeg kawiri patsiku kuphatikiza ndi PHGP kuyerekezedwa ndi kuyang'anira biphasic insulin aspart 30 kawiri pa tsiku limodzi ndi PHGP m'maphunziro awiri mwa odwala omwe ali ndi matenda a shuga a 2.

Kukhazikitsidwa kwa Ryzodeg kamodzi patsiku limodzi ndi insulin aspart kumayerekezedwanso ndikuwongolera insulir kamodzi kapena kawiri pa tsiku limodzi ndi insulin aspart odwala omwe ali ndi mtundu 1 matenda a shuga.

Kusowa kwa kuphatikiza kwa mankhwala oyerekeza kuposa mankhwala a Ryzodeg poyerekeza ndi kuchepa kwa chisonyezo cha HbA1C m'maphunziro onse mothandizidwa ndi odwala mpaka cholinga kudatsimikiziridwa.

Odwala omwe ali ndi matenda a shuga a mtundu wa 2 omwe sanalandire chithandizo cha insulin, komanso odwala omwe adalandira chithandizo cha insulin kale, Ryzodeg osakanikirana ndi PHGP amapereka chiwonetsero chofanana cha glycemic poyerekeza ndi insulin glargine.

Ryzodeg® imapereka kuyendetsa bwino kwa prandial glycemic poyerekeza ndi insulin glargine yokhala ndi kutsika kwa nocturnal hypoglycemia (kutanthauzidwa ngati episode ya hypoglycemia yomwe idachitika pakati pa maola 0 ndi maola 6 m'mawa, zomwe zimatsimikiziridwa ndi zotsatira za kuyeza kwa plasma glucose osakwana 3.1 mmol / l kapena umboni wa izi kuti wodwala amafunikira thandizo la anthu ena).

Kuwongolera kwa Ryzodeg kawiri pa tsiku kumapereka chiwonetsero chofanana cha glycemic (HbA1c) poyerekeza ndi biphasic insulin aspart 30, yomwe idatumizidwanso kawiri patsiku.

Mankhwala Ryzodeg amapereka zabwino zabwino pakuchepetsa kuchuluka kwa shuga mu plasma pamimba yopanda kanthu.

Pogwiritsa ntchito kukonzekera kwa Ryzodeg, phindu la plasma glucose la 5 mmol / L linakwaniritsidwa mwachangu kwa odwala poyerekeza ndi odwala omwe amachitidwa ndi biphasic aspart insulin 30. Mankhwala a Ryzodeg amayambitsa hypoglycemia nthawi zambiri (kuphatikiza nthawi yausiku).

Odwala omwe ali ndi matenda a shuga 1 amodzi, amamuthandizira Ryzodeg kamodzi patsiku limodzi ndi insulin aspart musanadye chakudya china adawonetsa chiwonetsero chofanana cha glycemic (HbA1c ndi glucose kudya kwapafupipafupi) poyerekeza ndi hypoglycemia yausiku poyerekeza ndi momwe zimakhalira ndi insulin ndi insulin aspart ndi chakudya chilichonse.

Malinga ndikufufuza kwa meta kawiri sabata 26 zowunika zotseguka malinga ndi lingaliro la "kuchiritsa cholinga" chomwe chimakhudza odwala omwe ali ndi matenda a shuga a 2, mankhwala a Ryzodeg, omwe amaperekedwa kawiri patsiku, adawonetsa kuchepa kwamakalata a hypoglycemia ambiri ( Chithunzi 2) ndi ma episode a nocturnal hypoglycemia (Chithunzi 3) poyerekeza ndi insulini ya biphasic 30. Zotsatira zake zikuwonetsa kuti Ryzodeg amachepetsa kusala kwa glucose mwachangu ndi chiopsezo chochepa cha hypoglycemia emy mu ndondomeko komanso kufufuza mu Mlingo yokonza kwa masabata 16 (Table 1).

Onani Chithunzi 2 pam CD. Zolemba zotsimikizika za hypoglycemia, kukonzekera kwa Ryzodeg (2 kawiri pa tsiku) poyerekeza ndi biphasic insulin aspart 30 (2 kawiri pa tsiku), malinga ndi ntchito yowonjezereka kwa masabata a 26, mayeso omaliza otchulidwa molingana ndi mfundo ya "kuchitira kufikira cholinga" kwa odwala omwe ali ndi mtundu 2 shuga

Onani chithunzi 3pa ma CD. Zolemba zotsimikizika za usiku za hypoglycemia, Ryzodeg (2 kawiri pa tsiku) poyerekeza ndi biphasic insulin aspart 30 (2 kawiri pa tsiku), malinga ndi ntchito yowonjezera ya masabata a 26, mayeso omaliza otchulidwa molingana ndi mfundo ya "kuchitira cholinga" mwa odwala ndi matenda a shuga a 2.

Panalibe kupangika kwofunikira kwambiri kwa ma antibodies pambuyo pa mankhwala ndi Ryzodeg kwa nthawi yayitali.

Pharmacokinetics:

Mafuta

Pambuyo pa jekeseni wa subcutaneous, kupanga mapangidwe osungunuka a insludec insulin multihexamers kumachitika, komwe kumayambitsa insulin depot mu minofu ya subcutaneous, ndipo nthawi yomweyo musasokoneze kutulutsidwa kwa insulin aspart monomers m'magazi.

Multihexamers pang'onopang'ono amadzisiyanitsa, ndikumasokoneza maukodifine a insludec, zomwe zimapangitsa kuti magazi azilowa pang'onopang'ono m'magazi.

Kuyanʻanila kwa ndende ya chinthu chophatikizika kwambiri (insulin degludec) m'magazi amwazi zimatheka patadutsa masiku atatu pambuyo popereka mankhwala a Ryzodeg.

Zizindikiro zodziwika bwino za kuyamwa mwachangu kwa insulin aspart zimasungidwa mu Risedeg. Mbiri ya pharmacokinetic ya insulin aspart imawonekera mphindi 14 pambuyo pa kubayidwa, ndende yayikulu imawonedwa pambuyo pa mphindi 72.

Kugawa

Kuyanjana kwa insludec insulin ya serum albin kumafanana ndi kuchuluka kwa mapuloteni a plasma> 99% m'madzi am'magazi a anthu. Mu insulin aspart, mphamvu ya plasma yomangira imakhala yotsika (

Tresiba flex touch solution r / c 100me / ml 3ml n5 syringe cholembera

Transparent colorless solution. Chizindikiro sichikuphatikiza singano zovulala. Singano zogulitsidwa mosiyana.

FlexTouch syringe pens amagwiritsidwa ntchito molumikizana ndi NovoFine - Novofine 30G 8 mm No. 100 kapena Novofine 31G 6 mm No. 100 singano. Ndizosatheka kugwiritsa ntchito zolembera popanda sindano.

1 ml ya mankhwala ali: yogwira mankhwala: insulin degludec 100 IU (3.66 mg), zotuluka: glycerol 19.6 mg, phenol 1.5 mg, metacresol 1.72 mg, zinc 32.

7 μg (mu mawonekedwe a zinc acetate 109.7 μg), hydrochloric acid / sodium hydroxide (kusintha pH), madzi a jakisoni mpaka 1 ml, pH yankho ndi 7.6. Senti imodzi ya syringe ili ndi 3 ml ya yankho, yofanana ndi 300 PIERES.

Cholembera cha syringe chimakupatsani mwayi kuti mulowe mpaka ma unit 80 pa jekeseni iliyonse pakukula kwa 1 unit.

Zambiri ndi zisonyezo

Insulin yangwiro yotereyi imapangidwa ndi kampani yopanga mankhwala Novo Nordisk, ndipo amalembedwa pansi pa dzina la malonda a Tresiba. Mankhwala akupezeka mitundu iwiri:

• Njira yothetsera ma syringe (ma insulin dzina "Tresiba Flextach"),
• Njira yothetsera makatoni a zolembera za Tusiba Penfill.

Nthawi zambiri, mankhwalawa amagwiritsidwa ntchito kwa odwala omwe ali ndi matenda a shuga omwe amadalira insulin.

Pambuyo pang'onopang'ono pakhungu, molekyu ya insulin yowongoleredwa bwino imapangika ma protein osakhazikika, omwe ndi mtundu wa depot ya timadzi timeneti.

Zopangidwazo zimawonongeka pang'onopang'ono, chifukwa chomwe insulin imangolowa magazi nthawi zonse. Mankhwalawa nthawi zambiri amaperekedwa kamodzi pa tsiku, chifukwa zotsatira zake zimapitirira pafupifupi maola 24.

Ndikofunikira kuti kutalika kwa mankhwalawa sikukutengera zaka, mtundu komanso mtundu wodwala. Ngakhale odwala omwe ali ndi vuto la chiwindi ndi impso, insulin yotere imagwira ntchito kwa nthawi yayitali ndipo imagwira ntchito bwino.

Mankhwalawa amagwiritsidwanso ntchito ngati mbali ya kaphatikizidwe ka mankhwala a odwala omwe ali ndi matenda a shuga a 2. Ngati kapamba amachepa kapena ntchito zake zili ndi vuto lalikulu, kuwonjezera pa mapiritsi ochepetsa shuga, wodwalayo angafunikire chithandizo cha insulin.

Pali mayina ambiri amalonda a mahomoni omwe angagwiritsidwe ntchito pazifukwa izi, ndipo Treshiba ndi amodzi mwa iwo. Kugwiritsa ntchito mankhwalawa kumathandizira kuti magazi asungunuke, kusintha thupi lonse ndikuyenda bwino.

Kugwiritsa ntchito mankhwalawa m'magawo oyamba a chitukuko cha matenda a kapamba mu mtundu 2 wa shuga kumakupatsani mwayi wambiri ndi kutalika kochepa komanso nthawi yayifupi

Insulin Degludec: zotsatira zokhazikika ndi chiwopsezo cha hypoglycemia

Owonjezera akuchita insulin kukonzekera bastard (degludec) Novo Nordisk amathanso kuwongolera bwino shuga m'magazi at odwala matenda ashugakomanso kampani yopikisana ndi mankhwala ya Lantus (Lantus) Sanofi (Sanofi), yokhala ndi mlingo wokhazikika. Malinga ndi European Association for the Study of matenda ashuga (European Association for the Study of Diabetes, EASD), insulin degludec (degludec) adapeza kuchepetsa kwakukulu kwa shuga m'magazi odwala mtundu 2 shuga, ngakhale ndi mlingo umodzi wa maola makumi anayi. Novo Nordisk akuti insulin degludec imakhala yosavuta kwa odwala, chifukwa imatha kutengedwa nthawi iliyonse masana, mosiyana ndi mankhwala a Lantus omwe ali ndi insulin glargine, yomwe iyenera kutengedwa panthawi yodziwika.

Kafukufuku watsopano adawonetsa kuti mulingo wa hemoglobin A1c, chizindikiro cha kuwongolera kwamafuta amwazi, idachepetsedwa ndi 1.28% mpaka 7.2% pakadutsa masabata 26 mothandizidwa ndi insulin degludecs, yomwe ikufanizidwa ndi Lantus, mankhwala a insulin omwe amagulitsa kwambiri padziko lonse lapansi.

Odwala omwe amatenga kampani yopanga mankhwala a Novo Nordisk, kuchuluka kwa shuga m'magazi nawonso kunachepa kwambiri, ndipo mwa odwala omwe amamwa mankhwalawo Lantus, amachepetsa pokhapokha kumapeto kwa phunzirolo.

Mankhwalawa onse amatengedwa kamodzi patsiku, koma Novo Nordisk amaphunziranso kuyesa kwamankhwala ogwira ntchito mwanjira ya masiku atatu ya insulin dewlydek.

Malinga ndi a Stephen Atkin, pulofesa pa kafukufukuyu ku York Hull Medical School, UK, kafukufukuyu akuwonetsa kuti kuwongolera glycemic kumatha kukhazikitsidwa ndi insulini yotengedwa, ngakhale anthu atazengereza mosazindikira phwando insulin, kapena mutenge nthawi ina masana.

Pamsonkhano wapachaka wa 71 wa American Diabetes Association, womwe unachitika mu June 2011 ku San Diego, California, zotsatira za maphunziro awiri a insulin yatsopano adakambirana. Malinga ndi zotsatira zake, insulin deglyudec mwa odwala omwe ali ndi mtundu 1 ndi mtundu 2 wa shuga amawongolera glycemic pomwe akuchepetsa chiopsezo cha nocturnal hypoglycemia poyerekeza ndi Glargin insulin.

Insulin Degludek - basulin insulinomwe, pambuyo pa subcutaneous makonzedwe, amapanga mitundu yambiri yosungunulira, yomwe imatsogolera ku mbiri yayitali yotalikilapo. Zotsatira za maphunziro a gawo lachiwiri, zomwe zidasindikizidwa kale ku Lancet mu 2011, zidafotokozedwa.

Degludek pa matenda a matenda a shuga a 2

Kafukufuku wina adaphatikizapo odwala omwe ali ndi matenda a shuga a mtundu wa 2 (mtsogoleri wa gulu lofufuzira anali Prof. Alan J. Garber, kuchokera ku Dipatimenti ya shuga, Endocrinology ndi Metabolism ku Baylor College of Medicine, Houston, Texas).

Zinayerekezera kufunikira ndi chitetezo chogwiritsira ntchito degludec poyerekeza ndi Glargin insulin.

Ma insulini onse anali kutumikiridwa kamodzi patsiku, kuphatikiza ndi insulin asanadye, kapena kuphatikiza ndi metformin kapena pioglitazone.

Mayeso azachipatala anali otseguka, osatha chaka chimodzi, ndipo anaphatikiza odwala 992 okhala ndi hemoglobin wapakati pa 8.3% omwe adasunga HbA1C wambiri 7 mpaka 10% kwa miyezi itatu 3 yogwiritsa ntchito insulin limodzi ndi mankhwala amkamwa kapena popanda iwo.

Odwala adasinthidwa mosawerengeka pa 3: 1 kwa magulu omwe amalandila Degludec insulin kapena Glargin insulin. Mlingo wa basal insulin unasinthidwa molingana ndi kuthamanga kwa shuga m'magazi mpaka mulingo womwe umakwaniritsidwa (osakwana 5 mmol).

Phunziroli lidamalizidwa ndi opitilira 80% ya odwala ochokera m'magulu onse awiri. Pambuyo pa miyezi 12, kuchuluka kwa hemoglobin wa glycated kunatsika pafupifupi ndi 1.2% pagulu la degludec komanso ndi 1.

3% pagulu la glargine (kusiyana sikofunikira kwambiri), theka la odwala adafika pa chandamale cha HbA1C (ochepera 7%).

Kutsika kwa kuthamanga kwa glucose m'magulu awiriwa sikunasinthe kwakukulu (pafupifupi, ndi 2.4 mmol mu gulu la degludec komanso ndi 2.1 mmol mu gulu la glargine).

Kusiyanitsa kumodzi kokha komwe kunapezeka pakati pamagulu: kugwiritsa ntchito degludec kunapangitsa kuti kuchepetsa kwakukulu kwa nocturnal hypoglycemia (plasma glucose ochepera 3.1 mmol kapena hypoglycemia yayikulu, malinga ndi tanthauzo la ADA).

Gulu la Refludec lidawonetsa kuchepa kwa 25% pafupipafupi kwa zochitika izi poyerekeza ndi gulu la glargine (1.4 motsutsana ndi 1.8 episode pa 1 wodwala pachaka, p = 0.0399).

Kuphatikiza apo, kufalikira kwa zochitika zonse zotsimikizika za hypoglycemic kunali kotsika pagulu la degludec poyerekeza ndi gulu la glargine (11.1 motsutsana ndi 13.6 episode / mgonjwa-chaka, p = 0.0359).

Patatha chaka chimodzi, avareji ya tsiku ndi tsiku anali 1.46 IU / kg kwa insulin deglude ndi 1.42 IU / kg kwa insulin glargine, ndikugawa basal ndi bolus insulin pafupifupi 50:50 m'magulu onse awiri. Pafupipafupi zotsatirapo zake zinali zofanana.

Insulin degludec pochiza matenda amtundu wa 1 shuga

Kafukufuku wachiwiri adachitidwa ku Sheffield University, UK, ndi Pulofesa Simon Heller. Mapangidwe a phunziroli anali ofanana, koma adaphatikizanso odwala omwe mtundu 1 shuga. Onsewa alylyudec ndi glargine anali kuthandizira kamodzi patsiku, insulin kapena chakudya asanadye.

Anthu 629 omwe ali ndi mtundu 1 shuga okhala ndi HbA1C pafupifupi 7,7%, kulandira insulin mu regimen yoyambira kwa pafupifupi chaka chimodzi, idasinthidwa mosawerengeka pa chiyerekezo cha 3: 1 m'magulu a degludec ndi glargine.

Pakatha chaka, mulingo wa HbA1C udatsika ndi 0,4% m'magulu onse awiri. Pafupifupi 40% ya odwala adafika pamlingo wa HbA1C (wochepera 7%), kuchuluka kwa glucose kosala kudya kumatsika ndi 1,3 mmol / L m'gulu la degludec, ndi 1.4 mmol / L pagulu la glargine.

Mu gulu la degludec, odwala amafunika nthawi yochepa kuti athe kufikira zomwe akufuna kudya m'magazi a glucose (ochepera 5 mmol / L), wapakatikati mwa gulu la degludec anali masabata 5, pomwe pagulu la glargine panali masabata 10 (p = 0.002).

Pafupipafupi a nocturnal hypoglycemia anali otsika pagulu la Refludec poyerekeza ndi gulu la glargine (4.4 vs. 5. episode / odwala-chaka, p = 0.021), komabe, panalibe kusiyana kwakukulu pamafupipafupi a hypoglycemia pakati pamagulu (42,5 vs. 40.2 episode / mgonjwa-chaka) .

Patatha chaka chimodzi chiyambire kafukufukuyu, avareji ya insulin tsiku lililonse anali 0,75 U / kg mgulu la zigludec, ndi 0.82 U / kg pagulu la glargine, lomwe limagawidwa ndi basal / bolus insulin pafupifupi 50:50 m'magulu onse awiri. Zotsatira zoyipa zimachitikanso.

Dr. Heller, mtsogoleri wa gulu lofufuzira, amakhulupirira kuti zotsatira za mayeso azachipatala adatsimikizira kuti chiwonetsero chatsopano cha insulin yowonjezera chimatha kuchepetsa chiopsezo cha hypoglycemia, makamaka usiku, zomwe ndizofunikira kwambiri kwa odwala ambiri ndi mabanja awo. Kugwiritsa ntchito degludec kumatha kusintha moyo wa odwala otere.

Degludec komanso mtundu wosinthika wa dosing

Gulu la Dr. Luigi Meneghini wochokera ku Yunivesite ya Miami, Florida, adafotokoza zambiri zosintha za insulin dewlydes.

Ofufuzawo adawona kuti kuwongolera kamodzi kwa degludec patsiku kumatha kutumikiridwa kwa nthawi yayitali - kuyambira maola 8 mpaka 40 pambuyo pa kumwa koyamba popanda kuwongolera glycemic control, mosiyana ndi glargine, yomwe imafunikira makonzedwe pafupifupi nthawi imodzi tsiku lililonse. Pambuyo pa kafukufuku wamasabata 26, kuchuluka kwa HbA1C kunatsika ndi 1.2% m'magulu onse awiri, ma pafupipafupi a zochitika komanso obwera usiku a hypoglycemia anali ofanana m'magulu onse awiri a dosing.

Izi ndizofunikira kwambiri kwa anthu omwe amafunika kusintha jakisoni nthawi yake (kugona, mochedwa kubwerera kunyumba, ndi zina) ndi zifukwa zaluso (ntchito yosinthira, nthawi ya usiku, ndi zina).

Kuthekera kwa kusiyanasiyana kwa jakisoni nthawi kwambiri kumatha kusintha kutsata kwa wodwala ndipo mwina zotsatira zazitali. glycemic controlKomabe, lingaliro ili limafuna kutsimikiziridwa mu maphunziro ena.

American Diabetes Association (ADA) 71st Sayansi magawo: Abstract 0074-AU, yoperekedwa June 25, 2011, Abstract 0070-AU, yoperekedwa June 25, 2011, Abstract 0035-LB, yoperekedwa June 24, 2011.

Zisonyezo zakusankhidwa kwa Tresiba

Mankhwalawa amagwiritsidwa ntchito limodzi ndi ma insulin othamanga othandizira am'magazi a mitundu yonse ya matenda a shuga. Ndi matenda 2 a mtundu, ndi insulin yayitali yokha yomwe ingafotokozedwe gawo loyamba.

Poyamba, malangizo a ku Russia omwe amagwiritsidwa ntchito adalola kugwiritsa ntchito Treshiba kokha kwa odwala akuluakulu.

Pambuyo pa maphunziro omwe amatsimikizira chitetezo chake chamoyo chokula, zosintha zidapangidwa ku malangizowo, ndipo tsopano zimalola kuti mankhwalawa azigwiritsidwa ntchito mwa ana kuyambira chaka chimodzi.

Mphamvu ya degludec pa mimba komanso kukula kwa makanda mpaka chaka sichinaphunzirepo, chifukwa chake, Tresib insulin sinafotokozeredwe magulu awa a odwala. Ngati wodwala matenda ashuga adanenanso kale kuti thupi lawo siligwirizana ndi Refludec kapena mbali zina za yankho, ndikofunikanso kupewa kumwa mankhwala a Tresiba.

Malangizo ogwiritsira ntchito

Popanda kudziwa malamulo a kayendetsedwe ka insulini, kubwezera kwabwino shuga sikungatheke. Kulephera kutsatira malangizo kumatha kubweretsa zovuta kwambiri: ketoacidosis ndi hypoglycemia yayikulu.

Momwe mungapangire chithandizo:

• ndi matenda amtundu wa 1 shuga, muyezo woyeserera uyenera kusankhidwa kuchipatala. Ngati wodwalayo adalandira kale insulin yayitali, ndikasamutsidwa ku Tresiba, mlingo woyamba umasinthidwa, ndiye umasinthidwa kutengera deta ya glycemic. Mankhwala amafotokozera tanthauzo lake mkati mwa masiku atatu, kotero kukonza koyambirira ndikololedwa pokhapokha nthawi iyi itatha,
• ndi matenda amtundu wa 2, mlingo woyambira ndi magawo 10, ndi kulemera kwakukulu - mpaka pafupifupi mayunitsi 0,2. pa kilogalamu Kenako imasinthidwa pang'onopang'ono mpaka glycemia imasinthidwa. Monga lamulo, odwala omwe ali ndi kunenepa kwambiri, kuchepa kwa ntchito, kukana kwamphamvu kwa insulin, komanso kusungunuka kwa shuga kwa nthawi yayitali kumafunikira Mlingo waukulu wa Treshiba. Mathandizo awo amathandizidwa pang'onopang'ono,
• ngakhale Tresiba insulin imagwira ntchito kwa maola opitilira 24, imabayidwa kamodzi patsiku panthawi yoikika. Zotsatira za kumwa kotsatira ziyenera kuwonekera pang'ono ndi chimodzi cham'mbuyomu,
• Mankhwala atha kuperekedwa pokhapokha. Jekeseni wam'mitsempha ndi osafunika, chifukwa imatha kutsitsa shuga, mtsempha wa magazi umabweretsa moyo,
• tsamba la jakisoni silofunika, koma nthawi zambiri ntchafu imagwiritsidwa ntchito kwa insulin yayitali, popeza timadzi tambiri timene timabayidwa m'mimba - momwe ndi momwe mungabayire insulin,
• cholembera ndi chida chophweka, koma ndi bwino ngati sing'anga wakudziwa bwino malamulo oti mugwire. Zingachitike, malamulowa adapangidwanso muupangiri womwe waphatikizidwa pa paketi iliyonse,
• Asanayambe chilichonse, muyenera kuwonetsetsa kuti yankho lake silinasinthe, cartridge ndiwotsimikizika, ndipo singano ndiyotheka. Kuti muwone thanzi la dongosololi, mlingo wa mayunitsi awiri wakhazikitsidwa pa cholembera. ndikukankha pisitoni. Dontho lowonekera liziwoneka pabowo. Kwa Treshiba FlexTouch singano zoyambirira NovoTvist, NovoFayn ndi zolemba zawo kuchokera kwa opanga ena ndizoyenera,
• atayambitsa yankho, singanoyo samachotsa pakhungu kwa masekondi angapo kuti insulini isayambitse kutayikira. Malowo a jakisoni sayenera kutenthedwa kapena kuwonongeka.

Treshiba ikhoza kugwiritsidwa ntchito ndi mankhwala onse ochepetsa shuga, kuphatikiza anthu ndi ma insulin a insulin, komanso mapiritsi olembedwa a mtundu 2 wa shuga.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zingachitike chifukwa cha chithandizo cha matenda a shuga a Tresiba komanso kuwunika kwawo: