Mlingo wa insulin ndi shuga

Kuchuluka kwa odwala omwe ali ndi matenda a shuga (DM), makamaka a 2 matenda a shuga, komanso kuchuluka kwa zovuta zake, makamaka kuchokera ku mtima ndi impso, masiku ano ndivuto lalikulu kwambiri. Nkhaniyi ikuwonetsa zambiri kuchokera ku maphunziro apadziko lonse omwe aphunzira njira zingapo zoyendetsera glycemic kuti aletse kukula ndi kupitilira kwa zovuta za shuga- komanso zazikulu za matenda ashuga, kufunikira kwa kusankha zolinga zamankhwala kutengera zaka, nthawi yodwala, kupezeka kwa matenda amtima komanso chindapusa cha matenda ashuga chikuwonetsedwa. zikuwonetsa insulin mankhwala a matenda a shuga 2, komanso kuthekera kogwiritsira ntchito insulin.

Kuchuluka kwa odwala omwe ali ndi matenda a shuga (DM), makamaka a 2 matenda a shuga, komanso kuchuluka kwa zovuta zake, makamaka kuchokera ku mtima ndi impso, masiku ano ndivuto lalikulu kwambiri. Nkhaniyi ikuwonetsa zambiri kuchokera ku maphunziro apadziko lonse omwe aphunzira njira zingapo zoyendetsera glycemic kuti aletse kukula ndi kupitilira kwa zovuta za shuga- komanso zazikulu za matenda ashuga, kufunikira kwa kusankha zolinga zamankhwala kutengera zaka, nthawi yodwala, kupezeka kwa matenda amtima komanso chindapusa cha matenda ashuga chikuwonetsedwa. zikuwonetsa insulin mankhwala a matenda a shuga 2, komanso kuthekera kogwiritsira ntchito insulin.

Zaka makumi awiri zapitazi, gulu la anthu padziko lonse lapansi lakhala likukumana ndi mliri wa matenda osachiritsika monga matenda a shuga (matenda ashuga), matenda amtima, matenda am'mapapo, matenda a impso, kapena mitundu ingapo. Malinga ndi World Health Organisation (WHO), mu 2008, matenda osakhudzana anapha anthu 36 miliyoni. Mu 2011, anthu 1.4 miliyoni (2.6%) adamwalira ndi matenda a shuga, omwe ndi 400 zikwi zoposa 2000.

Malinga ndi International Diabetes Federation (IDF), mu 2013, panali odwala 382 miliyoni omwe ali ndi matenda ashuga. Ndipo ngati padziko lapansi kufalikira kwa matendawa mu zaka 20-9 ndi 8,8%, ndiye ku Russia - 10,9%. Zotsatira zake, Russia idalowa kumayiko khumi apamwamba ndi odwala kwambiri omwe ali ndi matenda ashuga.

Pofika chaka cha 2035, akatswiri a IDF amalosera kuwonjezeka kwa odwala ndi 55% mpaka 592 miliyoni.

Matenda a 2 a matenda a shuga ndi matenda ochitika pang'onopang'ono, mawonetsedwe azachipatala ndi zovuta zake zomwe zimayambitsidwa chifukwa cha matenda oopsa a hyperglycemia. Chifukwa chake, kuwunikira kwa meta kolemba kwa M. Coutinho et al. , adawonetsa kulumikizana pakati pa kukhazikika kwa matenda amtima (CVD) ndi kuchuluka kwambiri osati kokha gypcemia ya postprandial, komanso kusala glycemia (n = 95 zikwi, nthawi yotsatira inali pafupifupi zaka 12,4). Chiwopsezo cha chitukuko cha CVD panthawi yopenyerera chinawonjezeka nthawi 1.33 ndikusala kudya kwa glycemia> 6.1 mmol / L.

Amadziwika kuti ngati apeza njira yofufuzira, odwala opitilira 50% amakhala ndi zovuta zazing'ono komanso zazikulu, komanso mtengo wa chisamaliro chamankhwala osagwirizana ndi zovuta zimawonjezeka katatu.

Mwachidziwikire, kuzindikira koyambirira kwa matendawa ndikuwongolera mwamphamvu glycemic popanda kuwonjezera chiwopsezo cha hypoglycemia kungalepheretse kapena kuchedwa kukula kwa zovuta zovuta za matenda ashuga.

Glycemic control ndi zovuta za matenda ashuga

Udindo wa kayendetsedwe ka glycemic popewa kukula ndi kupitilira kwa zovuta za micro- ndi macrovascular zikuwonetsedwa m'maphunziro akulu monga DCCT, EDIC, UKPDS, ADVANCE, VADT, ACCord ndi ORIGIN.

Chifukwa chake, mu kafukufuku wa ACCORD, chithandizo chambiri cha hypoglycemic chinalumikizidwa ndi chiopsezo chowonjezereka cha hypoglycemia ndi kufa chifukwa cha mtima ndi zina, zomwe zidapangitsa kuyimitsidwa koyambirira kwa nthambi ya kafukufuku. Mu kafukufuku wa ADVANCE, m'malo mwake, chiopsezo cha zovuta zazing'ono komanso zazikulu kwambiri zomwe zimachitika ndikusamalidwa kwambiri zimachepa kwambiri (10%) poyerekeza ndi zomwe zimachitika. Kusiyana kwa zotsatira kumatha kukhala chifukwa, choyambirira, mpaka pakufika pakuchepa kwa msana wa glycated hemoglobin (HbA1c). Ngati mu kafukufuku wa ADVANCE m'miyezi isanu ndi umodzi yoyambirira idatsika ndi 0.5%, ndipo gawo la chandamale (6.5%) lidafikiridwa pambuyo pa miyezi 36 ndipo lidatsalira mpaka kumapeto kwa zowonekerazi, mu kafukufuku wa ACCord m'miyezi isanu ndi umodzi yoyamba ya HbA1c idatsika ndi 1.5 %, ndipo pakatha miyezi 12 - kuchokera pa 8.1 mpaka 6.4%. Kachiwiri, ndikuchiritsidwaku: mu kafukufuku wa ACCORD, thiazolidinediones ndi insulin adagwiritsidwa ntchito pafupipafupi, mu kafukufuku wa ADVANCE, gliclazide. Chachitatu, kuchuluka kwa thupi panthawi ya mankhwala ndi 3.5 motsutsana ndi 0.7 kg, motsatana.

Nthawi yomweyo, kafukufuku onse awiri adawonetsa kuti kuchepa kwakukulu kwa HbA1c sikuchepetsa chiopsezo cha CVD mwa odwala omwe ali ndi matenda ashuga omwe ali pachiwopsezo chachikulu. Komabe, ndizosatheka kupatula mphamvu ya chisamaliro chokwanira kwa odwala omwe ali ndi chiopsezo chochepa, popeza maphunziro ngati awa sanachitike. Kuphatikiza apo, mgulu laling'ono la ophunzira nawo mu kafukufuku wa ACCORD wopanda CVD kapena HbA1c ya 9%.

Izi zimachitika makamaka chifukwa cha zovuta za insulin mankhwala, zomwe zimachepetsa onse pakuyambira komanso kukulitsa kwa hypoglycemic therapy.

Zotsatira zoyipa zoyipa za mankhwala a insulin ndi kuwonjezeka kwa thupi. Zotsatira zoyipa izi nthawi zambiri zimayambitsa kuchepa kwa insulin mankhwala kwa odwala omwe ali ndi matenda a shuga a 2 komanso kunenepa kwambiri.

Zotsatira za kusanthula kwa meta kwa mayesero azachipatala osasinthika kunawonetsa kuti kulemera kwa odwala omwe amatenga jakisoni imodzi ya basal insulin patsiku kumakulirakulira pang'ono kuposa kwa odwala omwe adalandira jakisoni awiri a basal kapena jakisoni angapo a prandial insulin (popanda kusiyana kwakukulu pakati pa maulamuliro awiri omaliza).

Mu kafukufuku wa ORIGIN, kumbuyo kwa mankhwala a insulin, odwala adawonetsa kuwonjezeka kwa thupi la 1.5 makilogalamu, pomwe ali kumbuyo kwa mankhwala othandizira odwala shuga, adatsika ndi 0,5 kg.

Pakufufuza kwa CREDIT kwa zaka zinayi, odwala adawonetsa kuwonjezeka kwa thupi lolemera makilogalamu 1.78, pomwe 24% yaiwo imachulukanso kuposa 5.0 kg. Zotsatira zoterezi zimakhudzana ndi kuchuluka kwa insulin (mosasamala mtengo wa insulin), malo apamwamba a HbA1c ndi index yotsika ya thupi. Chifukwa chake, pofuna kupewa izi zosafunikira, ndikofunikira kuyamba mankhwala a insulini mpaka mfundo zazikulu za HbA1c zifikire komanso musanenepe kwambiri chifukwa cha kuwonongeka kwakukulu kwa matenda ashuga. Popeza ntchito ya beta-cell imachepa pang'onopang'ono, ndikupatsidwa mankhwala a insulin koyambirira, mlingo wake ungakhale wochepa, womwe ungathandizenso kuchepetsa kunenepa.

Tiyenera kudziwa kuti muzochita zamankhwala, zamankhwala a insulin nthawi zambiri zimayendera limodzi ndi kuwonjezeka kwa thupi. Mwinanso, izi zosafunikira zitha kuchepetsedwa chifukwa chokonzanso zakudya komanso kuchuluka kwa zochitika zolimbitsa thupi.

Njira yachiwiri yosasangalatsa ndi kukula kwa hypoglycemia. Pafupifupi maphunziro akulu onse, ma epicode a hypoglycemia owopsa anali pafupipafupi pagulu lolamulira poyerekeza ndi gulu lolamulira wamba: ACCORD - 16.2 poyerekeza 5.1%, VADT - 21.2 poyerekeza 9.9%, ADVANCE - 2.7 motsutsana 1.5%, UKPDS 1.0 motsutsana ndi 0.7%. M'maphunzirowa, pamene kuchuluka kofanana ndi glycemia kudakwaniritsidwa mwa odwala omwe ali ndi mtundu wa 2 shuga kumbuyo kwa zovuta za insulin, chiwopsezo cha zochitika za hypoglycemic chinali chachikulu kwambiri poyerekeza ndi kafukufuku wa ORIGIN. Kusiyana kwakukulu pachiwopsezo kunali 2.1% mu kafukufuku wa ACCORD, 1.4% mu kafukufuku wa UKPDS, 2.0% mu kafukufuku wa VADT, ndi 0.7% mu kafukufuku wa ORIGIN. Hypoglycemia yotsika imalumikizidwa ndi njira yofatsa komanso nthawi yofupikitsa ya matendawa komanso kuchepa kwa HbA1c poyambitsa insulin. Ndikofunika kunena motsimikiza kuti zotsatira za kafukufuku wa ACCORD sizifukwa zongosiya kulimbana ndi vuto la glycemic, zikuwonetsa kufunikira kwa njira yolondola yakhazikitsidwe kwa gulu la odwala ndikusintha zolinga zaumoyo molingana ndi kuopsa kwa vutolo, kupezeka kwa zovuta ndi mtima wokhudzana ndi mtima.
matenda.

Nthawi zambiri kuyamba kwa insulin mankhwala osavomerezeka komanso kuperewera koyipa kwa mtundu wachiwiri wa shuga poyambira maziko ake ndi zotsatira za malingaliro olakwika a odwala panjira iyi. Chifukwa chake, pakati pa odwala omwe ali ndi matenda a shuga omwe amalandira insulin, oposa 50% amasemphana jakisoni ndipo pafupifupi 20% amatero pafupipafupi. Komabe, pogwiritsa ntchito insulin, malingaliro olakwika pa chithandizo chamankhwala amachepa. Chifukwa chake, pakufunikira maphunziro a odwala, chifukwa kuwonjezera luso lawo kumathandizira kuti insulini ichite bwino.

Zisonyezo za insulin mankhwala a matenda a shuga a 2

Poganizira za ubale womwe ulipo pakati pa kubwezeretsa kwa chakudya cha carbohydrate ndi pafupipafupi pakukula kwa zovuta zamankhwala, chitetezo cha maselo a beta ku zotsatira za proapoptotic stimuli, kugwiritsa ntchito insulin kumakhalabe njira yothandiza kwambiri yothandizira matenda a shuga 2. Kusanthula momwe umagwirira ntchito, kulolera komanso mtengo wa njira zosiyanasiyana zochizira matenda osokoneza bongo kunawonetsa kuti chithandizo cha insulin sichiri champhamvu kwambiri, komanso chotsika mtengo.

Masiku ano, zikuwonetsa kuti kugwiritsa ntchito insulin mtundu wa 2 shuga kwachuluka kwambiri. Malinga ndi mgwirizano wa American Diabetes Association (ADA) ndi European Association for the Study of Diabetes (EASD), mankhwala a basal insulin amadziwika kuti ndi mankhwala oyambira a matenda oyamba a shuga 2 chifukwa cha kusintha kwa moyo komanso kudya kwa metformin. Zomwe chiwongolero cha glycemic chikakwaniritsidwa kapena sizingatheke pokhapokha pochotsa mankhwalawo, tikulimbikitsidwa kuti muonjezere insulin. Therapy yokhala ndi zophatikizika zopangidwa mokonzekera imawerengedwa ngati njira ina pakuyambitsa ndi kukulitsa kwa insulin. Malingana ndi miyezo ya ku Russia, kuphatikiza kwa basulin insulin kumathandizidwa ngati mankhwala ochepetsa shuga a pakamwa sangathe kugwira ntchito poyambira matenda. M'mayendedwe aku Russia, mosiyana ndi malingaliro a ADA / EASD, zosakaniza zopangidwa mokonzekera zimawonetsedwa poyambira insulin mankhwala (komanso basal insulin) ndikuwonjezera kwake komanso kuphatikiza kwa prandial insulin.

Pa HbA1c milingo ya 6.5-7,5% ndi 7.6-9.0%, pankhani ya kusakwanira kwa mankhwala ophatikizika atatu, tikulimbikitsidwa kuyambitsa kapena kukulitsa mankhwala a insulin. Ndi mtengo woyambira wa chizindikirocho> 9.0%, insulin yofunikanso kuti muchepetse vuto la glucose.

Kudya kwa insulini kungakhale kwakanthawi kapena kokhazikika, kutengera magwiridwe antchito a maselo a pancreatic beta.

Malinga ndi malingaliro a WHO, kuti apereke insulin yokhazikika kwa odwala omwe ali ndi anthu opitilira 50 miliyoni, kupanga kwawo mankhwalawa kuyenera kupangidwa.

Mmodzi mwa atsogoleri pantchito yopanga ndi kupanga mankhwala opangidwa ndi majini ku Russia amatchedwa Geropharm LLC. Kuphatikiza apo, kampaniyo ndiyomwe imapanga Russia yokha yapamwamba kwambiri yopanga ma insulin (kuchokera kuzinthu mpaka mitundu yotsiriza). Pakadali pano, kampaniyo imatulutsa insulin yocheperako komanso yapakatikati - Rinsulin R ndi Rinsulin NPH.

WHO ndi IDF, komanso komiti ya Pharmacological ya Unduna wa Zaumoyo ku Russia kuchitira ana, achinyamata ndi amayi apakati omwe ali ndi matenda ashuga, amalimbikitsa kugwiritsa ntchito insulin yaumunthu ngati yogwirizana kwambiri ndi mphamvu ya thupi ya insulin. Chifukwa chake, mwayi watsopano ukutsegulidwa kuthetsa mavuto ambiri a matenda ashuga ku Russia, kuphatikiza azachuma.

Kafukufuku M.I. Balabolkina et al. awonetsa bwino hypoglycemic zotsatira komanso kusowa kwa zochita za antigenic nthawi yayitali ndimankhwala opangidwa ndi majini opanga majini. Pazowonera panali odwala 25 (azimayi 9 ndi amuna 16) azaka 25 mpaka 58, omwe ali ndi matenda a shuga 1. 21 A iwo anali ndi matenda oopsa. Odwala onse adalandira ma insulin aumunthu: Actrapid NM, Monotard NM, Protafan NM kapena Humulin R ndi Humulin NPH pamtunda wa 43.2 ± 10.8 U (Median 42 U), kapena 0,6 ± 0.12 U / kg kulemera kwa thupi, kamodzi patsiku. Glycemia ndi HbA1c anali ofanana ndi omwe amapezeka ndi insulin chithandizo cha opanga akunja. Olembawo adati gawo la antibodies ku insulin yakunyumba silisintha. Ngati mulingo wa anti-insulin antibodies mu seramu (njira ya radioimmunological idagwiritsidwa ntchito) mwa odwala asadasamutsidwe insulins zapakhomo anali 19.048 ± 6.77% (wapakatikati - 15.3%), ndiye pofika kumapeto kwa kafukufuku - 18.77 ± 6.91% (wapakatikati - 15,5%). Panalibe ketoacidosis, thupi lawo siligwirizana, komanso magawo a hypoglycemia omwe amafunikira njira zowonjezera zochizira. Pankhaniyi, mlingo wa insulin wa tsiku ndi tsiku sunasinthe kwenikweni ndi mlingo wa insulin yomwe analandira asanayambe phunziroli, mayunitsi 41.16 ± 8.51 (ma Median - 44 mayunitsi), kapena mayunitsi a 0.59 ± 0,07 / kg.

Chokondweretsa ndichowerengera pakufanizira kwa kutsitsa kwa shuga kwa Rinsulin R ndi Actrapid, Rinsulin NPH ndi Protafan mwa odwala 18 omwe ali ndi matenda a shuga a 2 muzochita zamankhwala, zochitidwa ndi A.A. Kalinnikova et al. . Mapangidwe ake ndiwokhazikika, oyembekezeredwa, owongoleredwa mwachangu. Monga kulowererapo, jakisoni wokhazikika wa Rinsulin R ndi Rinsulin NPH mu Mlingo wowerengeka wowerengeka unayesedwa. Monga ulamuliro - kukhazikitsidwa kwa Actrapid ndi Protafan mu Mlingo wofanana ndi mtundu wa makonzedwe. Chofunikira chofanizira ndikusintha kwa glycemia pambuyo pobayira jekeseni pazotsatira zoyambira. Popeza machitidwe a insulin adawunika mwa wodwala aliyense ndipo kuwunika kunachitika ndi njira yofananizira ziwiri, mawonekedwe oyamba a odwalawo anali ofanana pa insulin iliyonse ndipo sizingasokoneze kugwira ntchito kwawo. Kusiyana kwakukulu pakuchepa kwa shuga kwa ma insulin ndi dongosolo limodzi lokhazikika sikunakhazikitsidwe. Olembawo adamaliza: posamutsa Rinsulin NPH ndi Rinsulin P kuchokera ku mitundu ina ya insulin, Mlingo womwewo ndi mitundu yomweyo ya kayendedwe angagwiritsidwe ntchito ndikudzikongoletsa pambuyo pake potsatira zotsatira zakudziyang'anira nokha.

Kuzindikira koyambirira kwa matenda a shuga a 2 komanso kugwiritsa ntchito mankhwala a insulin panthawi yake kumapangitsa kuti pakhale kusintha kwakukulu pakuwongolera glycemic ndipo, chifukwa chake, kusungidwa kwa malo osungirako a pancreatic beta cell. Zotsatira zabwino zowongolera glycemic kudziunjikira ndikulimbikira kwa nthawi yayitali. Kuyang'anira glycemic kwamphamvu popanda kuwonjezera chiopsezo cha hypoglycemia ndiyo njira yokhayo yolepheretsa kapena kuchedwetsa kukula kwa zovuta zamagazi a shuga. Kuphatikiza apo, kusankha kwa mankhwala ochepetsa shuga kuyenera kukhala kotengera munthu payekhapayekha, motero, mulingo womwewo wa HbA1c. Choyamba, munthu ayenera kuganizira zaka za wodwalayo, nthawi yomwe akukhala ndi moyo, kukhalapo kwa zovuta zazikulu, chiopsezo chokhala ndi hypoglycemia yoopsa. Malinga ndi zotsatira za kafukufuku, ma insulins apanyumba ndi othandiza komanso otetezeka.

Mlingo wa Matenda a shuga

Mitundu yofala kwambiri ya matenda ashuga ndi:

• 1st
• 2
• gestational (mkhalidwe wa hyperglycemia womwe umayamba pamene mayi ali ndi pakati, monga lamulo, umadutsa pakubala mwana).

Ndi matenda amtundu woyamba, kapamba amasiya kutulutsa insulin yokwanira thupi (zosakwana 20 peresenti). Zotsatira zake, glucose samayamwa, kudziunjikira, amakhumudwitsa mkhalidwe wa hyperglycemia.

Mwachidziwikire, kuyezetsa magazi kwa insulin pamenepa ndikofunikira kuzindikira. Zimathandiza osati kungodziwa matendawa, komanso kupatsa wodwala mlingo wina wa mahomoni omwe akusowa mthupi. Ndipo kale ndikuganiza izi, syringe yosankhidwa imasankhidwa, njira yatsiku ndi tsiku ndi zakudya zimapangidwa, ndipo zina zambiri zofunikira zamankhwala zimasankhidwa.

Mtundu wachiwiri wa matenda ashuga, insulini imapangidwa mokwanira, koma maselo, pazifukwa zosiyanasiyana, amatenga matendawo. Zotsatira: shuga sangayikidwebe, mulingo wake umakwezedwa. Kuti muthane ndi insulin, kapamba amayamba kupanga mahomoni ofunikira kwambiri, kuphatikiza kwake kumawonjezereka. Palibe zizindikiro za kuchuluka kwa glucose pakadali pano. Chifukwa chake, kuyesa kwa mahomoni ndikofunikira kwambiri.

Kuchita ntchito yayitali pakanthawi kumatha maselo a England, gawo latsopano la matenda limayamba: zinthu zomwe zimapangidwa ndi zake sizokwanira. Monga lamulo, muzochitika zotere, jakisoni wa mahomoni amaperekedwa kwa wodwala yemwe ali ndi matenda a insulin-Independent endocrine.

Tsopano kufunikira kwa kuyesedwa kwa magazi koyeretsa kumveka. Tiyeni tiwuzenso zina zomwe zotsatira zake zingakhale.

Zizindikiro zogwiritsidwa ntchito

Chizindikiro chachikulu komanso chokhacho chomwera mankhwalawo ndi gulu la endocrine pathologies yolumikizidwa ndi kulowetsedwa kwa shuga ndikupanga hyperglycemia.

Rinsulin R insulin imaperekedwa kwa odwala omwe ali ndi matenda amtundu wa 2 komanso a 2. Amasankhidwa ngati mtundu wachiwiri wa shuga uli mu gawo la kukana mbewu kapena mankhwala ochepetsa shuga.

Ndibwino kugwiritsa ntchito mankhwalawa motsutsana ndi mankhwalawa mukaphatikizidwa chithandizo. Amawerengera matenda omwe adalumikizana mwangozi, omwe amaphatikizana ndi matenda ashuga.

Rinsulin P amawerengera amayi apakati omwe ali ndi matenda a shuga a 2, ndipo matendawa akaphatikizana ndi kuwonongeka kwa kagayidwe kazakudya.

Mankhwalawa amaloledwa mu nthawi iliyonse ya mimba. Chidacho chogwiritsa ntchito sichidalowa mu zotchinga pang'ono. Sichitha kupita kwa mwana limodzi ndi mkaka wa m'mawere, chifukwa chake, mankhwalawa amaloledwa kugwiritsidwa ntchito ndi amayi omwe akuyamwitsa.

Kutulutsa mawonekedwe ndi kapangidwe kake

Rinsulin R - jekeseni. Kupezeka mu RinAstra syringe cholembera. Pali zidutswa 5 mu phukusi. Mu cholembera chimodzi - 3 ml ya malonda.

Mankhwalawa amapangidwa, amathiriridwa m'mabotolo agalasi. Kukula Mwadzina - 10 ml.

Fomu yachitatu yotulutsidwa ndi ma 3 galasi makatoni olimba.

Chofunikira chachikulu ndicho insulin ya anthu. Zilibe kanthu kuti mankhwalawo adagulidwa, 100 ml ali mu 1 ml yankho.

Mtengo wa Rinsulin P ndi wochepa. Kugulitsa ndi mankhwala.

Malangizo ogwiritsira ntchito

Kubayilitsa ndizotheka m'njira zitatu. Jakisoni amachitidwa kudzera m'mitsempha, kudzera m'mitsempha ndi m'magazi. Njira yotsirizayi imakonda kuchitidwa ndi odwala matenda ashuga.

Jakisoni amapangidwa m'chafu, phewa, pamimba kapena matako. Malo oyendetsera mankhwala ayenera kusinthidwa.

Njira imeneyi yogwiritsira ntchito Rinsulin P imapewa kuchepa kwamafuta. Amayamba ndi kuperekera mankhwala pafupipafupi m'dera limodzi.

Ndi jakisoni wotsekemera, samalani kwambiri. Ngozi yayikulu yolowa mumtsempha wamagazi.

Ntchito malangizo Rinsulin R:

• Jakisoni amapangidwa theka la ola musanadye chakudya chamoto.
• Pamaso pa jekeseni, konzekerani syringe m'manja.
• Kuchulukana kwa kugwiritsa ntchito mankhwalawa mankhwalawa yekha - 3 r / tsiku. Madokotala ambiri amapereka mankhwalawa 5-6 kugwiritsa ntchito mankhwalawa. Kugwiritsa ntchito pafupipafupi kumalimbikitsidwa pa mlingo wa tsiku ndi tsiku woposa 0.6 IU / kg.
• Nthawi zambiri zotchulidwa limodzi ndi rinsulin NPH, chifukwa mankhwala oyamba ndi osakhalitsa. Mwachitsanzo, ndibwino kugwiritsa ntchito mankhwala achiwiri usiku.
• Gwedeza mbale ndi ma syringe musanagwiritse ntchito. Palibe zoyera zoyera zomwe zikuyenera kuwonekera mchombo.
• Kuthira mankhwala pakhungu lisanayambike ndi singano. Ndi chala chachikulu ndi kutsogolo kwa dzanja lamanzere, sonkhanitsani khungu, ndipo ndi dzanja lamanja ikani singano ya insulin pakona madigiri 45. Osatulutsa syringe yomweyo. Ndikofunikira kusiya singano kwa masekondi 6 pansi pa khungu kuti mankhwalawo adayambitsidwe kwathunthu.

Jakisoni amapangidwa ndi syringe yapadera ya insulin. Simungagwiritsenso ntchito. Syringe yodziwika siyingagwiritsidwe ntchito, chifukwa madzi obayidwa adzadziunjikira malo amodzi, ndipo ndizosatheka kutikita pamalowo jakisoni.

Singano ya insulin imalola kuti mankhwalawo alowe mkatikati mwa minofu yaying'ono ndikuwunjikana malo amodzi.

Zotsatira zoyipa

Rinsulin P ndi mankhwala otetezeka ngati atengedwa malinga ndi zomwe dokotala wanena, kutsatira malangizo ake.

Odwala ambiri omwe agula mankhwalawa amadandaula za zotsatira zoyipa. Ena mwa iwo safuna chithandizo. Zotsatira zoyipa zimatha pakapita nthawi.

Maganizo osiyanawa ndi monga:

• migraine
• chizungulire
• utachepa kowoneka bwino (wonenedwa koyambirira kwa chithandizo m'chipatala chachiwiri chilichonse),
• hyperhidrosis
• njala yayikulu
• kuzizira (ngakhale nyengo yotentha).

Mwa zina zopanda zoyipa, redness imadziwika kuti imachitika pamene chotengera chigwirira ndi magazi. Kuyabwa kumachitika pamalo a jakisoni, omwe amasowa pambuyo pa maola 8-12.

Komabe, zovuta zina sizinganyalanyazidwe. Amatha kubweretsa zovuta zowonjezereka.

Mwachitsanzo, zonse zimayamba ndi zotupa pakhungu. M'malo mwake, sizibweretsa mwiniwake mavuto ena kupatula kukongoletsa. Popitiliza kumwa mankhwalawa, zidzolo zimasintha kukhala urticaria waukulu. Quincke edema imayamba, yotchuka kwambiri ndi kutupa kwa pakhungu, minofu ya adipose komanso zimagwira pakhungu.

Mukamaliza kugwiritsa ntchito mankhwalawa, kuyembekezera kuchepa kwa matenda ndi kupitiliza kumwa mankhwalawo, mantha anaphylactic angayambike. Vutoli limachitika pokhapokha kukhudzana ndi allergen.

Mavuto akulu kwambiri am'thupi a hypoglycemic ndi kugwedezeka, mtima palpitations ndi kukula kwa hypoglycemic chikomokere.

Kuzindikira kwa mavuto aliwonse ndi mwayi woonana ndi dokotala. Ndi magawo pafupipafupi otaya chikumbumtima - itanani ambulansi, sonkhanitsani mankhwala onse kuti madotolo amvetsetse vuto, ngati atafika wodwalayo amakomoka.

Malinga ndi ndemanga ya odwala matenda ashuga, Rinsulin P imagwira ntchito bwino, koma mavuto omwe amawoneka atatha kugwiritsa ntchito mankhwalawa.

Rinsulin R analogues: Actrapid, Biosulin R, Vozulim R, Gansulin R, Gensulin R, Humodar R 100 Mitsinje, Insukar R, Recombinant insulin ya anthu.

Dokotalayo amapereka mankhwala ngati mankhwala omwe adagwiritsidwa ntchito kale sanathandize kapena kuyambitsa mavuto. Mankhwalawa ali ndi Mlingo wosiyana ndi mawonekedwe a ntchito, zidziwitsozi zikuwonetsedwa mu malangizo.

Ma Analogs ndi mankhwala omwe amafanananso ndi thupi ndipo ali ndi zinthu zomwezi.

Contraindication

Pali zotsutsana zochepa pakugwiritsira ntchito mankhwala. Mankhwalawa amaletsedwa kwa odwala omwe ali ndi vuto lililonse la insulin kapena chinthu china.

Osatengera odwala omwe ali ndi hypoglycemia. Uku ndi mkhalidwe womwe shuga ya magazi imachepetsedwa mpaka 3.5 mmol / L. Hypoglycemia ndizovuta zachipatala zomwe zimadziwika ndi kutsegulira kwa mtima wamanjenje komanso kusokonezeka kwamanjenje.

Izi zimakhudza kuyendetsa magalimoto ndikugwira ntchito ndi zina. Sungakhale chifukwa choyambirira chomwe kuvomerezedwa ndikuvomerezedwa, komanso kwachiwiri. Ndiye - bongo.

Malangizo apadera

Malangizo a mankhwalawa amawonetsa malangizo apadera. Amagwira ntchito kwa odwala okalamba, ana ndi odwala omwe ali ndi vuto la impso ndi kwa chiwindi.

Anthu otere ayenera kutsatira mosamalitsa mlingo womwe dokotala watchulidwa. Simungathe kupatuka munjira yamankhwala, apo ayi mavuto sangathe kupewedwa.

Odwala okalamba ayenera kuyang'anitsitsa zaumoyo wawo, ndipo pakakhala zovuta zilizonse, pitani kuchipatala. Ngakhale kupweteka mutu komanso kuzizira. Dokotala amayenera kuwongolera njira ya mankhwalawo ndikuzindikira zonse zomwe zimachitika kwa wodwala.

Odwala okalamba amatha kukhala ndi hypoglycemia, motero muyenera kuyang'anira shuga pofufuza kawiri kawiri patsiku. Ndikofunika kusintha mankhwalawo ngati mankhwala ena atengedwa.

Pogwiritsa ntchito chiwindi ndi impso, kuwonongeka, odwala amafunika kusintha pafupipafupi. Pafupipafupi kuyeza shuga wamagazi kumachulukitsa kangapo monga munthu amadya.

Muyenera kudziwa kuti mankhwalawa amakhudza kufunika kwa insulin. Pakuwonekera kwa adotolo, ndikofunikira kukambirana za mankhwala onse omwe amwedwa, mlingo komanso nthawi yayitali ya chithandizo. Kutengera izi, adotolo amasankha njira yoyenera yothandizira.

Mankhwala othandizira Insulin: carbonic anhydrase inhibitors, clofibrate, othandizira okhala ndi ethanol, mankhwala okhala ndi lithiamu, ketoconazole ena.

Mankhwala omwe amachepetsa mphamvu ya hypoglycemic: estrogens, Heparin, Danazole, Morphine, chikonga, ayodini wokhala ndi chithokomiro.

Insulin yocheperako yamunthu, pamene mlingo umayang'aniridwa, umatsitsa shuga. Gwiritsani ntchito mankhwalawa molingana ndi malangizo, osasintha nokha. Ngati palibe zotheka, funsani dokotala.

Mlingo wa insulin m'magazi

Choyambirira kuchita ndikudziwa izi. Insulin ndi mahomoni omwe, monga momwe tikudziwira kale, amapangidwa mu kapamba. Ma cell a Beta omwe amapezeka mu islet zida za Langerhans ndi omwe amapanga. Thupi limathandizira pakukweza kwa thupi ndi mphamvu.

Maselo ali ndi ma cell receptor omwe amachititsa chidwi. Akalandira chizindikiro, amatsegula njira zama gluu. Mwanjira imeneyi, gwero lamphamvu lamagetsi limatengedwa.

Masautso a insulin mthupi amasintha mosalekeza. Izi ndichifukwa choti nthawi zosiyanasiyana zimakhala zosiyanasiyana. Pakati pa chakudya, chiwerengerochi ndi chochepa, komanso kugona. Izi ndi zomwe zimadziwika kuti zakapangidwe ka mahormone, komwe kumafunika kuti mulingo wina wa mahomoni ena agwiritsidwe ntchito - glucagon, womwe umakulitsa kuchuluka kwa shuga m'magazi.

Tikaona chakudya, kumanunkhiza, insulin secretion imayamba kukula. Chakudya chikalowa m'thupi, glucose amatuluka, ichi ndi chizindikilo cha maselo a beta kuti zinthuzo zizigwira ntchito kwambiri. Mukatha kudya, kuchuluka kwa mahomoni ndi okwera kwambiri (nsonga).

Mayeso a labotale a kuchuluka kwa insulin mu biomaterial ya wodwalayo amachitika pamimba yopanda kanthu. Chifukwa chake, miyambo yosala kudya imavomerezedwanso. Mwa munthu wathanzi, ali motere:

• Akuluakulu, amakhala ndi ma virus 3 mpaka 25 pa millilita,
• mwa ana (mpaka zaka 12), cholembera cha kumtunda sichochepa ndipo chimafika 20 μU / ml.

Miyezo ya ana, monga momwe tikuonera, ndi yotsika kwambiri. Izi ndichifukwa choti gawo la insulin musanathe msinkhu silimadalira chakudya.

Kuphatikiza apo, akatswiri amatsogozedwa ndi zisonyezo zapadera zoyezetsa poyesa odwala omwe ali ndi pakati komanso okalamba (woposa zaka 60). Kwa iwo, zotsatira zabwinobwino zitha kupitilira zovomerezeka. Kwa amayi oyembekezera, malire ochepa ndi 6, apamwamba 27, kwa anthu azaka zapakati pa 6 ndi 35. Zizindikiro zofananira muma labotale osiyanasiyana zitha kusiyana, kotero katswiri ayenera kufotokozera momwe mukuwunikira.

Fomu, kapangidwe ndi kapangidwe ka ntchito

"Rosinsulin" amatanthauza mankhwala a gulu la "hypoglycemic agents". Kutengera kuthamanga ndi kutalika kwa kuchitapo, pali:

• "Rosinsulin S" ndi nthawi yayitali yochitapo kanthu,
• "Rosinsulin R" - mwachidule,
• "Rosinsulin M" ndi wothandizirana wopanga 30% sungunuka insulini ndi 70% insulin-isophan.

Mankhwala amtundu wa insulin omwe amapezeka m'thupi la munthu kudzera pakusintha kwa DNA. Malangizowo akuwonetsa kuti lingaliro la chochita limatengera kulumikizana kwa chinthu chachikulu cha mankhwala omwe ali ndi maselo komanso mapangidwe a insulin zovuta.

Zotsatira zake, kuphatikiza kwa ma enzyme ofunikira pakugwira ntchito bwino kwa thupi kumachitika. Matenda a mtundu wa shuga amapezeka chifukwa cha michere ya intracellular ndi mayamwidwe okwanira.

Malinga ndi akatswiri, zotsatira za ntchito zimawonekera patatha maola 1-2 mutayendetsa pakhungu.

"Rosinsulin" ndi kuyimitsidwa koyendetsedwa pansi pa khungu. Kuchitikako kumachitika chifukwa cha zomwe zili ndi insulin-isophan.

Kuyanjana kwa mankhwala

Mankhwalawa akuwonetsedwa mtundu uliwonse wa matenda a shuga, makamaka pakakana kwathunthu kapena pang'ono mapiritsi ochepetsa shuga. Amagwiritsidwanso ntchito pamavuto azikhalidwe za anthu odwala matenda ashuga motsutsana ndi kuwonongeka kwa kagayidwe kazinthu kagayidwe kachakudya ndi matenda omwe amayanjana. Komabe, mankhwalawa saikidwa pa hypoglycemia komanso tsankho la munthu pazigawo zake.

Mankhwalawa amapangidwira utsogoleri wa iv, v / m, s / c. Njira yoyendetsera ndi mlingo wake ndi mankhwala a endocrinologist kutengera mtundu wa wodwalayo. Pakatikati mwa mankhwalawa ndi 0,5-1 IU / kg pa kulemera kwake.

Mankhwala a insulin omwe amangokhala mwachangu amaperekedwa m'mphindi 30. musanayambe kudya chakudya chamafuta. Koma, choyamba, muyenera kudikirira mpaka kutentha kwa kuyimitsidwa kukhale mpaka madigiri 15.

Pankhani ya monotherapy, insulin imayendetsedwa katatu mpaka katatu patsiku. Ngati mlingo wa tsiku ndi tsiku umaposa 0,6 IU / kg, ndiye kuti muyenera kulowetsa jakisoni awiri kapena angapo m'malo osiyanasiyana.

Monga lamulo, wothandizirayo amapaka jekeseni m'mimba khoma. Koma jakisoni amathanso kupanga m'mapewa, matako ndi ntchafu.

Nthawi ndi nthawi, malo a jakisoni amayenera kusinthidwa, zomwe zingateteze kuoneka ngati lipodystrophy. Pankhani ya kayendedwe ka subcutaneous of the hormone, muyenera kusamala kuti muwonetsetse kuti madziwo salowa mumtsempha wamagazi. Komanso, jakisoni atatha, jakisoni sangasambe.

Kukonzekera kwa / mu ndi / m kumatheka pokhapokha kuyang'anira achipatala. Makatoni amagwiritsidwa ntchito pokhapokha ngati mawonekedwe amadzimadzi ali ndi mawonekedwe osayera, chifukwa chake, pakuwonekera kwina, yankho sayenera kugwiritsidwa ntchito.

Ndikofunika kukumbukira kuti ma cartridge ali ndi chida chodziwika chomwe sichimalola kusakanikirana ndi zomwe zili ndi mitundu ina ya insulin. Koma ndikadzaza zolondola za cholembera, amatha kugwiritsidwanso ntchito.

Pambuyo poikapo, singano iyenera kutulutsidwa ndi kapu yake yakunja kenako ndikuitaya. Chifukwa chake, kupewetsa kumatha kupewedwa, kusokonekera kungatheke, ndipo mpweya sungalowe ndi singano ndikutseka.

Zotsatira zoyipa ndizolephera mu chakudya cha carbohydrate. Chifukwa chake, kuwunika kwa madotolo ndi odwala kumatsikira kuti pambuyo pa kuperekedwa kwa Rinsulin P, hypoglycemia ikhoza kuyamba. Izi zimawonetsedwa ndi malaise, khungu lotumbulika, kupweteka mutu, kupindika, kunjenjemera, njala, hyperhidrosis, chizungulire, ndipo muzovuta, hypoglycemic coma imayamba mu matenda a shuga.

Zotsatira zoyipa, monga edema ya Quincke, zotupa pakhungu, ndizothekanso. Kugwedezeka kwa anaphylactic, komwe kumatha kubweretsa imfa, nthawi zina kumayamba.

Rosinsulin ndi yoyenera kugwiritsidwa ntchito zovuta molumikizana ndi mankhwala ena.Musanayambe kuphatikiza mankhwala, muyenera kufunsa dokotala.

Dokotala adzalembera ndi kuwerengetsa Mlingowo, poganizira momwe zinthu zimayendera. Mosamala, Rosinsulin iyenera kutengedwa molumikizana ndi mankhwala ena kuti magazi abwinidwe.

Kufooka kwa kufunika komwe kumawonedwa ndikumawatenga ndi njira zakulera, okodzetsa ndi antidepressants.

Kufunika kwa wogwirizira kumatsimikiziridwa ndi adokotala. Cholinga chofufuza analogue ndikusowa kwa malonda kapena kukhalapo kwa ma contraindication. Malangizo a Rosinsulin akuwonetsa njira zoyenera zosinthira. Izi ndi monga Biosulin, Gansulin, Protafan, Rinsulin, Humodar ndi Humulin. Sizoletsedwa popanda kudzipatula ndikuyamba kulandira mankhwala pogwiritsa ntchito fanizo.

Kodi mayeso amachitika bwanji?

Monga lamulo, kuyezetsa kuchipatala sikumangokhala pakuwunika m'mimba yopanda kanthu. Nthawi zambiri, kuyesedwa kawiri kumachitika:

• pamimba yopanda kanthu
• Ma 1.5-2 mawola atatha kudya (shuga).

Zotsatira zawo siziyenera kukhala zochuluka kwambiri, kuchuluka kwa insulin mukatha kudya kumakhala pakati pa magawo atatu mpaka 35. Choyambitsa nkhawa yayikulu ndi chisonyezero chowonjezera katatu cha kufunika kosanthula mwachangu.

Kuphatikiza apo, mayeso omwe amadziwika kuti ndiwotsutsa amagwiritsidwa ntchito pozindikira, malinga ndi momwe wodwalayo amasala kudya ndikuwunika gawo lililonse la maola asanu ndi limodzi. Kuchepa kwake kosakhala kwachilengedwe / kotsika komwe kumayimira zovuta ndi kapamba. Makamaka, matenda a shuga angakhale omwe amayambitsa.

Nthawi yomweyo kuyesa insulin, kafukufuku wokhudza kuchuluka kwa shuga m'magazi amachitika. Malinga ndi zotsatira za mayesowa, madotolo amatha kudziwa za momwe wodwalayo alili.

Zizindikiro za Low insulin

Kuphatikiza pa mayeso a labotale, palinso njira zina zopezera insulin yochepa mwa anthu. Pali zizindikiro zingapo zomwe zikuwonetsa kuti pali vuto la mahormone.

Zizindikiro zake zopanda thupi m'thupi zimaphatikizapo izi:

• kulakalaka kwambiri, kumva kusalamulirika kwanjala,
• ludzu lalikulu lopanda maziko, kukodza kwakukulu ndi pafupipafupi,
• miyendo yanjenjemera
• kukomoka mtima,
• wowoneka bwino
• dzanzi la zala, pakamwa, nasopharynx,
• nseru
• kutuluka thukuta kwambiri
• kukomoka
• kukhumudwa, kusakhazikika.

Modabwitsa, zizindikiro za kuchuluka kwa insulini ndizofanana ndi zisonyezo za kuchuluka kosakwanira. Uku ndikuwopseza kwadzidzidzi kwanjala, kufooka, kutopa, kufupika, kukokana, komanso kuyabwa pakhungu ndi kuphwanya njira zobwezera, kuwonjezeka kwa mkodzo.

Chimodzi mwazonse mwazizindikirozi chimatha kukhala ndi chifukwa chakuthupi chomwe sichikugwirizana ndi matendawa. Koma ndikwabwino kukayezetsa kamodzi kuposa kungoyambitsa matendawa.

Chithandizo cha matenda a shuga a insulin

Ngati mukudwala matenda a shuga a mtundu woyamba wodwala amayamba jekeseni wa mahomoni osiyanasiyana mu mankhwala atangozindikira, ndiye kuti ndi matenda a shuga a 2 zinthu sizili bwino. M'magawo oyambira, monga tanena kale, kapamba amagwira ntchito bwino, ngakhale kwambiri, chifukwa kuphatikizira kwa insulin m'magazi kumakhala mkati mwa malire (kapena apamwamba). Pakadali pano, chithandizo cha insulin sichofunikira, mankhwala ochepetsa shuga komanso zakudya zimayambitsidwa. Popita nthawi, chitsulo chimatha, pokhapokha pakufunika chithandizo chatsopano.

Odwala ambiri odwala matenda ashuga amachita mantha ndi chiyembekezo cha kubayidwa pafupipafupi. Ena amakana mankhwala a insulin. Chisankhochi ndi chowopsa, chifukwa nthawi zonse vuto la hyperglycemia limakhala ndi zotsatira zosasintha.

Mitundu yosiyanasiyana ya insulin imagwiritsidwa ntchito pochiza odwala matenda ashuga:

Mwa dzina, mutha kudziwa momwe jekeseni wothandizira angathere: pambuyo pa mphindi 5, 20, kapena patatha maola ochepa. Kugwiritsa ntchito mankhwala osiyanasiyana pamachitidwe awo, ndikotheka kutsata magwiridwe anthawi zonse: mankhwala apakati kapena a nthawi yayitali amabweza kumbuyo komwe secretion ya insulin, yochepa kapena yochepa kwambiri (mutatha kudya).