I-Insulin Detemir ilingana ne-insulin yabantu. Umuthi wenzelwe ukwelashwa kwe-hypoglycemic kweziguli ezinesifo sikashukela mellitus. Kubonakala ngesenzo esikhona isikhathi eside kanye nokuncipha kokukhula kwe-hypoglycemia ebusuku.
Igama Lezwe elingafanele
I-INN yalesi sidakamizwa i-Insulin detemir. Amagama okuhweba nguLevemir Flekspan noLevemir Penfill.
I-ATX
Lesi sidakamizwa se-hypoglycemic esingeqembu le-insulin. Ikhodi yayo ye-ATX yi-A10AE05.
Khipha amafomu nokwakheka
Umuthi uyatholakala ngendlela yesisombululo somjovo ohloselwe ukuphathwa ngaphansi kwesikhumba. Amanye amafomu wesilinganiso, kufaka phakathi amaphilisi, awenziwa. Lokhu kungenxa yokuthi i-insulin yokugaya ukudla idilizwa yaba ngama-amino acid futhi ayikwazi ukufeza imisebenzi yayo.
I-Insulin Detemir ilingana ne-insulin yabantu.
Ingxenye esebenzayo imelwe ngumtshado we-insulin. Okuqukethwe ku-1 ml kwekhambi kungama-14.2 mg, noma amayunithi ayi-100. Ukwenziwa okwengeziwe kufaka phakathi:
- i-sodium chloride;
- glycerin;
- hydroxybenzene;
- metacresol;
- i-sodium hydrogen phosphate dihydrate;
- i-zinc acetate;
- hlanganisa i-hydrochloric acid / sodium hydroxide;
- amanzi okujova.
Kubukeka njengesisombululo esicacile, esingafakwanga, esingenangqondo. Isatshalaliswa kuma-cartridge ama-3 ml (ama-Penfill) noma ama-syringes wepeni (i-Flekspen). Iphakethe le-carton engaphandle. Umyalo unamathiselwe.
Isenzo se-Pharmacological
Umuthi ungumkhiqizo wobunjiniyela bezakhi zofuzo. Itholakala ngokudala i-rDNA kwimvubelo yombhaki. Kulokhu, izingcezwana ze-plasmids zithathelwa indawo yizakhi zofuzo ezihlonza i-biosynthesis of insulin precursors. Lawa ma-plasmids e-DNA afakiwe afakwe kumaseli we-Saccharomyces cerevisiae, futhi aqala ukukhiqiza i-insulin.
Lapho usebenzisa lesi sidakamizwa, ubungozi be-nocturnal hypoglycemia buncishiswa ngo-65% (ngokuqhathaniswa nezinye izindlela).
I-ejenti ebhekelwa phansi iyi-analogue ye-hormone evikelwe iziqithi zeLangerhans emzimbeni womuntu. Kuboniswa isikhathi esengeziwe sesenzo futhi ngisho nokukhululwa ngaphandle kokugxuma okumangazayo ekuqoqweni kwento esebenzayo ku-plasma.
Ama-molecule we-insulin enza izinhlangano endaweni yomjovo, futhi abophe nakuma-albhamuin. Ngenxa yalokhu, umuthi uyangenwa bese ufaka izicubu eziqondiwe kwipheriphery kancane, okwenza ukuthi usebenze kakhulu futhi uphephe kunamanye amalungiselelo e-insulin (Glargin, Isofan). Uma uqhathanisa nabo, ubungozi be-hypoglycemia ebusuku buncishiswa baba ngama-65%.
Ngokusebenza kuma-receptor amaselula, isakhi esisebenzayo somuthi sibangela izinqubo eziningi zangaphakathi, kufaka phakathi ukwakheka kwama-enzymes abalulekile njenge-glycogen synthetase, pyruvate ne-hexokinase. Ukwehla kwe-plasma glucose kunikezwa ngu:
- ukucindezela ukukhiqizwa kwayo esibindini;
- ukuqinisa ukuthutha okungaphakathi;
- kusebenze kokufakwa emzimbeni kwezicubu;
- ukugqugquzela kokusebenza ku-glycogen namafutha acid.
Imiphumela yemithi yesidakamizwa ihambelana nomthamo ophathisiwe. Isikhathi sokuvezwa kuncike kusayithi lomjovo, umthamo, izinga lokushisa lomzimba, ijubane lokugeleza kwegazi, ukusebenza komzimba. Ingafinyelela amahora angama-24, ngakho-ke imijovo yenziwa amahlandla ama-1-2 ngosuku.
Isimo sezinso asithinti i-metabolism yento.
Ekuqhubekeni kwezifundo, ukubonakaliswa kwe-genotoxicity yesisombululo, imiphumela ye-carcinogenic, kanye nemiphumela emenyezelwe ekukhuleni kwamaseli nemisebenzi yokuzala akuzange kuvezwe.
I-Pharmacokinetics
Ukuthola ubukhulu be-plasma, amahora angama-6-8 kufanele aqhamuke kusukela esikhathini sokuphatha. I-Bioavailability icishe ibe ngama-60%. Iqoqo lokulinganisa ngokuphathwa kwezikhathi ezimbili linqunywa ngemuva kwemijovo engu-2-3. Umthamo wezilinganiso zokuhambisa ezi-0,1 l / kg. Inqwaba ye-insulin efakiwe ijikeleza ngokusakazwa kwegazi. Umuthi awuhlangani namafutha acid nama-pharmacological agents abopha amaprotheni.
Ukusebenza ngemetabolism kwehlukile ekucutshungweni kwe-insulin yemvelo. Ukuqedwa kwesigamu sempilo kwenza kusuka emahoreni amahlanu kuya kwayi-7 (ngokusho komthamo osetshenzisiwe). I-Pharmacokinetics ayincike ebulilini kanye nasebangeni lesiguli. Isimo sezinso nesibindi naso asizithinti lezi zinkomba.
Izinkomba zokusetshenziswa
Umuthi uhloselwe ukulwa ne-hyperglycemia lapho ukhona uhlobo 1 nesifo sikashukela sohlobo 2.
I-insulin yakhelwe ukulwa ne-hyperglycemia lapho kukhona uhlobo 1 nesifo sikashukela sohlobo 2.
Contraindication
Leli thuluzi alinqunyelwe i-hypersensitivity esenzweni sengxenye ye-insulin noma ukungabekezeleli ababukeli. Umkhawulo wobudala yiminyaka emi-2.
Ungayithatha kanjani i-Insulin Detemir
Isixazululo sisetshenziselwa ukuphathwa kwe-subcutaneous, ukumfaka kwe-intravenous kungadala i-hypoglycemia enzima. Akujovwa intramuscularly futhi ayisetshenziswa kumaphampu we-insulin. Ukufakwa kungahanjiswa endaweni:
- ihlombe (umsipha odlekayo);
- okhalweni
- udonga olungaphambili lwe-peritoneum;
- izinqe.
Indawo yomjovo kufanele iguqulwe njalo ukuze kuncishiswe amathuba wezimpawu ze-lipodystrophy.
Uhlobo lomthamo lukhethiwe ngokuhlukile. Imithamo incike kushukela we-plasma glucose. Ukulungiswa komthamo kungenzeka kudingekile ukuzikhandla ngokomzimba, ushintsho ekudleni, izifo ezihambelanayo.
Umuthi uphathwa ezindaweni ezahlukahlukene, kufaka phakathi nodonga lwangaphandle lwe-peritoneum.
Ukusetshenziswa kwomuthi kuvunyelwe:
- ngokuzimela;
- ngokuhlangana nemijovo ye-bolus insulin;
- ngaphezu kwe-liraglutide;
- ngama-ejenti omlomo we-antidiabetes.
Nge-tiba eyinkimbinkimbi ye-hypoglycemic, kunconywa ukuphatha umuthi isikhathi esingu-1 ngosuku. Udinga ukukhetha noma yisiphi isikhathi esikahle bese unamathela kuso lapho wenza imijovo yansuku zonke. Uma kunesidingo sokusebenzisa ikhambi izikhathi ezi-2 ngosuku, kuthathwa umthamo wokuqala ekuseni, bese owesibili unqunyelwe amahora ayi-12, ngesidlo sakusihlwa noma ngaphambi kokulala.
Ngemuva kokujova okufakwayo komthamo, inkinobho yepeni yesirinji ibanjwa phansi, inalithi ishiywe esikhunjeni okungenani imizuzwana eyi-6.
Lapho ushintsha kusuka kwamanye amalungiselelo e-insulin uye eDetemir-insulin emasontweni okuqala, ukulawula okuqinile kwenkomba ye-glycemic kuyadingeka. Kungadingeka ukuthi ushintshe irejimeni yokwelashwa, imithamo nesikhathi sesikhathi sokuphuza imishanguzo yesifo sikashukela, kubandakanya neyomlomo.
Kuyadingeka ukuqapha ngokucophelela izinga loshukela bese ulungisa ngesikhathi esifanele umthamo kubantu asebekhulile.
Kuyadingeka ukuqapha ngokucophelela izinga likashukela futhi uguqule ngesikhathi umthamo osekhulile nasezigulini ezine-hepatic pathologies.
Imiphumela emibi ye-Insulin Detemir
Le ejenti yemithi ibekezelelwa kahle. Ukusabela okungalungile okuhambisana nemiphumela yemithi ye-insulin.
Engxenyeni yesitho sombono
Ama-anomalies we-refraction (ukufiphalaza kwesithombe, abangela ukuphathwa ikhanda nokuokomisa ngaphandle kwamehlo) kwesinye isikhathi kuyaphawulwa. Retinopathy yesifo sikashukela. Ingozi yokuqhubeka kwayo inyuka ngokuqinisa i-insulin.
Kusuka ezicutshini zemisipha
Ngesikhathi sokulashwa, i-lipodystrophy ingakhula, ivezwe ku-atrophy ne-adipose izicubu zethishu.
Isistimu yezinzwa ephakathi
Kwezinye izikhathi i-neuropathy yangaphakathi iba. Ezimweni eziningi, iyaphenduka. Imvamisa, izimpawu zayo zivele ngokuvela okujwayelekile kwenkomba ye-glycemic.
Ngasohlangothini lwe-metabolism
Imvamisa kuba nokunciphisa ushukela egazini. I-hypoglycemia enkulu iba phakathi kwe-6% yeziguli. Kungadala ukuboniswa okukholisayo, ukufoka, ukungasebenzi kahle kobuchopho, ukufa.
Allergies
Kwesinye isikhathi ukusabela kwenzeka endaweni yomjovo. Kulokhu, ukulunywa, ubomvu kwesikhumba, ukuqubuka, ukuvuvukala kungavela. Ukushintsha indawo yomjovo we-insulin kunganciphisa noma kungabandakanyi lokhu kuvezwa; ukwenqaba komuthi kuyadingeka ezimweni ezingandile. Ukungezwani okwenzeka ngokujwayelekile kungenzeka (ukukhubazeka kwamathumbu, ukuphefumula, i-arterial hypotension, blanching of the integument, sweating, tachycardia, anaphylaxis).
Umthelela ekhonweni lokulawula izindlela
Ukunaka kanye nesivinini sokuphendula kungenzeka kukhubazeke nge-hypo- noma i-hyperglycemia. Kuyadingeka ukuvikela ukubukeka kwalezi zimo lapho wenza umsebenzi onobungozi futhi ushayela imoto.
Imiyalo ekhethekile
Amathuba okwehla kwamazinga kashukela ebusuku ancishiswa uma kuqhathaniswa nezidakamizwa ezifanayo, ezenza ukuthi zikwazi ukuqinisa inqubo yokujwayela kwe-glycemic indices yeziguli. Lezi zinyathelo aziholeli ekwenyukeni okuqinile kwesisindo somzimba (ngokungafani nezinye izixazululo ze-insulin), kodwa zingashintsha izimpawu eziyinhloko ze-hypoglycemic.
Ukwehliswa kokulashwa kwe-insulin noma umthamo onganele kungadala i-hyperglycemia.
Ukuqedwa kokulashwa kwe-insulin noma ukusetshenziswa kwemithamo enganele kungadala i-hyperglycemia noma kuvuse ketoacidosis, kufaka phakathi nokufa. Ubungozi obukhulu ngokukhethekile ngohlobo lwesifo sikashukela esincike ku-insulin. Izimpawu zokunyuka kokuhlushwa ushukela:
- ukoma
- ukuntuleka kokudla;
- ukuchama njalo;
- ukuphefumula kwenhliziyo;
- i-gag reflex;
- ukweqisa kwe-mucosa yomlomo;
- ukomiswa nokulunywa kwethamba;
- hyperemia;
- umuzwa wephunga le-acetone;
- ukozela
Isidingo se-insulin sanda ngokuzivocavoca ngokomzimba okungakahlelwanga, ukuphambuka ohlelweni lokudla, ukutheleleka, umkhuhlane. Isidingo sokushintsha umkhawulo wesikhathi sidinga ukubonisana ngaphambi kokuhlinzwa.
Umuthi awukwazi ukusetshenziswa:
- Nge-intravenously, nge-intramuscularly, kumaphampu wokufaka.
- Lapho umbala nokubonakala kwe-ketshezi kuguqukile.
- Uma usuku lokuphelelwa isikhathi seluphelelwe yisikhathi, ikhambi ligcinwe ngaphansi kwezimo ezingafanele noma liqandisiwe.
- Ngemuva kokulahla noma ukucindezela i-cartridge / isirinji.
I-Detemir insulin ayivunyelwe ukuphathwa ngokuhlinzwa.
Sebenzisa ebudaleni
Ezigulini esezikhulile, ukugxila kwe-glucose glucose kufanele kugadwe ngokunakekelwa okuthile. Uma kunesidingo, lungisa umthamo wokuqala.
Isabelo sezingane
Akunasipiliyoni somtholampilo ngokusetshenziswa komuthi ezinganeni zeqembu elincane leminyaka (kuze kube yiminyaka emi-2). Imithamo yezingane neyentsha kufanele ikhethwe ngokunakekelwa okuthile.
Sebenzisa ngesikhathi sokukhulelwa nokukhishwa komzimba
Lapho wenza izifundo, imiphumela engemihle ezinganeni ezinomama abasebenzisa umuthi lapho bekhulelwe azange zikhonjwe. Noma kunjalo, yisebenzise lapho uthwala ingane kufanele isetshenziswe ngokuqapha. Esikhathini sokuqala sokukhulelwa, isidingo sowesifazane se-insulin sincipha kancane, bese kamuva sikhula.
Akunabufakazi bokuthi i-insulin idlulela ebisini lwebele. Ukudonswa kwalo ngomlomo ezinganeni akufanele kuboniswe kabi, ngoba emgodini wokugaya ukudla umuthi uyaqhuma ngokushesha futhi umunca umzimba ngesimo sama-amino acid. Umama ongumhlengikazi angadinga ukulungiswa kwamthamo kanye noshintsho ekudleni.
Isicelo sokusebenza kokulimala kwezinso
Umthamo unqunywa ngawodwana. Isidingo somuthi singancishiswa kancane uma isiguli siphazamise umsebenzi wezinso.
Sebenzisa umsebenzi wesibindi okhubazekile
Ukulawulwa okuqinile kweleveli kashukela nokushintshwa okuhambisanayo kwimithamo ephethwe kuyadingeka.
Ukweqisa kwe-Insulin Detemir
Awekho ama-doses achazwe kahle angaholela ku-overdose yesidakamizwa. Uma ivolumu elilimazayo lidlula kakhulu umthamo ngamunye odingekayo, izimpawu ze-hypoglycemic zingavela kancane kancane. Izimpawu zokukhathazeka:
- blanching ye-integument;
- umjuluko obandayo;
- ikhanda
- indlala
- ubuthakathaka, ukukhathala, ukozela;
- ukuphefumula kwenhliziyo;
- ukukhathazeka, ukuphazamiseka;
- izibuko
- izinto ezingahambi kahle.
Ukwehla okuncane kwenkomba ye-glycemic kuqedwa ukusetshenziswa kweglucose, ushukela, njll.
Ukwehla okuncane kwenkomba ye-glycemic kuqedwa ukusetshenziswa kwe-glucose, ushukela, ukudla okune-carbohydrate noma iziphuzo umuntu onesifo sikashukela okufanele abe nazo ngaso sonke isikhathi (amakhukhi, amaswidi, ushukela ocolisisiwe, njll.). Kwi-hypoglycemia ebukhali, isiguli esingazi lutho sifakwa umsipha noma ngaphansi kwe-glucagon yesikhumba noma ngaphakathi kwe-glucose / dextrose. Uma isiguli singavuki imizuzu engu-15 ngemuva komjovo we-glucagon, sidinga ukwethulwa kwekhambi le-glucose.
Ukuxhumana nezinye izidakamizwa
Ukuqanjwa ngeke kuhlanganiswe nolunye uketshezi lwemithi kanye nezixazululo zokufakwa. Amasela nama-sulfite abangela ukubhujiswa kwesakhiwo se-ejenti okukhulunywa ngaso.
Amandla omuthi akhuphuka ngokusetshenziswa okufanayo:
- Clofibrate;
- I-Fenfluramine;
- I-Pyridoxine;
- Bromocriptine;
- ICyclophosphamide;
- Mebendazole;
- I-Ketoconazole;
- Theophylline;
- umuthi womlomo we-antidiabetesic;
- Ama-inhibitors e-ACE;
- antidepressants zeqembu le-IMOA;
- ama-beta-blockers angakhethi;
- i-carbonic anhydrase shughuli inhibitors;
- amalungiselelo e-lithium;
- ama-sulfonamides;
- okususwayo kwe-salicylic acid;
- ama-tetracyclines;
- ama-anabolics.
Kuhlanganiswe neHeparin, Somatotropin, Danazole, Phenytoin, Clonidine, Morphine, corticosteroids, mahomoni we-thyroid, ama-sympathomimetics, ama-calcium antagonists, ama-thiazide diuretics, ama-TCAs, izindlela zokuvimbela inzalo ngomlomo, i-nicotine, ukusebenza kwe-insulin kuncishisiwe.
Kunconywa ukwenqaba ukuphuza utshwala.
Ngaphansi kwethonya leLanreotide ne-Octreotide, ukusebenza kahle kwezidakamizwa kungancipha futhi kukhule. Ukusetshenziswa kwe-beta-blockers kuholela ekubushelelekeni kwezimpawu ze-hypoglycemia futhi kuvimbela ukubuyiselwa kwamazinga kashukela.
Ukuhambisana notshwala
Kunconywa ukwenqaba ukuphuza utshwala. Isenzo sotshwala be-ethyl kunzima ukusibikezela, ngoba siyakwazi ukuqinisa futhi senze buthaka imiphumela ye-hypoglycemic yomuthi.
Ama-Analog
Ama-analogues aphelele weDetemir-insulin yiLevemir FlexPen nePenfill. Ngemuva kokubonisana nodokotela, ezinye izinkomba (i-glargine, i-Insulin-isophan, njll.) Zingasetshenziswa njengendawo yalowo muthi.
Imibandela yekhefu lekhemisi
Ukutholakala kwemithi kukhawulelwe.
Ngingakwazi ukuthenga ngaphandle kadokotela
Uyakhishwa umuthi onikezwa umuthi.
Intengo
Izindleko zesisombululo somjovo iLevemir Penfill - kusuka kuma-ruble angama-2154. kuma-cartridge ama-5.
Izimo zokugcina zomuthi
I-insulin igcinwa emaphaketheni emazingeni okushisa we- + 2 ... + 8 ° C, kugwenywa iqhwa. Ipeni lesirinji elisetshenzisiwe kanye nomuthi livikelekile esenzweni sokushisa ngokweqile (izinga lokushisa lifinyelela ku + 30 ° C) nokukhanya.
Isikhathi sokuphelelwa yisikhathi
Umuthi ungagcinwa izinyanga ezingama-30 kusukela ngosuku lokukhiqizwa kwawo. Impilo yeshelufu yesisombululo esetshenzisiwe kungamaviki ama-4.
Umkhiqizi
Lesi sidakamizwa senziwa yinkampani yemithi yaseDenmark uNovo Nordisk.
Ukubuyekezwa
UNikolay, oneminyaka engama-52, uNizhny Novgorod
Sekuphele unyaka wesithathu ngisebenzisa le insulin. Yehlisa ngempumelelo ushukela, isebenza isikhathi eside futhi ingcono kunemijovo yangaphambilini.
UGalina, oneminyaka engama-31 ubudala, e-Ekaterinburg
Lapho ukudla kungasizanga, kwadingeka ngibhekane nesifo sikashukela sokukhulelwa ngesikhathi sokukhulelwa ngomuthi. Umuthi ubekezelelwa kahle, imijovo, uma yenziwe kahle, ayinabuhlungu.
