UKUBALWA KOMTHAMO WE-INSULIN: IMIGOMO NEMIPHUMELA - IZINDLELA NEZINDLELA ZOKWELASHWA

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Isisekelo irejimeni le-insulin

Ngohlobo lwe-basal-bolus regimen lokulawulwa kwe-insulin (imininingwane engaphezulu kwerejimeni ekhona ingatholakala kulendatshana), uhhafu womthamo ophelele wansuku zonke ophelele uwela kwi-insulin esebenza isikhathi eside, nengxenye ngamafuphi. Izingxenye ezimbili kwezintathu ze-insulin isikhathi eside ziphathwa ekuseni nantambama, ezinye ziphumule kusihlwa.

Umthamo we-insulin esebenza ngokubambelela okufushane kuya ngenani nokwakheka kokudla okuthathiwe.

Isibonelo sesikimu sokulawulwa kwansuku zonke kwe-insulin (amayunithi):

I-insulin esebenza ngokushesha - ekuseni (7), ntambama (10), kusihlwa (7);
I-insulin ephakathi - ekuseni (10), kusihlwa (6);
I-insulin esebenza isikhathi eside kusihlwa (16).

Imijovo kufanele iphathwe ngaphambi kokudla. Uma izinga likashukela egazini lenyuka kakade ngaphambi kokudla, khona-ke isilinganiso se-insulin esisebenza ngokushesha kufanele sonyuswe ngenani le-UNITS:

Nge-glucose 11 - 12 mmol / l nge-2;
Nge-glucose 13 - 15 mmol / l ngo-4;
Nge-glucose 16 - 18 mmol / l ngo-6;
Nge-glucose ephakeme kune-18 mmol / l ngo-12.

Izincomo ezingenhla zihambisana nedatha yezibalo esezingeni eliphansi, ngakho-ke, esimweni ngasinye, kunconywa ukunquma umthamo wakho owengeziwe we-insulin, ovimba ukwanda koshukela wegazi.

Isisekelo - irekhodi le-bolus yokuphathwa kwe-insulin libonisa ngokulingana nokufana kwemijovo.

Ukudakwa kwe-insulin ngokweqile kwesilinganiso esibekiwe kungaholela ekwehlekeni ushukela okuthe xaxa, ngokungenisa okungaphansi kwenani elibekiwe lomuthi kungadala inqubo ephambene. Ukusetshenziswa kwesisekelo - uhlelo lwe-bolus kudinga ukubambelela ngokuqinile esimisweni esithile somsebenzi womzimba, ukudla nokudla.

Isifo sikashukela kufanele sisebenzise ama-pancreas ngezandla saso nesirinji, esesimweni esijwayelekile, kuya ngesibalo nokudla kokudla okudliwayo kanye nezinga lomsebenzi womzimba, sikhiphe i-insulin impela njengoba kwakudingeka ukwehlisa ushukela wegazi. Ngo-gland onesifo, umuntu uqobo kufanele alawule le nqubo, acubungule ngenani inani le-insulin. Inani elilinganiselwe lemithi libalwa ngamandla - ngokulinganisa amazinga kashukela ngaphambi nangemva kokudla. Ngaphezu kwalokho, kukhona amatafula akhombisa amanani amayunithi wesinkwa kanye nomthamo we-insulin odingekayo lapho kudliwa lo mkhiqizo.

Isisekelo sesisekelo - uhlelo lwe-bolus:

Ubukhulu bezokwelapha - imijovo ye-insulin ikhishwa izikhathi ezi-4 kuye kwezi-5 ngosuku;
Ukufakwa kwenziwa usuku lonke, okungahambisani nendlela yokuphila ejwayelekile (ukutadisha, ukusebenza, ukuhamba ngezithuthi zomphakathi), ngaso sonke isikhathi kufanele ube nesirinji nepeni;
Kunamathuba aphezulu okukhuphuka okubukhali kweshukela okuhambisana nokudla okunganele noma imithamo elawulwa ngokweqile ye-insulin.

Ushukela wegazi

Nganoma yiluphi uhlobo lwe-insulin yokwelapha, kudingeka wazi amanani kashukela wegazi ajwayelekile.

Izinga loshukela lomuntu onempilo (isimo A):

Isimo a	mmol / l
Esiswini esingenalutho	3,3 - 5,5
Ngemuva kwamahora amabili udlile	4,4 - 7,8
Ebusuku (2 - 4 amahora)	3,9 - 5,5

Izinga loshukela kwabanesifo sikashukela (isimo B):

Isimo b	Ngaphansi kweminyaka engama-60	Ngemuva kweminyaka engama-60
Isimo b	mmol / l
Esiswini esingenalutho	3,9 - 6,7	kufika ku-8.0
Ngemuva kwamahora amabili udlile	4,4 - 7,8	kufika ku-10,0
Ebusuku (2 - 4 amahora)	3,9 - 6,7	kufika ku-10,0

Iziguli ezinesifo sikashukela i-mellitus kufanele zinamathele ezinkombeni zamazinga kashukela abalingiswa abantu abanempilo, ngoba izinga eliphakeme le-glucose eliphakeme lesifo sikashukela libangela ukuthuthukiswa kwezifo ezingamahlalakhona (ukulimala kwemithambo yezinso, imilenze, amehlo).

Ngo-mellitus wesifo sikashukela otholakala ebuntwaneni noma esemncane, ngokungahambisani nezinga le-glucose ebekiwe lomuntu ophilile, kunamathuba aphezulu okuthola isifo esingamahlalakhona kungakapheli iminyaka engama-20 kuye kwengama-30.
Abantu abanesifo sikashukela ngemuva kweminyaka engu-50 yobudala bangaba nezinga likashukela eliphakeme, ngoba izifo ezingamahlalakhona mhlawumbe azinaso isikhathi sokukhula noma ziyohambisana nokufa komuntu okwemvelo. Abantu abadala abanesifo sikashukela kufanele banamathele ezingeni le-glucose le-9 - 10 mmol / L. Amazinga kashukela isikhathi eside esedlula i-10 mmol / L aholela ekukhuleni okungazelelwe kwezifo ezingamahlalakhona.

Izinga likashukela kusihlwa kufanele libe ngu-7 - 8 mmol / l, njengoba noshukela ophansi kukhona amathuba aphezulu we-hypoglycemia yasebusuku

I-Hypoglycemia imbi ngoba ephusheni umuntu akakwazi ukulawula isimo sakhe. Ukulahlekelwa ukwazi emaphusheni, umuntu onesifo sikashukela ungena ekhefini uma kungenzeki. Izihlobo zesifo sikashukela zidinga ukwazi ukuthi izimpawu eziphambili ze-hypoglycemia ukulala okungapheli nokujuluka ngokweqile. Lapho kuvela izimpawu ezinjalo, kufanele uvuse isiguli ngokushesha bese umnikeza itiye noshukela.

Umthamo wakusihlwa we-insulin. Isikhathi sokufaka

Ezigulini ezingasebenzisi i-basic - regimen regimen of management insulin, it is not Kunconywa ukuthi unikeze umjovo ngemuva kuka-10 pm, ngoba isidlo esilandela amahora ayi-11 sizoholela ekwandeni kokusebenza kwe-insulin ende ngehora lesibili, lapho onesifo sikashukela eyolala futhi engeke akwazi ukulawula isimo sakhe . Kungcono uma inani eliphakeme lomsebenzi we-insulin livela ngaphambi kwamahora ayi-12 kusihlwa (umjovo kufanele wenziwe ngehora lesi-9) kanti onesifo sikashukela usesimweni esingalali.
Ezigulini ezenza isisekelo sokwelashwa kwe-bolus, isikhathi sokudla kwakusihlwa asidlali indima ekhethekile, ngoba kungakhathalekile isikhathi sokudla, ukwelashwa kufaka phakathi ukukhethwa komthamo onjalo we-insulin ongeke ubangele ukwehla ebusuku kwenqanaba likashukela futhi kuzohambisana neglue evamile ekuseni esiswini esingenalutho.

Uma i-hypoglycemia yasebusuku yenzeka, izinga likashukela ekuseni esiswini olungenalutho lizokwandiswa kanye nokwazisa komthamo owanele we-insulin kusihlwa.

Izinga le-glucose lapho umthamo uphansi kakhulu ukwehlisa ushukela:

Isikhathi (amahora)	Izinga le-glucose, mol / l
20.00 - 22.00	16
24.00	10
2.00	12
8.00	13

Yenza umthamo uphakame kakhulu kokwehlisa ushukela:

Isikhathi (amahora)	Izinga le-glucose, mol / l
20.00 - 22.00	16
24.00	10
2.00	3
8.00	4

Ukwanda koshukela wegazi ngemuva kwe-hypoglycemia kungenxa yokuthi umzimba ukhipha ushukela ezindaweni ezigcinwe isibindi, ngaleyo ndlela uzisindise ekwehleni okubukhali kwe-glucose. Umkhawulo lapho i-hypoglycemia isetha kuwo uhlukile kubantu abanesifo sikashukela abahlukahlukene, abanye bane-3-4 mmol / l, abanye bane-6-7 mmol / l. Konke kumuntu nomuntu.

Izimbangela Zoshukela Omkhulu

Amazinga kashukela aphezulu aphezulu kakhulu kunokwejwayelekile angahlanganiswa nomkhuhlane ojwayelekile, inqubo yokuvuvukala eyenzeka emzimbeni ngemuva kokudla ukudla okusindayo. Kunezindlela ezimbili zokunciphisa:

Umjovo owengeziwe we-insulin;
Umsebenzi womzimba.

Umthamo owengeziwe we-insulin ubalwa ifomula:

Dose_insul. = 18 (SahN-SahK) / (1500 / Dose_usuku) = (SahN-SahK) / (83.5 / Dose_usuku),

lapho iCaxH inoshukela ngaphambi kokudla;

Ushukela - izinga loshukela ngemuva kokudla;

Dose_usuku - umthamo ophelele we-insulin wesiguli nsuku zonke.

Isibonelo, ukubala umthamo owengeziwe we-insulin onomuthi ophelele nsuku zonke wama-32 PIERES, izinga likashukela ngaphambi kokudla - 14 mmol / L kanye nesidingo sokunciphisa amazinga kashukela ngemuva kokudla kuya ku-8 mmol / L (SahK), sithola:

Dose_insul= (14-8)/(83,5/32) = 2,

lokhu kusho ukuthi kumthamo we-insulin, obalwe enanini lokudla, udinga ukufaka amanye amayunithi ama-2. Uma inkomba ephelele yemikhiqizo eyenzelwe ukudla kwasemini ingama-4 amayunithi wesinkwa, khona-ke amayunithi ayisishiyagalombili e-insulin esebenza ngokufushane ahambelana nayo. Kepha ngezinga likashukela eliphakeme, ngaphambi kokudla sekuvele sekuyi-14 mmol / l, kuyadingeka ukufaka i-2 PIECES eyengeziwe ye-insulin amayunithi ayi-8. Ngokuvumelana nalokho, kunikezwe umjovo wamayunithi ayi-10.

Indlela yesibili yokwehlisa ushukela yenziwa ngamanani kashukela we-12 - 15 mmol / l futhi iphakamisa ukungabikho kwe-contraindication yezemidlalo kwisifo sikashukela. Ushukela ngaphezulu kwe-15 mmol / l, kufanele kukhishwe umthamo owengeziwe we-insulin "omfishane".

Esinye isizathu sezinga likashukela eliphakeme kungenxa yesigqi semvelo somzimba womuntu.

Ushukela ukhuphuka ekuseni, noma ngabe kunomthamo owanele we-insulin olawulwa ebusuku, ukuntuleka kwe-hypoglycemia yango-nocturnal, ukubambelela okufanele ekudleni. I-Syndrome yokukhuphuka ushukela, obizwa ngokuthi yi- "ekuseni dawn" syndrome, ihlotshaniswa nesivinini esikhulu kanye nokuqina kokukhiqizwa kokusa kwe-glucagon, i-adrenaline, ne-cortisone.

Uma kumuntu ophilile lena inqubo evamile eyandulela ukuqala kosuku, kwisifo sikashukela, ukwanda kushukela kusongela nge-hyperglycemia. Izimpawu zokwanda ushukela wasekuseni yinto eyindida futhi engenakuphikwa. Konke okungenziwa ukwenza amazinga ashukela ajwayelekile ukwethula ngo-5 - 6 ama-oveni ekuseni umthamo owengeziwe we-insulin "emfishane" ngenani lama-2 - 6 amayunithi.

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