Ukubalwa komthamo we-insulin ngaphambi kokudla

Kunconywa ukuthi uqale ufunde i-athikili “Ultrashort Insulin Humalog, NovoRapid ne-Apidra. I-insulin emfishane yabantu. " Kuyo uzofunda ukuthi yiziphi izinhlobo ze-insashort kanye nezinqamulelayo ze-insulin, ukuthi zihluke kanjani phakathi kwazo nokuthi yimaphi amacala enzelwe wona.

Ngosizo lwethu, uzothola ukuthi ungawbala kanjani umthamo we-insulin ngokuya ngokudla kwesiguli okunesifo sikashukela nezinkomba ze-glucometer. Qiniseka ukuthi ayikho imfihlo. Izibalo zezibalo zisezingeni le-arithmetic esikoleni samabanga aphansi. Uma ungeyena neze umhlobo onezinombolo, kuzodingeka ukuthi ufake umjovo kuphela olinganiselwe udokotela azowunikeza. Kepha indlela enjalo elula ayivimbi ukuqala kwezinkinga zesifo sikashukela.

Ukulandelana kwezenzo:

1. Thenga isikali ekhishini futhi ufunde ukuthi ungasisebenzisa kanjani. Thola ukuthi mangaki amagremu ama-carbohydrate, amaprotheni, namafutha owadlayo isikhathi ngasinye sokudla kwasekuseni, kwasemini nangedina.
2. Kala ushukela izikhathi eziyi-10-12 ngosuku ngosuku lwezinsuku ezi-3-7. Rekhoda imitha yakho kashukela kanye nezimo ezihlobene. Ngale ndlela, bonisa ngaphambi kokudla okudingayo ukuthola imijovo ye-insulin esheshayo, futhi ngaphambi kwalokho ongase ungayidingi.
3. Funda imithetho yokugcina i-insulin nokuthi yini okufanele uyenze uma kungazelelwe i-insulin ingasebenzi.
4. Funda inqubo yokulimala kwe-insulin engeyona buhlungu. Funda ukuthatha imijovo ye-insulin ngokuphelele ngaphandle kobuhlungu!
5. Funda ukujova i-insulin ebusuku futhi, uma kunesidingo, ekuseni. Khetha umthamo ofanele ukuze ushukela wakho wokuzila usujwayelekile. Bheka i-athikili kuLantus, Levemir neProtafan. Lokhu kumele kwenziwe ngaphambi kokubhekana nezinhlobo ezisheshayo ze-insulin.
6. Funda ukuthi ungahluza kanjani i-insulin. Uma ulandela ukudla okune-carbohydrate ephansi, kuzodingeka ukuthi ukwenze lokhu.
7. Bala ukuqala imithamo ye-insulin emfushane noma ye-ultrashort ngaphambi kokudla. Ungakwenza kanjani lokhu kuchazwe ngezansi. Ukuqala imithamo ngokusobala izokwehla ngokungaphansi uma udinga ukufaka umshuwalense ngokumelene ne-hypoglycemia.
8. Funda i-athikili "Hypoglycemia: Ukuvimbela, Izimpawu nokwelashwa". Thenga amaphilisi eglucose ekhemisi ukumisa i-hypoglycemia engenzeka. Zigcine zilusizo ngaso sonke isikhathi.
9. Faka imithamo yokuqalisa i-insulin. Qhubeka nokukala ushukela njalo bese ugcine idayari.
10. Phakamisa noma wehlise imithamo yakho ye-insulin ngaphambi kokudla, ngoshukela wakho wegazi. Qinisekisa ukuthi ushukela ungama-4.6 ± 0,6 mmol / L ngaphambi nangemva kokudla, uzinzile. Ngasiphi isikhathi, kufaka phakathi ebusuku, akufanele ibe ngaphansi kuka-3.5-3.8 mmol / l.
11. Mangaza ukuthi adinga kangakanani ama-insulin doses ngaphambi kokudla uma ulandela ukudla okuphansi kwe-carb :).
12. Thola ukuthi imizuzu emingaki ngaphambi kokudla udinga ukujova i-insulin. Ukuze wenze lokhu, yenza ukuhlolwa okuchazwe ku-athikili.
13. Thola ngqo ukuthi iyunithi elilodwa le-insulin emfushane ne-ultrashort yehlisa kanjani ushukela wakho. Ukuze wenze lokhu, yenza ukuhlolwa okuchazwe ku-athikili.
14. Funda ukuthi ungaluqeda kanjani ushukela ophezulu ngemijovo ye-insulin ukulenza libe lijwayelekile, kepha ngaphandle kwe-hypoglycemia. Landela le ndlela lapho idingeka.
15. Funda ukuthi ungabuthola kanjani ushukela wasekuseni osheshayo. Landela izincomo. Qinisekisa ukuthi ushukela wakho ekuseni awuphakeme kune-5.2 mmol / L, ngaphandle kwe-hypoglycemia ebusuku.
16. Ngokusekelwe kukalwa ushukela, hlola i-insulin sensitivity factor yakho kanye ne-carbohydrate ratio ngokwahlukana ngokudla kwasekuseni, kwasemini kanye nakusihlwa.
17. Hlola izinto zesibili ezithinta ushukela wegazi, ngaphezu komsoco, imijovo ye-insulin, nemithi yesifo sikashukela. Funda ukulungisa imithamo yakho ye-insulin ngalezi zinto.

Izazi eziningi ze-endocrinologists zisakholelwa ukuthi ukuguqula ushukela ezigulini ezinesifo sikashukela sohlobo 1 kunzima kakhulu, akunamsebenzi, noma kuyingozi. Uma umuntu onesifo sikashukela ekwazi ukubala imithamo ye-insulin ngokuya ngamanani akhe wokudla noshukela, udokotela uzomphatha ngenhlonipho futhi anikeze usizo olufanele kunazo zonke. Iziguli ezinjalo aziba nezinkinga zesifo sikashukela, ngokungafani nenqwaba yeziguli ezivilaphayo ukuphathwa ngendlela ejwayelekile.

Ukulawulwa kwesifo sikashukela nge-insulin emfushane noma ye-Ultra-iDemo kusiza ukwehlisa ushukela ngokushesha kube ngokujwayelekile. Lokhu kuvimbela ukufa kwamaseli we-beta osaphila kumanyikwe akho. Amaseli we-beta amaningi agcinwa emzimbeni, uhlobo olulula lwe-1 noma uhlobo 2 sikashukela. Uma unenhlanhla futhi amanye amaseli akho e-beta esasebenza, zinakekele. Ukuze wenze lokhu, landela ukudla okunama-carbohydrate aphansi bese ufaka i-insulin ukunciphisa umthwalo kumanyikwe.

Imigomo ehlobene nokwelashwa kwe-insulin nezincazelo zayo

Chaza amagama esidinga ukuchaza ukwelashwa kwesifo sikashukela nge-insulin.

Isisekelo - i-insulin enwetshiwe, okuthi ngemuva kokuba umjovo uhlale isikhathi eside (amahora angama-8-24). Le nguLantus, Levemir noma iProtafan. Kwakha ukunqunyelwa kwangemuva kwe-insulin egazini. Imijovo eyisisekelo yenzelwe ukugcina ushukela ojwayelekile esiswini esingenalutho. Ayilungele ukucima ushukela ophezulu noma ukudla okugayayo.

I-bolus umjovo we-insulin esheshayo (emfishane noma ye-ultrashort) ngaphambi kokudla ukuze kudle ukudla okudliwayo futhi kuvikele noshukela ukuthi ungakhuphuki ngemuva kokudla. Futhi, i-bolus umjovo we-insulin esheshayo ezimweni lapho ushukela ukhuphuke khona futhi udinga ukulungiswa.

I-bolus yokudla umthamo we-insulin esheshayo, edingekayo ukumunca ukudla. Akukhathaleli lesi simo lapho isiguli sikashukela sesivele sikhuphule ushukela ngaphambi kokudla.

Ukulungiswa kwe-bolus - umthamo we-insulin esheshayo, odingekayo ukwehlisa ushukela wegazi ophakeme ube ojwayelekile.

Umthamo we-insulin emfushane noma ye-ultrashort ngaphambi kokudla iyisamba semigqumo yokudla nokulungisa. Uma ushukela ngaphambi kokudla kuyinto evamile, khona-ke i-bolus yokulungisa ingu-zero. Uma ushukela wagxuma ngokuzumayo, lapho-ke kufanele ufake umjovo wokulungiswa okwengeziwe, ngaphandle kokulinda isidlo esilandelayo. Ungafaka futhi imithamo emincane ye-insulin esheshayo prophylactically, ngokwesibonelo, ngaphambi kokukhuluma okucindezelayo komphakathi, okuzoqhakambisa ushukela nakanjani.

I-insulin esheshayo ingaba yifushane yabantu (i-Actrapid NM, i-Humulin Regular, i-Insuman Rapid GT, i-Biosulin R nabanye), kanye ne-analoges yakamuva ye-Ultra-iDemo (Humalog, Apidra, NovoRapid). Kuyini futhi kuhluka kanjani, funda lapha. Uma ulandela ukudla okune-carbohydrate ephansi ngaphambi kokudla, kungcono ukujova i-insulin efushane yomuntu. Izinhlobo ze-Ultrashort zinhle ukusebenzisa uma udinga ukuletha ushukela ophezulu ngokujwayelekile.

I-Basis-bolus insulin therapy - ukwelashwa kwesifo sikashukela ngemijovo ye-insulin eyengeziwe ebusuku nasekuseni, kanye nokujova kwe-insulin ngokushesha ngaphambi kokudla ngakunye. Le ndlela inzima kakhulu, kepha inikezela ngokulawula ushukela futhi ivimbela ukuthuthukiswa kwezinkinga zikashukela. Ukwelashwa kwe-insulin-Basus-bolus insulin kubandakanya imijovo engama-5-6 ngosuku. Kuyadingeka kuzo zonke iziguli ezinesifo sikashukela sohlobo olubi. Kodwa-ke, uma isiguli sinesifo sikashukela sohlobo lwe-2 noma sithayipha isifo sikashukela esingu-1 ngendlela emnene (i-LADA, IMODY), khona-ke mhlawumbe uzokwazi ukukwenza ngemijovo embalwa ye-insulin.

I-insulin sensitivity factor - malini i-UNIT ye-insulin yehlisa ushukela wegazi.

I-carbohydrate coeffnty - mangakhi amagremu ama-carbohydrate adliwayo ahlanganisa iyunithi eyi-1 ye-insulin. Uma ulandela ukudla okune-carbohydrate ephansi ukulawula ushukela, "isilinganiso samaprotheni" sibalulekile nakuwe, yize lo mqondo ungasetshenziswa ngokusemthethweni.

I-insulin sensitivity factor kanye ne-carbohydrate ratio ihlukile kuzo zonke iziguli ezinoshukela. Amanani atholakala ezinkomba awahambisani nezinto zangempela. Zenzelwe kuphela ukubala imithamo yokuqala ye-insulin, ngokusobala ayinembile. I-insulin sensitivity factor kanye ne-carbohydrate coeffnty isungulwa ngokuhlola imithamo yokudla kanye ne-insulin. Ziyahlukahluka ngezinhlobo ezahlukene ze-insulin futhi ngisho nangezikhathi ezahlukahlukene zosuku.

Ngabe udinga imijovo ye-insulin ngaphambi kokudla

Ungabona kanjani ukuthi udinga imijovo ye-insulin esheshayo ngaphambi kokudla? Lokhu kunganqunywa kuphela ngokuziqapha ngokucophelela ushukela wegazi okungenani izinsuku ezintathu. Kungcono ukunikela hhayi izinsuku ezingama-3, kepha isonto lonke ukuze ubhekwe futhi ulungiswe. Uma unesifo sikashukela sohlobo olubi, lapho-ke udinga imijovo ye-insulin eyengeziwe ebusuku nasekuseni, kanye nama-bolume ngaphambi kokudla ngakunye. Kepha uma isiguli sinesifo sikashukela sohlobo 2 noma sithayipha isifo sikashukela esingu-1 ngendlela emnene (i-LADA, IMODY), khona-ke mhlawumbe imijovo engaphansi iyadingeka.

Isibonelo, ngokuya ngemiphumela yokubonwayo, kungavela ukuthi uneshukela elijwayelekile ngaso sonke isikhathi phakathi nosuku, ngaphandle kwesikhashana sokudla sakusihlwa. Ngakho-ke, udinga imijovo ye-insulin emfushane ngaphambi nje kokudla. Esikhundleni sokudla kwakusihlwa, ibhulakufesi noma isidlo sasemini kungaba ukudla okuyinkinga. Isiguli ngasinye esinesifo sikashukela sinesimo saso. Ngakho-ke, ukunquma izinhlobo ezisezingeni elifanele ze-insulin zokwelapha kuwo wonke umuntu kuyisibopho sodokotela okungenani ngokunganaki. Kepha uma isiguli sivila kakhulu ukulawula ushukela futhi siqophe imiphumela, akukho okunye okusele.

Funda futhi ukuthi udinga kangaki ngosuku ukukala ushukela wegazi.

Kuyiqiniso, akunakwenzeka ukuthi ithemba lokujova i-insulin kaningi phakathi nosuku lizokujabulisa. Kepha uma ulandela ekudleni okuphansi kwe-carbohydrate, kungavela ukuthi udinga imijovo ye-insulin ngaphambi kokudla okuthile, kodwa hhayi phambi kwabanye. Isibonelo, kwezinye iziguli ezinesifo sikashukela sohlobo 2, kungenzeka ukuthi kulondolozwe ushukela wegazi ojwayelekile ngokujova i-insulin emfushane ngaphambi kokudla kwasekuseni nangesikhathi sakusihlwa, futhi ngaphambi kokudla kwakusihlwa badinga kuphela ukuthatha amaphilisi weSiofor.

Sikukhumbuza ukuthi ekuseni i-insulin isebenza buthakathaka kunanoma yisiphi esinye isikhathi sosuku, ngenxa yomthelela wokusa kokusa. Lokhu kusebenza kwi-insulin yabo uqobo, ekhiqizwa ama-pancreas, kanye naleyo isiguli sikashukela esithola ngayo ngemijovo. Ngalesi sizathu, uma udinga imijovo ye-insulin esheshayo ngaphambi kokudla nhlobo, kungenzeka ukuthi azodingeka ngaphambi kokudla kwasekuseni. Ngesizathu esifanayo, ekudleni okune-carbohydrate ephansi, imvelo ye-carbohydrate yesidlo sasekuseni iphansi izikhathi ezimbili kunasemini nangesikhathi sokudla kwakusihlwa. Bheka futhi "Yini into yokusa yokusa nokuthi ungayilawula kanjani"

Ungabala kanjani imithamo ye-insulin ngaphambi kokudla

Akekho udokotela noma ogulayo onesifo sikashukela onganquma umthamo ofanele we-insulin ngaphambi kokudla kusukela ekuqaleni. Ukuze sinciphise ubungozi be-hypoglycemia, sibukela phansi imithamo ekuqaleni, bese siyandisa kancane kancane. Kulokhu, sivame ukukala ushukela wegazi nge-glucometer. Ezinsukwini ezimbalwa unganquma umthamo wakho ofanele. Umgomo ukugcina ushukela uvamile ngokujwayelekile, njengabantu abaphilile. Ungu-4.6 ± 0,6 mmol / L ngaphambi nangemva kokudla. Futhi, nganoma yisiphi isikhathi, kufanele okungenani ibe ngu-3.5-3.8 mmol / L.

Imithamo ye-insulin esheshayo ngaphambi kokudla incike ekutheni yikuphi ukudla okudlayo nokuthi kungakanani. Qopha ukuthi kungakanani futhi kukuphi ukudla okudlayo kugramu eseduze. Lokhu kusiza izikali zasekhishini. Uma ulandela ukudla okune-carbohydrate ephansi ukulawula ushukela, kuyalulekwa ukusebenzisa i-insulin emfushane yomuntu ngaphambi kokudla. Lezi yi-Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R nabanye. Kuyalule futhi ukuthi ube neHumalog bese uyinquma lapho udinga ukwehlisa ushukela ngokuphuthumayo. I-Apidra neNovoRapid kancane kancane kuneHumalog. Kodwa-ke, i-insulin efushane kakhulu ayilungelanga kakhulu ukufakwa kokudla okune-carbohydrate ephansi kakhulu, ngoba isebenza ngokushesha okukhulu.

Khumbula ukuthi umthamo we-insulin ngaphambi kokudla uyisamba se-bolus yokudla kanye ne-bolus yokulungisa. I-bolus yokudla - inani le-insulin elidingakalayo ukumboza ukudla ohlela ukukudla. Uma umuntu onesifo sikashukela elandela ukudla “okunokulinganisela,” kubhekwa ama-carbohydrate kuphela. Uma udla ukudla okune-carbohydrate ephansi, khona-ke ama-carbohydrate, kanye namaprotheni, ayabhekwa. Isisekelo sokulungiswa kwenani le-insulini elidingakalayo ukwehlisa ushukela wesiguli ube ojwayelekile uma iphakanyisiwe ngesikhathi somjovo.

Ungayikhetha kanjani ithamo elifanele lemijovo ye-insulin ngaphambi kokudla:

1. Ukusuka kudatha yesethenjwa (bheka ngezansi), abale umthamo wokuqala we-insulin esheshayo ngaphambi kokudla ngakunye.
2. Faka insulin, bese ulinda imizuzu engama-20-45, ulinganise ushukela ngaphambi kokudla, udle.
3. Ngemuva kokudla, ukukala ushukela wakho nge-glucometer ngemuva kwamahora we-2, 3, 4, kanye ne-5.
4. Uma ushukela uwela ngaphansi kwe-3.5-3.8 mmol / L, yidla amaphilisi ambalwa kashukela ukumisa i-hypoglycemia.
5. Ngezinsuku ezilandelayo, engeza imithamo ye-insulin ngaphambi kokudla (kancane! Ngokucophelela!) Noma yehle. Kuya ngokuthi ushukela ongakanani owagcina ukuwenza ngemuva kokudla.
6. Kuze kube yilapho ushukela uhlala uqinile, phinda izinyathelo eziqala ephuzwini 2. ngasikhathi sinye, ungafaki umthamo wokuqala we-insulin, kepha ulungiswe ngokwamanani kashukela izolo ngemuva kokudla. Ngakho-ke, kancane kancane nquma umthamo wakho ofanele.

Umgomo ukugcina ushukela ngaphambi nangemva kokudla 4.6 6 0,6 mmol / L uzinzile. Lokhu kuyinto enengqondo ngisho noma inesifo sikashukela sohlobo olubi, uma ulandela ukudla okune-carbohydrate encane bese ufaka imithamo ephansi, ebalwe kahle i-insulin. Ngaphezu kwalokho, lokhu kutholakala kalula ngesifo sikashukela sohlobo 2 noma uhlobo olumnene lwesifo sikashukela.

Ngohlobo 1 nesifo sikashukela sohlobo 2, kusetshenziswa izindlela ezihlukene ukubala imithamo yokuqala ye-insulin ngaphambi kokudla. Lezi zindlela zichazwe ngemininingwane engezansi. Ukulungiswa kwemithamo ye-insulin yenziwa ngokuhlukile kwisiguli ngasinye. Gcina amaphilisi we-glucose ekhona uma udinga ukumisa i-hypoglycemia. Funda ukufaka i-insulin ngaphambi kwesikhathi. Kuzodingeka wenze lokhu.

Into yokusa yasekuseni idida ukubalwa kwemithamo ye-insulin ngaphambi kokudla. Ngenxa yesenzo sayo, umjovo we-insulin ngaphambi kokudla kwasekuseni uzobe ungasebenzi cishe ngo-20% kunomjovo ofanayo we-insulin ngaphambi kokudla kwasemini noma isidlo sakusihlwa. Ukuphambuka okuqondile% kwesiguli ngasinye sikashukela kufanele kunqunywe ngokuhlukile ngokuhlolwa, bese umthamo kufanele ukhushulwe ngokufanele ngaphambi kokudla kwasekuseni. Funda kabanzi ngesimo sokusa kokusa nokuthi ungasilawula kanjani.

Manje ake sibheke izibonelo zokuthi imithamo yemithamo ye-insulin esebenza ngokushesha ibalwa kanjani ngaphambi kokudla. Ngaphezu kwazo zonke izibonelo, kucatshangwa ukuthi isiguli sikashukela siyozikhohlisa sifushane, kunokuba sibe yi-ultrashort, i-insulin ngaphambi kokudla. Izinhlobo ze-insulin ezisebenzisa i-insulin zinamandla kakhulu kune-insulin efushane yomuntu. Umthamo weHumalog kufanele ulingane cishe nemithamo eyi-0.4 ye-insulin emfushane, kanti umthamo weNovoRapid noma i-Actrapid kufanele ube cishe yi-⅔ (0.66) imithamo ye-insulin emfushane. Ama-coefficients 0.4 no-0.66 adinga ukucaciswa ngawodwana.

Thayipha isifo sikashukela esingu-1 noma uhlobo 2 lwesifo sikashukela

Ngohlobo olunzima lwesifo sikashukela, udinga ukujova i-insulin ngokushesha ngaphambi kokudla ngakunye, kanye ne-insulin eyengeziwe ebusuku nasekuseni. Kuvela imijovo engama-5-6 ngosuku, kwesinye isikhathi. Ngohlobo 2 lwesifo sikashukela esithuthukile, into efanayo. Ngoba empeleni ingena kuhlobo lwe-1 yesifo sikashukela esincike ku-insulin. Ngaphambi kokubala umthamo we-insulin esheshayo ngaphambi kokudla, udinga ukuhlela ukwelashwa nge-insulin ende. Funda ukuthi ungamjova kanjani kahle uLantus, Levemir noma uProtafan ebusuku nasekuseni.

Ake sixoxe ngokuthi uhlobo 2 sikashukela luhumusha kanjani kulolu hlobo lwesifo sikashukela esinzima ngenxa yempatho engafanele. Iningi leziguli ezinesifo sikashukela sohlobo 2 zilimala kakhulu kunokulashwa okusemthethweni. Ukudla okune-carbohydrate ephansi okwamanje akukaze kube yindlela eyinhloko yokwelapha isifo sikashukela sohlobo 2, ngoba izikhulu zezokwelapha zilwenqaba ngamandla ushintsho. Ngeminyaka yama-1970, baphinde bamelana nokuqalwa kwama-glucometer ... Ngokuhamba kwesikhathi, ukuqonda okuvamile kuzokwenzeka, kepha namuhla isimo ngokwelashwa kwesifo sikashukela sohlobo 2 kudabukisa.

Iziguli zidla ukudla “okunokulinganisela”, okugcwele ama-carbohydrate. Baphinde baphuze namaphilisi ayingozi adonsa ama-pancreas abo. Ngenxa yalokhu, amangqamuzana e-pancreatic beta afa. Ngakho-ke, umzimba uyeka ukukhiqiza i-insulin yayo. Thayipha isifo sikashukela sohlobo 2 sihumushela kuhlobo olubi lwesifo sikashukela. Lokhu kuqashelwa emuva kokuthi lesi sifo sihlala iminyaka eyi-10-15, futhi sonke lesi sikhathi selashwa ngokungalunganga. Isibonakaliso esiyinhloko ukuthi isiguli ngokushesha futhi ngokungenakuphinda sehla isisindo. Amaphilisi ngokuvamile ayeka ukwehlisa ushukela. Indlela yokubala imithamo ye-insulin echazwe lapha ilungele amacala anjalo.

Ngakho-ke, isiguli esinesifo sikashukela sohlobo 1 noma uhlobo 2 sikashukela esinqunyiwe sinqume ukushintshela ohlotsheni olusha ngezindlela zokwelapha ezingasebenzi kahle. Uqala ukudla ukudla okuphansi kwe-carbohydrate. Kodwa-ke, unecala elinzima. Ukudla ngaphandle kwemijovo ye-insulin, noma kwehlisa ushukela, akwanele. Kuyadingeka ukujova i-insulin ukuze izinkinga zikashukela zingakhuli. Hlanganisa imijovo ye-insulin enwetshiwe ebusuku nasekuseni ngemijovo ye-insulin esheshayo ngaphambi kokudla ngakunye.

Ngokunokwenzeka, usuvele uzijolela umthamo we-insulin onqunyiwe, owawunqunywe esibhedlela. Udinga ukushintshela ekubalweni okuguqukayo kwemithamo ngokuya ngokudla kwakho nezinkomba zoshukela. Imininingwane elandelayo ukuthi ungakwenza kanjani lokhu. Qiniseka ukuthi kulula kunokuzwakala. Izibalo ze-Arithmetic zisezingeni lokuqala lesikole. Ukushintsha kokudla "okunokulinganisela" ekudleni okuphansi kwe-carbohydrate, udinga ukunciphisa ngokushesha umthamo we-insulin ngezikhathi ezi-2-7, uma kungenjalo kuzoba ne-hypoglycemia. Iziguli ezinesifo sikashukela esinobunzima zinethuba lokuthi “zigxume” zisuke kumijovo. Kepha iziguli ezinesifo sikashukela sohlobo olu-1 noma isifo sikashukela sohlobo 2 esihambile akufanele sithembele kulokhu.

Odinga ukukwenza:

1. Khetha umthamo ofanele we-insulin enwetshiwe ebusuku nasekuseni. Funda i-athikili mayelana neLantus, Levemir neProtafan ngemininingwane engaphezulu. Kunenqubo yokubala.
2. Thola ukuthi mangaki amagremu ama-carbohydrate kanye namaprotheni ambozwe yi-1 UNIT ye-insulin oyifaka ngaphambi kokudla. Sibala umthamo wokuqala ngokuya ngemininingwane yereferensi (bheka ngezansi), bese siyichaza “empeleni” kuze kuthi ushukela uhlale uzinzile futhi uvamile.
3. Thola ukuthi ushukela wegazi wakho uphansi kangakanani 1 UKUPHAKATHI kwe-insulin esheshayo oyifakayo. Lokhu kwenziwa ngokwenza isivivinyo, esichazwe ngezansi.
4. Thola ukuthi imizuzu emingaki ngaphambi kokudla ufakwe kahle nge-insulin. Okujwayelekile: i-insulin emfushane ngemizuzu engama-45, i-Apidra neNovoRapid ngemizuzu engama-25, iHumalog ngemizuzu engu-15. Kepha kungcono ukuthola ngamunye, ngokuhlolwa okukhanyayo, okubuye kuchazwe ngezansi.

Ubunzima ukuthi kufanele ukhethe ngesikhathi esisodwa umthamo we-insulin ende futhi ushesha. Lapho kuphakama izinkinga ngoshukela wegazi, kunzima ukuthola ukuthi zibangelwa yini. Umthamo ongalungile we-insulin enwetshiwe? Kufakwe umthamo ongafanele we-insulin ngaphambi kokudla? Noma ingabe imithamo efanelekile ye-insulin, kepha idle okungaphezulu / ngaphansi kwalokho okuhleliwe?

Ake sithi namuhla unoshukela omningi noma ugxuma. Kulokhu, kusasa ushintsha enye yezinto ezisemqoka ezibhalwe ngenhla. Ngasikhathi sinye, gcina ezinye izinto ezimbili ngokufana nezolo. Bona ukuthi ushukela ushintshe kanjani bese ufinyelela iziphetho. Ungaqala umbuso ozinzile ngokuhlola okuningi ngemithamo ye-insulin nokunempilo. Ngokuvamile kuthatha izinsuku ezingama-3-14. Ngemuva kwalokhu, udinga ukubhekana nezinto zesibili - ukusebenza ngokomzimba, izifo, izimo ezicindezelayo, izinkathi zonyaka ezishintshayo, njll. Funda kabanzi ngokuningiliziwe "Okuthinta ushukela wegazi: izinto zesibili".

Ngokufanelekile, uzosebenzisa i-insulin emfushane ngaphambi kokudla kanye ne-ultrashort eyengeziwe lapho udinga ukucisha ushukela ophezulu ngokushesha. Uma kunjalo, ke kulolo nalunye lwalezi zinhlobo ze-insulin, kufanele ngokuhlukile uthole ukuthi iyunithi elilodwa lehla kanjani ushukela wakho. Empeleni, bambalwa abanesifo sikashukela abazofuna “ukudonsa” ngezinhlobo ezintathu ze-insulin - eyodwa enwetshiwe namabili okushesha. Uma uqinisekisa ukuthi uHumalog, i-Apidra noma iNovoRapid ayisebenzi kahle ngaphambi kokudla, imbangela ushukela bese ushintshela ku-insulin emfushane yomuntu.

Imininingwane ebonakalayo yokubala umthamo wokuqala (izinombolo azilungile!):

• I-insulin emfushane - i-Actrapid NM, i-Humulin Regular, i-Insuman Rapid GT, i-Biosulin R nabanye.
• Zonke izinhlobo ze-insulin ezimfushane cishe zinamandla alinganayo futhi ziqala ukwenza ngesivinini esifanayo.
• I-Ultrashort insulin - uHumalog, uNovoRapid, i-Apidra.
• I-NovoRapid ne-Apidra zinamandla izikhathi ezingama-1.5 kunanoma iyiphi i-insulin emfushane. Umthamo weNovoRapid ne-Apidra kufanele ube yi-0. (0.66) yomthamo olinganayo we-insulin emfushane.
• I-Humalog inamandla izikhathi ezingama-2,5 kunanoma iyiphi i-insulin emfushane. Umthamo weHumalog kufanele ube yimithamo efanayo ne-insulin eyi-0,4.

Ezigulini ezinesifo sikashukela esibuhlungu, i-pancreas yayo engakhiqizi i-insulin, igramu eyi-1 yama-carbohydrate izonyusa ushukela wegazi cishe nge-0.28 mmol / l enesisindo somzimba esingu-63,5 kg.

Esigulini esinesifo sikashukela esinzima esinesisindo esingu-63,5 kg:

• Iyunithi eli-1 le-insulin efushane lizokwehlisa ushukela wegazi cishe ngo-2.2 mmol / L.
• Iyunithi eli-1 le-insulin Apidra noma iNovoRapid izokwehlisa ushukela wegazi cishe ngo-3.3 mmol / L.
• I-1 U ye-insulin Humalog izokwehlisa ushukela wegazi cishe ngo-5.5 mmol / L.

Wazi kanjani ukuthi i-1 unit ye-insulin emfushane izokwehlisa ushukela kumuntu onesisindo somzimba esihlukile? Kuyadingeka ukwenza isilinganiso nokubala.

Isibonelo, esigulini esinesifo sikashukela esinzima esinesisindo somzimba esingama-70 kg, izotholakala ngo-2.01 mmol / L. Kwentsha enesisindo esingu-48 kg, umphumela uzoba ngu-2.2 mmol / L * 64 kg / 48 kg = 2.93 mmol / L. Lapho umuntu eba nesisindo, ithonya le-insulin liba mbi. Ukunaka! Lezi akuzona izinombolo eziqondile, kepha kuyinkomba, ukubala imithamo yokuqala ye-insulin. Zihlanze ngokwakho ngokuzihlola. Ziyahlukahluka ngezikhathi ezihlukile zosuku. Ngaphambi kwesidlo sasekuseni, i-insulin yibuthakathaka kakhulu, ngakho-ke umthamo wayo udinga ukwandiswa.

Siphinde sazi cishe:

• Iyunithi eli-1 le-insulin emfushane limboza cishe ama-8 amagremu ama-carbohydrate.
• Iyunithi eli-1 le-insulin Apidra neNovoRapid ihlanganisa cishe amagremu ayi-12 ama-carbohydrate.
• Iyunithi eli-1 le-insulin Humalog ihlanganisa cishe amagremu ama-20 ama-carbohydrate.
• Iyunithi eli-1 le-insulin emfushane limboza cishe amagremu angama-57 eprotheni edliwayo noma cishe amagremu angama-260 enyama, inhlanzi, izinkukhu, ushizi, amaqanda
• I-1 UNIT ye-insulin Apidra neNovoRapid imboza cishe amagremu ama-87 amaprotheni adliwayo noma cishe amagremu angama-390 enyama, inhlanzi, izinkukhu, ushizi, amaqanda.
• I-1 UNIT ye-insulin Humalog ihlanganisa cishe amagremu ayi-143 eprotheni edliwayo noma cishe amagremu ayi-640 enyama, inhlanzi, izinkukhu, ushizi, amaqanda.

Yonke imininingwane engenhla iyabonakala. Kuhloswe kuphela ukubala umthamo wokuqala, ngokusobala awunembile. Chaza isibalo ngasinye ngokwakho ngokuhlolwa. Izilinganiso zangempela zesiguli ngasinye sikashukela zihlukile. Lungisa umthamo we-insulin ngawodwana, isivivinyo nephutha.

Amanani akhonjiswe ngenhla abhekisa kwiziguli ezinesifo sikashukela sohlobo lokuqala lapho i-pancreas ingakhiqizi i-insulin nhlobo futhi engahlushwa yi-insulin. Uma ukhuluphele, usakhula ngesikhathi sokukhula okusheshayo noma owesifazane okhulelwe, khona-ke isidingo se-insulin sizoba ngaphezulu. Ngakolunye uhlangothi, uma amaseli we-beta we-pancreas akho eqhubeka nokukhiqiza i-insulin, khona-ke umthamo ofanele we-insulin emijoweni ungaphansi kakhulu.

Ukubalwa kwemithamo ye-insulin yohlobo 1 sikashukela: isibonelo

Sizohlaziya icala eliqondile lokuhlela imenyu nokubala umthamo we-insulin. Ake sithi isiguli esinesifo sikashukela esinzima esinesisindo somzimba samaphawu angama-64 kg ngaphambi kokudla i-Actrapid NM - insulin emfushane yomuntu. Isiguli sizodla inani elilandelayo lama-carbohydrate namaprotheni nsuku zonke:

• Ukudla kwasekuseni - amagremu ama-6 ama-carbohydrate nama-86 amagremu amaprotheni;
• Ukudla kwasemini - amagremu ama-12 ama-carbohydrate namagremu ayi-128 amaprotheni;
• Ukudla isidlo sakusihlwa - amagremu ama-12 ama-carbohydrate kanye nama-171 amagremu amaprotheni.

Asazi ukubheka amafutha adliwayo, ngoba empeleni awathinti ushukela wegazi. Yidla amafutha atholakala ekudleni kwamaprotheni ngokuzolile. Khumbula ukuthi inyama, inhlanzi, izinkukhu, amaqanda noshizi kanzima kuqukethe ama-20-25% amaprotheni ahlanzekile. Ukuthola isisindo semikhiqizo yamaprotheni iqhawe lethu elizoyidla, udinga ukuphindaphinda inani lamaprotheni ngo-4 noma 5, ngokwesilinganiso esingu-4,5. Ngeke nakanjani ulambe nokudla okune-carb ephansi kancane :).

Lapho sibala imithamo yokuqala ye-insulin ngokushesha ngaphambi kokudla, sifuna ukuvikela abanesifo sikashukela ku-hypoglycemia. Ngakho-ke, manje singawunaki umphumela wokuntwela kokusa, kanye nokumelana ne-insulin (ukuzwela okuncishisiwe kwamangqamuzana ukuya ku-insulin), okungenzeka uma isiguli siphezulu. Lezi yizici ezimbili ezingasenza ukuthi sikhuphule imithamo ye-insulin ngaphambi kokudla. Kepha ekuqaleni asibanaki.

Ukubala ukuqala kokudla kokudla, sisebenzisa imininingwane yasemuva enikezwe ngenhla. Iyunithi eli-1 le-insulin emfushane cishe ihlanganisa amagremu ama-8 ama-carbohydrate. Futhi, iyunithi eli-1 le-insulin emfushane limboza cishe amagremu angama-57 eprotheni yokudla.

Indawo yokudla kwasekuseni:

• Amagremu ama-6 ama-carbohydrate / 8 amagremu ama-carbohydrate = ¾ I-UNITS ye-insulin;
• Amagremu angama-86 amaprotheni / ama-gramu angama-57 amaprotheni = 1.5 IZINHLOBO ze-insulin.

I-TOTAL ES PIECES + 1.5 PIECES = 2.25 PIECES of insulin.

Indawo yokudla kwasemini:

• Amagremu ayi-12 ama-carbohydrate / 8 amagremu ama-carbohydrate = 1.5 IZINHLOBO ze-insulin;
• Amagremu ayi-128 amaprotheni / ama-gramu angama-57 amaprotheni = amayunithi we-insulin angu-2.25.

I-PULACES EYONKE 1.5 PIERES + 2.25 PIECES = 3.75 PIECES of insulin.

Indawo yokudla isidlo sakusihlwa:

• Amagremu ayi-12 ama-carbohydrate / 8 amagremu ama-carbohydrate = 1.5 IZINHLOBO ze-insulin;
• Amagremu ayi-171 amaprotheni / amagremu ayi-57 amaprotheni = amayunithi ama-3 e-insulin.

I-PULACES engu-1.5 EYONKE I-PIECES + 3 AMA-PIECES = ama-4.5 PIECES we-insulin.

Uma ama-pancreas akho eqhubeka nokukhiqiza inani elithile le-insulin yakhe, khona-ke imithamo enikezwe ngaphezulu izodinga ukwehliswa. Ukuthi amaseli we-pancreatic beta asindile anganqunywa ngokusebenzisa ukuhlolwa kwegazi kwe-C-peptide.

Yini okufanele ngiyenze uma isiguli sizokujova hhayi esifushane, kodwa i-insulin efushane kakhulu ye-insidra, iNovoRapid noma iHumalog ngaphambi kokudla? Siyakhumbula ukuthi imithamo elilinganisiwe ye-Apidra neNovoRapida iyithamo le-insulin emfushane, esayibala. I-Humalog inamandla kakhulu. Umthamo wayo kufanele ube kuphela ngemithamo ye-insulin emfushane eyi-0,4.

Uma kunesidingo, siguqula amandla okudla okuqala kusuka ku-insulin emfushane kuya kofushane kakhulu:

Uyacelwa ukuthi uqaphele: isiguli sinesifiso esinamandla (umuntu wethu! :)). Kwasemini, udla amagremu ayi-128 amaprotheni - cishe ama-550 amagremu wokudla kwamaprotheni. Njengomthetho, iziguli ezinesifo sikashukela sohlobo 1 zidla okuncane kakhulu. Ake sithi uhlela ukudla ama-200 amagremu wokudla kwamaprotheni kwasemini aqukethe amagremu angama-45 eprotheyini emsulwa. Futhi isaladi yemifino eluhlaza, lapho ama-12 g ama-carbohydrate. Kulokhu, uzodinga ukufaka umjovo wokudla ongama-2.25 amayunithi we-insulin amafushane, amayunithi ayi-1.5 we-apidra noma uNovoRapida noma 1 iyunithi leHumalog ngaphambi kokudla. Ngokudla kwasekuseni nakusihlwa, imithamo izoba yaphansi kakhulu. Isiphetho: Qiniseka ukuthi ufunda ukusebenzisa i-insulin.

Impela ukuqala imithamo ye-insulin ekudleni okuthile kuzoba yincane kakhulu, nakwabanye - kukhulu kakhulu. Ukuthola ukuthi i-insulin isebenza kanjani, udinga ukukala ushukela wegazi 4 kanye namahora ama-5 ngemuva kokudla. Uma kukalwa ngaphambili, umphumela ngeke ube olunembile, ngoba i-insulin iyaqhubeka ukusebenza, futhi isidlo sisagaywa.

Sikubukela phansi ngamabomu ukuqala kwamabhodlela okudla kwimithamo ye-insulin. Ngakho-ke, akunakwenzeka ukuthi ushukela wakho ngemuva kokunye kokudla uzokwehla ufike ezingeni le-hypoglycemia. Kepha noma kunjalo, lokhu akuhlanganisiwe. Ikakhulu uma usuhlakulele i-gastroparesis yesifo sikashukela, isb., Ibambezele ukuphuma kwe-gastric ngemuva kokudla ngenxa ye-neuropathy. Ngakolunye uhlangothi, uma ukukhuluphala futhi ngenxa yalokhu kumelana ne-insulin, khona-ke imithamo ye-insulin esheshayo ngaphambi kokudla idingeka kakhulu.

Ngakho-ke, ngosuku lokuqala lomjovo we-insulin emfushane noma ye-ultrashort, sikala ushukela wethu ngaphambi kokudla, bese siphinda futhi ngemuva kwamahora ayi-2, 3, 4 no-5 ngemuva kokudla ngakunye. Sinesifiso sokuthi ushukela usukhule kangakanani ngemuva kokudla. Ukwanda kungaba okuhle noma okubi. Uma kungalungile, khona-ke umthamo we-insulin ngaphambi kokudla ngokuzayo lapho udinga ukunciphisa.

Uma ushukela ungamahora angama-2-3 ngemuva kokudla okuphansi kunangaphambi kokudla, ungashintshi umthamo we-insulin. Ngoba ngalesi sikhathi, umzimba awukakwazanga ukugaya nokuthola ukudla kwe-carbohydrate ephansi. Umphumela wokugcina ungamahora angama-4-5 ngemuva kokudla. Finyelela iziphetho kuso. Yehlisa umthamo kuphela uma, ngemuva kwamahora ama-1-3 ngemuva kokudla, ushukela “oshukela” ngaphansi kuka-3.5-3.8 mmol / L.

Ake sithi isiguli sethu sinemiphumela elandelayo:

• Amahora angama-4-5 ngemuva kokudla kwasekuseni - ushukela ukhuphuke ngo-3.9 mmol / l;
• Amahora angama-4-5 ngemuva kwasemini - anciphe ngo-1.1 mmol / l;
• Amahora angama-4-5 ngemuva kwesidlo sakusihlwa - lenyuke ngo-1.4 mmol / L.

Umthamo we-insulin ngaphambi kokudla ubhekwa njengowulungile uma, ngemuva kwamahora ama-5 ngemuva kokudla, ushukela uphambuka kulokho obekungaphambi kokudla ungabi ngaphezu kuka-0.6 mmol / L nangaluphi uhlangothi. Ngokusobala, saphuthelwa imithamo yokuqala, kodwa lokhu kwakulindelwe. Umphumela wento yokusa yokusa, onciphisa ukusebenza kahle komjovo we-insulin esheshayo ngaphambi kokudla kwasekuseni, uboniswa ngokucacile uma uqhathaniswa nemijovo ngaphambi kwasemini nangedina.

Ngabe udinga malini ukuze ushintshe umthamo we-insulin? Ukuthola, ake sibheke ama-boluses wokulungiswa. Esigulini esinesifo sikashukela esibi, i-pancreas yaso engakhiqizi i-insulin nhlobo, iyunithi elilodwa le-insulin elifushane lizokwehlisa ushukela wegazi cishe ngo-2.2 mmol / l, uma umuntu enesisindo esingu-64 kg.

Ukuthola inani elibonakalayo lesisindo sakho, udinga ukwenza isilinganiso. Isibonelo, kumuntu onesisindo esingu-80 kg, uthola u-2.2 mmol / L * 64 kg / 80 kg = 1.76 mmol / L. Okomntwana onesisindo esingu-32 kg, kutholakala i-2.2 mmol / L * 64 kg / 32 kg = 4.4 mmol / L.

Isiguli esinzima sikashukela okukhulunywa ngaso kulolu cwaningo sinesisindo esingu-64 kg. Ukuqala, sicabanga ukuthi iyunithi elilodwa le-insulin efushane lehlisa ushukela wegazi lakhe cishe ngo-2.2 mmol / L. Njengoba sazi, ngemuva kwesidlo sasekuseni nesidlo sakusihlwa, ushukela wakhe weqa, kwathi ngemuva kwesidlo sakusihlwa. Ngokuvumelana nalokhu, udinga ukwandisa umthamo we-insulin ngaphambi kokudla kwasekuseni nangesikhathi sokudla, kanye nokwehla okuncane ngaphambi kwasemini. Ukuze senze lokhu, sihlukanisa ushintsho kushukela ngo-2.2 mmol / L bese sisusa umphumela ku-0,25 IU ye-insulin phezulu noma phansi

Manje siguqula umthamo we-insulin emfushane ngaphambi kokudla ngokusekelwe emiphumeleni yosuku lokuqala lokuhlolwa. Ngasikhathi sinye, sizama ukugcina inani lamaprotheni nama-carbohydrate adliwayo ngebhulakufesi, kwasemini kanye nakusihlwa ngokufanayo.

Ngosuku olulandelayo, phinda inqubo efanayo, bese enye futhi, njengoba kudingeka. Nsuku zonke, ukuphambuka kushukela wegazi ngemuva kokudla kuzoba ngaphansi. Ekugcineni, uzothola umthamo ofanele we-insulin emfushane ngaphambi kokudla ngakunye.

Njengoba ukwazi ukubona, izibalo azinzima. Ngosizo lwe-Calculator, noma yimuphi umuntu osemdala angazisingatha. Ubunzima ukuthi inani lokudla okuhlinzekwayo ngebhulakufesi, kwasemini kanye nelakusihlwa kufanele lihlale linjalo nsuku zonke. Ukudla nezitsha kungashintsha futhi kufanele kushintshwe, kepha inani lama-carbohydrate namaprotheni kufanele lihlale linjalo nsuku zonke. Ukulandela lo mthetho, izikali zasekhishini ziyasiza.

Uma ngemuva kokudla uhlale unomuzwa wokuthi awugcwele, ungenyusa inani lamaprotheni. Inani elifanayo elikhulayo lamaprotheni lizodinga ukudliwa ezinsukwini ezilandelayo. Kulokhu, awukwazi ukukhuphula inani lama-carbohydrate! Ungadli ngaphezulu kwama-6 amagremu we-carbohydrate ngesidlo sasekuseni, amagremu ayi-12 kwasemini kanye nenani elifanayo lesidlo sakusihlwa. Ungadla ama-carbohydrate amancane, uma kungenjalo kuphela. Ngemuva kokushintsha inani lamaprotheni kokunye kokudla, udinga ukubheka ukuthi ushukela uzoshintsha kanjani ngemuva kokudla bese ukhetha kabusha isilinganiso se-insulin esifanele.

Esinye isibonelo sempilo

Isiguli sohlobo 1 sikashukela, iminyaka engama-26, ukuphakama okungu-168 cm, isisindo esingu-64 kg. Ibheka ukudla okune-carbohydrate ephansi, ilimaza i-Biosulin R. ngaphambi kokudla.
Ngo-7 a.m. ushukela wokuzila wawungu-11.0 mmol / L. Ukudla kwasekuseni: ubhontshisi oluhlaza 112 amagremu, iqanda 1 pc. Ama-carbohydrate angama-gramu ayi-4,9 kuphela. Ngaphambi kwesidlo sasekuseni, bajova i-insulin i-Biosulin R kumthamo wamaayunithi ayi-6. Emva kwalokho, ngamahora ayi-9 imizuzu engama-35 ushukela wawungu-5.6 mmol / L, kwathi ngamahora ayi-12 wakhuphuka wafika ku-10,0 mmol / L. Kwadingeka ngijove amanye amayunithi ama-5 e-insulin efanayo. Umbuzo - wenzeni okungalungile?

I-Biosulin P iyi-insulin efushane yomuntu. Uma ulandela ukudla okuphansi kwe-carb komjovo ngaphambi kokudla, kungcono kunezinhlobo ze-insulin ezifushane.

Isiguli sinoshukela osheshayo ongu-11.0. Uhlela ukulunywa ngamagremu ayi-11 kabhontshisi ne-1 pc yamaqanda ebhulakufesi. Sibheka amatafula enani lomsoco lemikhiqizo. Amagremu ayi-100 kabhontshisi oluhlaza aqukethe amagremu ayi-2.0 amaprotheni nama-gramu ayi-3.6 ama-carbohydrate. Kumagremu angama-112, lokhu kuphumela kumagremu ayi-2.24 amaprotheni nama-gramu ayi-4 ama-carbohydrate. Iqanda lenkukhu liqukethe cishe amagremu ayi-12,7 amaprotheni nama-gramu ayi-0,7 ama-carbohydrate. Ngokubambisana, ibhulakufesi lethu liqukethe amaprotheni 2.24 + 12.7 = 15 amagremu nama-carbohydrate 4 + 0.7 = 5 amagremu.

Ukwazi inani lesidlo sasekuseni, sibala umthamo wokuqala we-insulin ngaphambi kokudla. Nasi isibalo: ukulungiswa kwebholodi + yokudla. Sicabanga ukuthi ngesisindo somzimba esingama-64 kg, i-1 U ye-insulin emfushane izokwehlisa ushukela wegazi cishe ngo-2.2 mmol / L. Ushukela ojwayelekile ngu-5.2 mmol / L. Kutholakala indawo yokulungiswa (amayunithi ayi-11.0 - 5.2) / 2.2 = 2.6. Isinyathelo esilandelayo ukucabanga ngendawo yokudla. Ukusuka kumkhombandlela sifunda ukuthi iyunithi eli-1 le-insulin emfushane limboza cishe amagremu ayisishiyagalombili ama-carbohydrate noma cishe amagremu angama-57 eprotheni yokudla. Iprotheni, siyayidinga (15 g / 57 g) = 0,26 IZITHOMBE. Kuma-carbohydrate, udinga (5 g / 8 g) = 0,625 PIECES.

I-isilinganiso se-insulin esilinganiselwe: I-2.6 IU yokulungisa i-bolus + 0,26 IU yamaprotheni + 0,625 IU yama-carbohydrate = 3.5 IU.

Futhi isiguli sajova ama-unit ayi-6 ngalolo suku. Kungani ushukela wakhuphuka, naphezu kweqiniso lokuthi i-insulin yajova ngaphezu kwalokho okudingekile? Ngoba isiguli sisencane. Umthamo owengeziwe we-insulin wamenza wadedelwa ukukhululwa okukhulu kwama-hormone okucindezela, ikakhulukazi, i-adrenaline. Ngenxa yalokhu, ushukela uyagxuma. Kuyavela ukuthi uma ufaka i-insulin encane, khona-ke ushukela ngeke unyuke, kodwa kunalokho uyancipha. Injalo indida.

Umthamo owengeziwe noma ongaphansi kakhulu we-insulin esifushane esimweni esichazwe ngenhla amayunithi angama-3.5. Ake sithi manje ungajova amayunithi ama-3 noma ama-4, futhi umehluko ngeke ube mkhulu kakhulu. Kepha sifuna ukuqeda ushukela oshukela. Uma ukwazi ukwenza lokhu, ngakho-ke ngeke udinge ukugwaza ama-bolms amakhulu okulungisa. Futhi yonke indawo yokudla imayelana ne-1 UNIT ± 0.25 UNITS.

Masithi kuzoba nokugcwala kokulungiswa kwe-1 PIECE ± 0.25 IZITHUTHA kanye nokudla okufana okufanayo kwe-1 PIECES ± 0.25 IZITHOMBE. Isamba amayunithi ama-2 ± amayunithi angu-0,5. Phakathi kwemithamo ye-insulin 3 ne-4 amayunithi, umehluko awusi mkhulu. Kepha phakathi kwemithamo ye-1.5 PIECES ne-2 PIECES, umehluko osezingeni lomthelela kushukela wegazi uzoba mkhulu. Isiphetho: kumele ufunde ukufaka i-insulin. Akunandlela ngaphandle kwawo.

Ukufingqa. Ngohlobo olunzima lwesifo sikashukela sohlobo lwe-1 kanye nesifo sikashukela sohlobo 2 oluthuthukisiwe, sifunde ukuthi singabalwa kanjani isamba sokudla nokulungiswa kwemijovo ye-insulin ngaphambi kokudla. Ufundile ukuthi okokuqala udinga ukubala umthamo wokuqala we-insulin ngokuya ngereferensi coefficients, bese uwahlela ngokuya ngezinkomba zoshukela ngemuva kokudla. Uma ushukela, ngemuva kwamahora angama-4-5 ngemuva kokudla, ukhule ngamaphesenti angaphezu kuka-0.6 mmol / L, imithamo ye-insulin kumele inyuswe ngaphambi kokudla. Uma yehla ngokungazelelwe - imithamo ye-insulin nayo idinga ukwehliswa. Lapho ushukela ugcina uvamile, uguquka ngokungadluli ± 0,6 mmol / l ngaphambi nangemva kokudla - umthamo we-insulin ukhethwe kahle.

Thayipha isifo sikashukela esingu-2 noma uhlobo olumnene 1 sikashukela i-LADA

Ake sithi unesifo sikashukela sohlobo 2, icala elinganakwa. Ulandela ukudla okune-carbohydrate ephansi, thatha amaphilisi ama-Siofor noma ama-Glucofage Long, futhi uthathe imijovo ye-insulin eyengeziwe ebusuku nasekuseni. Imithamo ye-insulin Lantus, Levemir noma iProtafan isivele ikhethwe kahle. Ngenxa yalokhu, ushukela wakho wegazi uhlala uvamile uma weqa ukudla. Kepha ngemuva kokudla, iyagxuma, noma ngabe uphuza inani elifanele kakhulu lamaphilisi. Lokhu kusho ukuthi imijovo emfishane ye-insulin iyadingeka ngaphambi kokudla. Uma uvila kakhulu ukuzenza, kuzokhula izinkinga zesifo sikashukela.

Ngokwesifo sikashukela sohlobo 2 noma uhlobo olungejwayelekile lwesifo sikashukela, i-LADA, kudingeka uqale ufake umjovo weLantus noma Levemir ebusuku nasekuseni. Funda kabanzi lapha. Mhlawumbe imijovo yesikhathi eside ye-insulin izokwanela ukugcina ushukela ojwayelekile. Futhi uma ushukela usakhuphuka ngemuva kokudla, ingabe basengeza i-insulin ngokushesha ngaphambi kokudla.

I-pancreas iyaqhubeka nokukhiqiza inani elithile le-insulin, futhi yilokhu isimo sakho esihlukile ezigulini ezinesifo sikashukela sohlobo olubi. Asazi ukuthi unamalini e-insulin yakho ukuze ucishe ushukela ophezulu ngemuva kokudla, kepha udinga malini ukufaka imijovo. Futhi, asazi ngokuthe ngqo ukuthi umuzwa we-insulin ompofu kangakanani (ukumelana ne-insulin) ngenxa yokukhuluphala kwandisa isidingo sakho se-insulin. Esimweni esinjalo, akulula ukuqagela ngethamo lokuqala le-insulin efushane ngaphambi kokudla. Ungayibala kanjani kahle ukuze kungabikho i-hypoglycemia? Okulandelayo kuyimpendulo enemininingwane yalo mbuzo.

Ngaphambi kokujova, udinga ukufaka i-insulin kuphela kulezi ziguli ezinesifo sikashukela sohlobo 2 ezivilapha ukuzivocavoca

Kuyaqondakala ukuthi ulandela ngokuqinile ekudleni okuphansi kwe-carbohydrate. Udinga futhi ukudla inani elilinganayo lama-carbohydrate namaprotheni nsuku zonke ukuze uthole isidlo sasekuseni, isidlo sasemini nakusihlwa. Bheka ushukela ngaphambi nangemva kokudla izinsuku ezingama-3-7, bese ubala imithamo ye-insulin ngaphambi kokudla, usebenzisa idatha.

Hlanganisa imininingwane yokuthi kukhuphuka kanganani ushukela wegazi ngemuva kwesidlo sasekuseni, isidlo sasemini kanye nesidlo sakusihlwa, uma ungafaki i-insulin ngaphambi kokudla, kepha thatha amaphilisi akho kashukela ejwayelekile.

Kuyadingeka ukukala ushukela ngaphambi kokudla, bese kuthi ngemuva kwamahora ama-2, 3, 4 no-5 ngemuva kokudla ngakunye. Yenza lokhu izinsuku ezingama-3-7 ngokulandelana. Qopha imiphumela yokulinganisa, gcina idayari. Lezi zinsuku udinga ukudla amahlandla ama-3 ngosuku, ungadli. Ukudla okuphansi kwe-carbohydrate kugcwele amahora angama-4-5. Uzogcwala ngaso sonke isikhathi ngaphandle kokudla.

Isikhathi sokuqalwa kokulungiselela siyizinsuku ezingama-3-7. Zonke izinsuku unesifiso sokwanda okuphezulu koshukela ngemuva kwesidlo sasekuseni, isidlo sasemini nesidlo sakusihlwa. Ngokunokwenzeka, kuzoba amahora ama-3 ngemuva kokudla. Kepha sonke isiguli esinesifo sikashukela sehlukile. Lokhu kungaba ngemuva kwamahora ama-2, nangemva kwamahora ama-4 noma ama-5. Udinga ukukala ushukela futhi uqaphele ukusebenza kwawo.

Usuku ngalunye, bhala ukuthi yikuphi ukwanda okuphezulu koshukela ngemuva kwesidlo sasekuseni, isidlo sasemini kanye nesidlo sakusihlwa. Isibonelo, ngoLwesithathu ngaphambi kokudla kwakusihlwa, ushukela wawungama-6.2 mmol / L. Ngemuva kokudla, waba:

Inani eliphakeme yi-7.8 mmol / L. Ukukhuphuka ngu-1,6 mmol / L. Siyayidinga, ibhale phansi. Yenza okufanayo nangesikhathi sebhulakufesi nangedina. Zonke izinsuku kufanele ulinganise ushukela nge-glucometer cishe izikhathi eziyi-15. Lokhu akunakugwenywa. Kodwa kunethemba lokuthi ngaphambi kokudla okuthile ngeke udinge imijovo ye-insulin esheshayo. Ngokwemiphumela yesikhathi sokubuka, uzoba cishe netafula elilandelayo:

Kuzo zonke izinzuzo zansuku zonke, funa amanani aphansi. Bazobala umthamo we-insulin ngaphambi kokudla ngakunye. Sithatha izinombolo ezisezingeni eliphansi ukuze imithamo yokuqalisa iphansi futhi ngenxa yalokho i-insure ngokumelene ne-hypoglycemia.

Isiguli sesifo sikashukela sohlobo 2, esiboniswa imiphumela yaso etafuleni, sidinga imijovo ye-insulin esheshayo kuphela ngaphambi kokudla kwasekuseni nangesikhathi sokudla, kodwa hhayi ngaphambi kwesidlo sakusihlwa. Ngoba ngemuva kwesidlo sakusihlwa ushukela wakhe awukhuli. Lokhu kungenxa yokudla okuphansi kwe-carbohydrate, ukuthatha amaphilisi weSiofor, kanye nokuzivocavoca phakathi nosuku. Ake nginikhumbuze ukuthi uma ufunda ukujabulela imfundo yezomzimba, inika ithuba lokwenqaba imijovo ye-insulin ngaphambi kokudla.

Ake sithi, ngokwemiphumela yokubonwa ushukela phakathi nesonto kuvela lokhu okulandelayo:

• Ukuthola ushukela omncane ngemuva kokudla kwasekuseni: 5.9 mmol / l;
• Ukuthola ushukela omncane ngemuva kokudla kwakusihlwa: 0,95 mmol / l;
• Ukuthola ushukela omncane ngemuva kokudla kwakusihlwa: 4.7 mmol / L.

Ekuqaleni, sicabanga ngokucophelela ukuthi i-1 U ye-insulin emfushane izokwehlisa ushukela wegazi esigulini esinesifo sikashukela sohlobo 2, onesifo sokukhuluphala, cishe ngo-5.0 mmol / L. Lokhu kukhulu kakhulu, kepha sibukela phansi ngokungatheni umthamo wokuqala we-insulin ukuvikela isiguli ku-hypoglycemia. Ukuthola umthamo wokuqala we-insulin ngaphambi kokudla, sihlukanisa inani eliphansi lokukhuphuka koshukela ngalesi sibalo. Sizungeza umphumela ku-0,25 PIECES phezulu noma phansi.

Sigcizelela ukuthi sikhuluma ngama-insulin amafushane abantu - i-Actrapid NM, i-Humulin Regular, i-Insuman Rapid GT, i-Biosulin R nabanye. Uma isiguli esinesifo sikashukela sizokhetha i-Apidra noma i-NovoRapid ngaphambi kokudla, khona-ke umthamo obaliwe kufanele uphindaphindwe ngo-0.66, futhi uma uHumalog - iphindaphindwe ngo-0.4.

Siqala ngokujova ukuqala imithamo ye-insulin emfushane imizuzu engama-40-45 ngaphambi kokudla, i-ultrashort - imizuzu eyi-15-25. Ukwenza imijovo ngokunemba kwe-0.25 ED, kuzodingeka ufunde ukuthi ungahluza kanjani i-insulin. Ezigcawini ezikhuluma isiRussia nezangaphandle zakwamanye amazwe, iziguli ezinesifo sikashukela ziyaqinisekisa ukuthi i-insulin emfushane ne-Ultra-iDemo. Siyaqhubeka nokukala ushukela 2, 3, 4, kanye namahora angama-5 ngemuva kokudla ukuthola ukuthi kusebenza kanjani ukwelashwa kwe-insulin.

Uma ngemuva kokunye kokudla ngemuva kwamahora angama-4-5 (hhayi ngemuva kwamahora angama-2-3!) Ushukela usakhuphuka ngokungaphezu kuka-0,6 mmol / l - umthamo we-insulin ngaphambi kwalesi sidlo ngosuku olulandelayo ungazanywa ukwandisa ngokunyuka Amayunithi angu-0.25, amayunithi angu-0,5 noma amayunithi ayi-1. Iziguli ezinesifo sikashukela sohlobo 2 ezinokukhuluphala obukhulu (ngaphezu kwama-40 kg wesisindo ngokweqile) zingadinga ukwandisa umthamo we-insulin ngaphambi kokudla kuma-unit ama-2. Kepha kuwo wonke umuntu, lokhu kugcwele i-hypoglycemia enzima. Uma kungazelelwe ushukela wakho ngemuva kokudla ungaphezulu kuka-0,6 mmol / L uphansi kunangaphambi kokudla, kusho ukuthi udinga ukwehlisa umthamo we-insulin ngaphambi kwalesi sidlo.

Inqubo engenhla yokulungisa imithamo ye-insulin ngaphambi kokudla kufanele iphindwe kuze kube yilapho ushukela emahoreni angama-4-5 ngemuva kokudla kahle ihlala icishe ifane naphambi kokudla. Nsuku zonke uzokucacisa ngokwengeziwe umthamo we-insulin. Ngenxa yalokhu, ushukela ngemuva kokudla uzovela usondele kokujwayelekile. Akufanele i-oscillate ngaphezu kwe-0.6 mmol / l phezulu noma phansi. Kuphakanyiswa ukuthi ulandela ukudla okuphansi kwe-carb ukulawula isifo sikashukela.

Zama ukudla inani elilinganayo lamaprotheni nama-carbohydrate nsuku zonke ukuze uthole isidlo sasekuseni, isidlo sasemini nakusihlwa. Uma kunoma yikuphi ukudla ufuna ukushintsha inani lamaprotheni owadlayo, inqubo-ke leyo yokubala bese ulungisa umthamo we-insulin ngaphambi kwalokhu kudla udinga ukuphindwa. Khumbula ukuthi inani lama-carbohydrate alikwazi ukuguqulwa, kufanele lihlale liphansi, ngoba ukudla kubizwa ngokuthi yi-low-carbohydrate.

Unganquma kanjani ukuthi imizuzu emingaki ngaphambi kokudla nge-insulin

Unganquma kanjani ukuthi imizuzu emingaki ngaphambi kokudla okudinga ukujova i-insulin ngokushesha? Lokhu kungenziwa ngokuhlola, okuchazwe ngezansi. Ukuhlolwa kunikeza imiphumela ethembekile kuphela uma isiguli sikashukela siqala ukukwenza lapho sinoshukela eduze nokujwayelekile. Lokhu kusho ukuthi ushukela wegazi uhlale ungaphansi kuka-7.6 mmol / L okungenani amahora amathathu edlule.

Thatha umjovo we-insulin esheshayo (emfishane) imizuzu engama-45 ngaphambi kokuba uhlele ukuhlala phansi ukuze udle. Kala ushukela nge-glucometer 25, 30, 35, 40, imizuzu engama-45 ngemuva komjovo. Lapho nje yehla ngo-0,3 mmol / L - sekuyisikhathi sokuqala ukudla. Uma lokhu kwenzeka ngemuva kwemizuzu engama-25 - khona-ke awukwazi ukukala, kodwa ngokushesha qala ukudla ukuze kungabikho i-hypoglycemia. Uma ngemuva kwemizuzu engama-45 ushukela wakho uhlala usezingeni elifanayo - kuhlehlisa ukuqala kokudla. Qhubeka nokukala ushukela wakho njalo ngemizuzu emi-5 uze ubone ukuthi sekuqale ukuwa.

Le ndlela elula futhi enembile yokunquma ukuthi imizuzu emingaki ngaphambi kokudla udinga ukujova i-insulin. Ukuhlolwa kufanele kuphindwe uma umthamo wakho we-insulin esheshayo ngaphambi kokudla ushintsha ngo-50% noma ngaphezulu. Ngoba uma kukhulu umthamo we-insulin, ngokushesha uqala ukusebenza. Nakulokhu futhi, umphumela uyobe ungathembeki uma ushukela wakho wokuqala wegazi wawungaphezu kuka-7.6 mmol / L. Misela ukuhlolwa kuze kube yilapho usondeza ushukela wakho kokujwayelekile. Ngaphambi kwalokhu, thatha ukuthi udinga ukujova i-insulin emfushane imizuzu engama-45 ngaphambi kokudla.

Ake sithi ukuhlolwa kukhombisa ukuthi udinga ukujova i-insulin imizuzu engama-40 ngaphambi kokudla. Kwenzekani uma uqala ukudla kungekudala? Uma uqala ukudla imizuzu emi-5 ngaphambili noma emuva kwesikhathi, ngeke kube nomehluko omkhulu. Uma uqala ukudla imizuzu eyi-10 ngaphambili kunokuba kunesidingo, khona-ke ngesikhathi sokudla ushukela wakho uzokhuphuka, kepha kamuva, ngokunokwenzeka, uzokwehla ngokujwayelekile. Lokhu futhi akusilo ukwethuka uma wenza amaphutha angavamile. Kepha uma ushukela wegazi ukhuphuka njalo phakathi nangemva kokudla, khona-ke kukhona ingozi yokwazi kahle izinkinga zesifo sikashukela.

Uma uqala ukudla imizuzu eyi-15 noma engama-20 ngaphambili kunokuba kunesidingo, khona-ke ushukela wegazi ungakhuphuka kakhulu, ngokwesibonelo, ufike ku-10,0 mmol / L. Kulesi simo, umzimba wakho uzokwazi ukumelana nengxenye ye-insulin esheshayo oyifakile. Lokhu kusho ukuthi umthamo wayo ojwayelekile ngeke wanele ukwehlisa ushukela. Ngaphandle komthamo owengeziwe we-insulin, ushukela uzohlala uphakeme isikhathi eside. Lesi yisimo esiyingozi ngokuya ngokuthuthukiswa kwezinkinga zesifo sikashukela.

Kwenzekani uma, ngemuva kokujova i-insulin esheshayo, uqala ukudla imizuzu eyi-10-15 ngemuva kwesidingo? Kulesi simo, ucela inkathazo. Ngemuva kwakho konke, asidli ama-carbohydrate asheshayo. Umzimba udinga kuqala ukugaya amaprotheni, bese uguqula amanye wawo abe ushukela. Le yinqubo ehamba kancane. Noma ukulibaziseka kwemizuzu eyi-10 kungenza ushukela wehle kakhulu, futhi ukuthathwa kwesidlo esinama-carbohydrate aphansi ngeke kusize ukubuyisela esimweni esijwayelekile. Ingozi ye-hypoglycemia ibalulekile.

Kunconywa ngokuvamile ukuthi kufakwe i-insulin emfushane yomuntu emizuzwini engama-45 ngaphambi kokudla, kanye ne-ultrashort - imizuzu eyi-15-25. Kodwa-ke, uDkt Bernstein uncoma ukuthi ungavilaphi, kodwa ukuthola isikhathi sakho sokujova esifanelekile. Sichaze ngenhla ukuthi ungakwenza kanjani lokhu nokuthi yiziphi izinzuzo ozozithola. Ikakhulu uma ulandela ekudleni okuphansi kwe-carbohydrate. Siyiphindaphinda i-axiom: ungagcini imichilo yokuhlola imitha ukuze ungahambeki lapho welapha izinkinga zesifo sikashukela.

Ngabe ngidinga ukuhlala ngidla ngasikhathi sinye?

Ngaphambi kokuqalwa kwezinhlobo ze-insulin ezimfishane kanye ne-ultrashort, iziguli ezinesifo sikashukela kwakufanele zihlale zidla ngasikhathi sinye. Lokhu bekuphazamisa kakhulu, futhi imiphumela yokwelashwa ibingalungile. Manje sinxenxa ukukhuphuka koshukela ngemuva kokudla nge-insulin emfushane noma ye-Ultra-iDemo. Lokhu kwenza ukuthi kudliwe lapho ufuna. Kuyadingeka kuphela ukwenza umjovo we-insulin ngesikhathi ngaphambi kokuhlala phansi ukuze udle.

Ungeqa ukudla uma uphuthelwa umjovo ofanele we-insulin ngaphambi kokudla. Uma ukhethe kahle umthamo we-insulin enwetshiwe, owawujova ebusuku kanye / noma ekuseni, lapho-ke weqa ukudla, ushukela wakho wegazi kufanele uhlale uvamile - ungawe kakhulu futhi ungavuki. Ungayinquma kanjani imithamo yezinhlobo ezandisiwe ze-insulin, funda isihloko esithi "I-insulin Lantus ne-Glargin enwetshiwe. I-Medium NPH-Insulin Protafan. "

Okufanele ukwenze uma ukhohlwe ukufaka umjovo i-insulin ngaphambi kokudla

Kungenzeka ukuthi ukhohlwe ukunikeza ihlumela le-insulin emfishane bese ucabanga ngayo lapho isidlo sesizokhonzwa noma usuqalile ukudla. Uma kwenzeka kunesimo esiphuthumayo esinjalo, kungakuhle ukuthi ube ne-insulin efushane kakhulu nawe, futhi yiHumalog, okuyiyona eshesha kunazo zonke. Uma usuqalile ukudla noma ngaphambi kokudla ngaphambi kokuqala imizuzu eyi-15 - nikeza umjovo weHumaloga. Khumbula ukuthi inamandla izikhathi ezingama-2,5 kune-insulin ejwayelekile. Ngakho-ke, umthamo weHumalog kufanele ube ngu-0.4 womthamo wakho ojwayelekile we-insulin emfushane. I-0.4 esebenzayo kufanele icaciswe ngawodwana.

Imijovo ye-Insulin yokudla endaweni yokudlela kanye nendiza

Ezitolo zokudlela, amahhotela nezindiza, ukudla kuhanjiswa ngohlelo lwabo, hhayi okwakho. Futhi imvamisa lokhu kwenzeka ngokuhamba kwesikhathi kunokuthenjiswa ngabasebenzi bokugcina noma izincwajana zokukhangisa. Labo abangenaso isifo sikashukela bayacasuka lapho bedinga ukuhlala belambile balinde isikhathi esingaziwa. Kepha uma usujova i-insulin esheshayo, khona-ke lokhu kulindela akugcini nje ukucaphukisa, kepha kungaba yingozi, ngoba kunengozi ye-hypoglycemia (ushukela ophansi).

Ezimweni ezinjalo, kungenzeka ukuthi ujove hhayi i-insulin emfushane, kodwa i-ultrashort. Faka kukho lapho ubona ukuthi isikhonzi silungiselela ukusebenzisa isifundo sokuqala noma i-appetizer. Uma ulindela ukubambezeleka kokusebenza kwekhambo eliyinhloko, hlukanisa umthamo we-insulin we-ultrashort ube ama-halves amabili. Shayela uhhafu wokuqala khona lapho, bese owesibili - lapho ubona ukuthi isikhonzi sithatha inkambo enkulu. Ushukela ungahle ukhuphuke kancane, kepha uqinisekisiwe ukuthi ugwema i-hypoglycemia, noma ngabe ukudla kunikezwa ngokubambezeleka. Uma wayala ukudla okune-carbohydrate ephansi futhi ukudle kancane, ungakugwema ukwanda kweshukela kusikhashana.

On indiza kungenzeka ukuthi unganikwa ukukhetha izitsha, ngaphandle kokuthi uhamba ngebhizinisi lebhizinisi. Imvamisa, bonke abagibeli bomoya baphekelwa ukudla okufanayo - hhayi okumnandi, kugcwele ama-carbohydrate futhi akulungele neze iziguli ezinesifo sikashukela. Ngakho-ke, umuntu onesifo sikashukela esihlakaniphile uthatha izikebhe zokudla okudla okuphansi. Kungaba izingcezu zenyama noma zenhlanzi, ushizi, izinhlobo ezivunyelwe zamantongomane. Thatha okuningi ukuze wabelane ngokwanele nomakhelwane abahleli e-рядом. Uma unenhlanhla-ke isaladi yemifino ezokhiswa izophenduka imifino eluhlaza efanelekile ekudleni okungama-carbohydrate aphansi.

Musa-oda noma ungadli ukudla “okuneshukela” ebhodini endizeni! Kuhlala kukudla okugcwele kakhulu ama-carbohydrate, mhlawumbe kungalimaza kakhulu kithi kunokudla kwendiza okujwayelekile. Uma i-airline ikunikeza okukhethwa kukho, bese u-oda ukudla kwasolwandle. Uma kungondliwe nhlobo endizeni, kungcono kakhulu, ngoba kunezilingo ezimbalwa zokusuka ekudleni. Ukube kuphela ababhekeli bezindiza bephuzisa abagibeli amanzi, futhi sizohlinzeka ngokudla okunempilo okuvela emikhiqizweni evunyelwe yesifo sikashukela.

Isixwayiso Uma ngabe usuhlakulele i-gastroparesis yesifo sikashukela, isb., Ukubambezeleka ukusula isisu ngemuva kokudla, bese ungalokothi usebenzise i-insulin ye-ultrashort, kodwa njalo imfushane nje. Uma ukudla kufakwa esiswini sakho, khona-ke i-insulin efushane eyingqayizivele iyohlala isebenza ngokushesha kunokuba kunesidingo. Siyakhumbula futhi ukuthi izinhlobo ze-insulin ze-insulin zinamandla kakhulu kunalezi zimfushane, futhi ngenxa yalokho umthamo wazo kufanele ube izikhathi eziphansi eziyi-1.5-2,5.

Yenza ushukela ojwayelekile abe ne-insulin

Akunandaba noma uzama ukulawula lesi sifo ngokuqhamuka nohlelo 2 lokwelapha isifo sikashukela noma uhlobo 1 lokuthola isifo sikashukela, kwesinye isikhathi ushukela usalokhu weqa. Kunezizathu ezahlukahlukene zalokhu:

• izifo ezithathelwanayo;
• ukucindezeleka okukhulu ngokomzwelo;
• ukubalwa okungalungile kokuthola ama-carbohydrate adliwayo namaprotheni;
• amaphutha kwimithamo ye-insulin.

Funda i-athikili enemininingwane, "Okuthinta Ushukela Wegazi."

Uma isifo sikashukela sohlobo lwe-2 beta cell yamanyikwe sisasebenza ukukhiqiza i-insulin, ushukela ophakeme ungaya kokujwayelekile emahoreni ambalwa uwedwa. Kodwa-ke, uma unesifo sikashukela sohlobo olubi futhi ukukhiqizwa kwe-insulin emzimbeni sekuye kwehla ku-zero, khona-ke kuzodingeka i-insulin eyengeziwe noma ye-insulin emfushane ukuqeda ukugxuma kushukela. Kufanele futhi ushaye phansi ushukela owandayo ngemijovo ye-insulin uma unesifo sikashukela sohlobo 2 kanye nokuphikiswa okukhulu kwe-insulin, okungukuthi, ukuzwela kwamangqamuzana esenzweni se-insulin kuncishisiwe.

Umthamo we-insulin esheshayo edingekayo ukuze ijwayele ushukela ophezulu ubizwa ngokuthi yi-bolus yokulungisa. Akuhlobene nezidlo. Isigaxa sokudla umthamo we-insulin ngaphambi kokudla, odingekayo ukuze ushukela wegazi ungavuki lapho ukudla kudakwe. Uma ushukela seqe futhi udinga ukwethula i-bolus yokulungisa, khona-ke kulokhu kungcono ukusebenzisa enye yezinhlobo ze-insulin ezifushane kakhulu, ngoba zisebenza ngokushesha kunokuba mfushane.

Ngasikhathi sinye, uma ulandela ukudla okune-carbohydrate ephansi ukulawula ushukela, kuyalulekwa ukusebenzisa i-insulin emfushane kune-ultra-short njenge-bolus yokudla. Bambalwa abaneshukela abanesifo sikashukela abalungele ukusebenzisa i-insulin esebenza kancane ngaphambi kokudla nsuku zonke, kuyilapho begcina i-insulin engapheli-isikhathi esifushane ilungele izikhathi ezikhethekile. Uma usakwenza lokhu, bese ukhumbula ukuthi izinhlobo ze-insulin ezinamandla kakhulu kunezifushane. I-Humalog icishe ibe ngu-2,5 izikhathi ezinamandla, kuyilapho uNovoRapid ne-Apidra enamandla izikhathi ezingama-1.5-2.

Ukuze ulungele ukusebenzisa i-insulin esheshayo njenge-bolus yokulungisa lapho ushukela ugxuma, kufanele wazi kahle ukuthi iyunithi elilodwa lale insulin yehlisa kanjani ushukela wakho. Ukuze wenze lokhu, kunconywa ukwenza ucwaningo kusengaphambili, okuchazwe ngezansi.

Ungathola kanjani ukuthi kanjani i-1 unit ye-insulin yehlisa ushukela

Ukwazi kahle ukuthi ingakanani i-0,5 U noma i-1 U ye-insulin emfushane noma ye-Ultra-iDemo yehlisa ushukela wakho, udinga ukuzihlola. Ngeshwa, lokhu kuhlolwa kudinga ukweqa ukudla kwasemini ngelinye ilanga. Kepha akudingi ukwenziwa kaningi, kwanele kanye, bese ukwazi ukukuphinda njalo eminyakeni embalwa. Umongo wokuhlola uchazwe ngokuningiliziwe ngezansi, nokuthi ungathola luphi ulwazi.

Linda kuze kube usuku ngaphambi kokuba ushukela wakho weqe okungenani ngo-1.1 mmol / L ngaphezulu kwelitshe. Ngenhloso yalokhu kuhlolwa, ushukela okhulayo ekuseni osesiswini esingenalutho awulungele, ngoba imiphumela izoguqula izehlakalo zokusa kokusa. Ushukela akufanele uphakanyiswe kungakapheli amahora angama-5 ngemuva kokudla kwasekuseni. Lokhu kuyadingeka ukuze umthamo we-insulin esheshayo ngaphambi kokudla kwasekuseni usuqedile ukwenza kwawo. Futhi qiniseka ukuthi uphuza umjovo wakho ojwayelekile we-insulin enwetshiwe namuhla ekuseni.

Ukuhlolwa ukuthi weqa ukudla kwasemini kanye nokudutshulwa kwe-insulin ngokushesha ngaphambi kokudla, okusebenza njengendawo yokudla. Esikhundleni salokho, ufaka i-insulin ngokushesha, isisekelo sokulungiswa, bese ubona ukuthi yehlisa kanjani ushukela wakho. Kubalulekile ukujova isilinganiso esilinganiselwe noma esingaphansi kakhulu se-insulin ukwehlisa ushukela - hhayi kakhulu kakhulu ukuvikela i-hypoglycemia. Ithebula elingezansi lizokusiza ngalokhu.

Iyunithi eli-1 le-insulin elisheshayo lingalilinganisa kanjani ushukela wegazi, kuye ngomthamo wansuku zonke we-insulin eyeluliwe

Amanothi etafuleni:

• Onke amanani anikezwe ayalinganiselwa, ahloselwe kuphela ukujova "kokuhlola" kokuqala kwe-insulin okusheshayo. Thola izinombolo eziqondile zokusebenzisa kwakho nsuku zonke wedwa, ngokwenza ukuhlolwa.
• Into esemqoka ukungayifaki i-insulin ngokweqile okokuqala, ukugwema i-hypoglycemia.
• IHumalog iyi-insulin enamandla kakhulu. Impela kuzodingeka ukuthi uklanywe ngendlela ehlanjululwe. Kunoma ikuphi, funda ukufaka i-insulin.

Kuphakanyiswa ukuthi ulandele ekudleni okuphansi kwe-carb bese ufaka imithamo elinganiselayo ye-insulin enwetshiwe. Ngiqonde - usebenzisa i-insulin isikhathi eside kuphela ukugcina ushukela ojwayelekile wokuzila. Siyaphinda futhi, sinxusa iziguli ezinesifo sikashukela ukuthi zingazami ukusebenzisa i-insulin isikhathi eside ukulingisa imiphumela yezinhlobo ezisheshayo ze-insulin ukwenza ushukela uvamile ngemuva kokudla. Funda isihloko esithi "I-insulin Lantus ne-Glargin eyengeziwe. I-Medium NPH-Insulin Protafan. " Landela izincomo ezichazwe kulo.

Ake sithathe isibonelo esisebenzayo. Ake sithi ufaka inani lama-9 amayunithi e-insulin enwetshiwe ngosuku, bese usebenzisa i-NovoRapid njenge-insulin esheshayo. Etafuleni sinemininingwane yemithamo ye-insulin enwetshiwe yamayunithi ayi-8 namayunithi ayi-10, kodwa amayunithi ayi-9 hhayi. Kulokhu, sizothola isilinganiso futhi sisisebenzise njengokucabanga kokuqala. Ukubala (4.4 mmol / L + 3.6 mmol / L) / 2 = 4.0 mmol / L. Ushukela wakho ngaphambi kokudla kwakusihlwa waba ngu-9.7 mmol / L, futhi izinga lokuqondisa bekuyi-5.0 mmol / L. Kuyavela ukuthi ushukela udlula okujwayelekile ngo-4.7 mmol / L. Mangaki amayunithi weNovoRapid okufanele agonywe ukwehlisa ushukela abe ejwayelekile? Ukuthola, bala i-4.7 mmol / L / 4.0 mmol / L = 1.25 IU ye-insulin.

Ngakho-ke, sifaka amayunithi ayi-1.25 weNovoRapida, weqa ukudla kwasemini futhi, ngokufanele, sijova ibolus yokudla ngaphambi kwasemini. Silinganisa ushukela wegazi emahoreni angama-2, 3, 4, 5 no-6 ngemuva komjovo we-bolus wokulungisa. Sinesifiso sokulinganisa okuzobonisa umphumela ophansi kakhulu. Inikeza imininingwane ebalulekile:

• kangango-mmol / l enza iNovoRapid empeleni yehlise ushukela wegazi lakho;
• Kuthatha isikhathi esingakanani umjovo uqhubeka.

Ezigulini eziningi, imijovo ye-insulin esheshayo iyeka ngokuphelele emahoreni ayi-6 alandelayo. Uma ushukela ophansi kakhulu ngemuva kwamahora ama-4 noma ama-5, kusho ukuthi ngawodwana le-insulin isebenza kuwe ngendlela yayo.

Ake sithi, ngokwemiphumela yokulinganisa, kuvela ukuthi ushukela wegazi lakho ngemuva kwamahora angama-5 ngemuva kokujova kweNovoRapida ka-1.25 IU kwehla kusuka ku-9.7 mmol / L kuya ku-4,5 mmol / L, kwathi ngemuva kwamahora ayi-6 akuzange kwehle ngisho nangaphansi. Ngakho-ke, sifunde ukuthi i-1.25 IU NovoRapida yehlise ushukela wakho ngo-5.2 mmol / L. Ngakho-ke, iyunithi eli-1 lale insulin yehlisa ushukela wakho ngo (5.2 mmol / l / 1.25) = 4.16 mmol / l. Leli inani elibalulekile lomuntu ngamunye elibizwa ngokuthi i-insulin sensitivity factor. Sebenzisa lapho udinga ukubala umthamo ukwehlisa ushukela omningi.

Uma phakathi kokuhlolwa ushukela ngandlela thile uwela ngaphansi kuka-3,5-3,8 mmol / L, yidla amaphilisi kashukela ambalwa ukuze kungabikho-hypoglycemia. Funda kabanzi ngokuthi ungayeka kanjani i-hypoglycemia. Ukuhlolwa kwehlulekile namhlanje. Phinda uyisebenzise ngolunye usuku, hlaba umjovo ophansi we-insulin.

Ungawucima kanjani ushukela ophezulu ngemijovo ye-insulin

Ngakho-ke, wenze ukuhlolwa futhi wanquma ukuthi i-1 unit ye-insulin emfushane noma ye-ultrashort yehlisa kanjani ushukela wakho wegazi. Manje ungasebenzisa le insulin njengesixazululo sokulungiswa, okungukuthi, ukucima ushukela ube ejwayelekile uma wagxuma. Emahoreni ambalwa ngemuva komjovo wethamo eliqondile le-insulin esheshayo, ushukela wakho kungenzeka ubuyele kokujwayelekile.

Uma ulandela ekudleni okuphansi kwe-carbohydrate, futhi usubalile kahle imithamo yakho ye-insulin enwetshiwe kanye ne-insulin esheshayo ngaphambi kokudla, khona-ke ushukela akufanele ube ngaphezu kwamanani ama-3-4 mmol / l ngaphezulu kokuhlosiwe. Lokhu kungenzeka kuphela ezimweni eziphuthumayo.

Uma imithamo emibili ye-insulin esheshayo isebenza kanyekanye, khona-ke ushukela ungahle wehle kakhulu futhi kuhlaselwe i-hypoglycemia. Linda okungenani amahora angama-4-5 kusukela ngomjovo wangaphambilini we-insulin esheshayo, bese kuphela lapho ufake i-bolus yokulungisa. Eqinisweni, isenzo sezinhlobo ezisheshayo ze-insulin sithatha amahora angama-6-8, kepha emahoreni wokugcina lokhu kungumthelela omncane "wokusala". Ngakho-ke, kwanele ukulinda amahora angu-4-5.

Kungaba ingozi kakhulu ukulinda amahora ayi-6 phakathi kwayo yonke imijovo ye-insulin emfushane noma ye-ultrashort. Uma udla amahlandla ama-3 ngosuku, kuzodingeka uhlale amahora amahora angu-18, futhi ukulala kuzobe kungadluli amahora ayi-6. Ukuzilolonga kukhombisa ukuthi izikhawu ezanele zamahora angama-4-5. Ngemuva kwalokhu, ungafaka umjovo olandelayo we-insulin esheshayo, ngoba owedlule usuvele unomphumela omncane.

Yini okufanele uyenze uma i-insulin inganciphisi ushukela

Kwesinye isikhathi kuyenzeka ukuthi imijovo ye-insulin emfushane noma ye-ultrashort ingawehlisi ushukela wegazi, njengenjwayelo, kodwa yenza kabi noma cha. Ake sibheke izizathu ezimbalwa ezingaholela kulokhu.

I-insulin inamafu - yilahle kude

Okokuqala, bheka i-vial noma i-cartridge ene-insulin ekukhanyeni ukuze uqiniseke ukuthi ayinamafu. Ungayiqhathanisa ne-insulin entsha engafakwanga yohlobo olufanayo ukuze uqiniseke. Noma iyiphi i-insulin, ngaphandle kwe-NPH-insulin (protafan) esezingeni eliphakathi nendawo, kufanele icace kahle futhi ibonakale njengamanzi. Uma enamafu amancane, kusho ukuthi ulahlekelwe ngokwengxenye amandla akhe okwehlisa ushukela wegazi. Ungayisebenzisi i-insulin enjalo, ilahle bese uyifaka entsha.

Ngendlela efanayo, i-insulin akufanele isetshenziswe uma ngabe iqandiswe ngengozi, ivezwe amazinga okushisa aphezulu noma ilele ngaphandle kwesiqandisi izinyanga ezingaphezu kwezingu-3. Ukushisa okubi ikakhulukazi ngenhla kwama-degrees Celsius kuthinta i-Levemir neLantus. Izinhlobo ezimfishane noma ze-ultrashort ze-insulin ziyamelana kakhulu nayo, kodwa futhi kudingeka zigcinwe ngokucophelela. Funda kabanzi ngemithetho yokugcina i-insulin.

Ungawamisa kanjani ushukela ekuseni esiswini esingenalutho

Uma ushukela ekuseni esiswini esingenalutho uvame ukuphakanyiswa, khona-ke kungaba nzima kakhulu ukuwehlisela kokujwayelekile. Le nkinga ibizwa ngokuthi yinto yokusa yokusa. Kwezinye iziguli ezinesifo sikashukela, kunciphisa kakhulu ukuzwela kwe-insulin, kwezinye - okuncane. Ungase uthole ukuthi ekuseni, i-insulin esheshayo yehlisa ushukela wegazi ngokungaphumeleli kunokuba ntambama noma kusihlwa. Ngakho-ke, umthamo wakhe wesibambiso sokulungisa ekuseni udinga ukwanda ngama-20%, ama-33% noma ngaphezulu. Xoxa nodokotela wakho ngalokhu. I-% ngqo inganqunywa kuphela ngecala nephutha. Usuku lonke, i-insulin kufanele isebenze njengokujwayelekile.

Uma uvame ukuba nenkinga ngoshukela omningi ekuseni esiswini esingenalutho, funda "Yini into yokusa yokusa nokuthi ungayilawula kanjani." Landela izincomo ezichazwe lapho.

Yini okufanele uyenze uma ushukela ukhuphuka ngaphezu kuka-11 mmol / l

Uma ushukela ukhuphuka ngaphezu kwe-11 mmol / l, khona-ke esigulini esinesifo sikashukela, ukuzwela kwamangqamuzana esenzweni se-insulin kungahle kwehle. Ngenxa yalokho, imijovo izoba yimbi kakhulu kunokujwayelekile. Lo mphumela ubizwa kakhulu uma ushukela ukhuphukela ku-13 mmol / L nangaphezulu. Kubantu abalandela ngokucophelela uhlelo lohlobo lwe-1 yesifo sikashukela noma uhlobo lwenkinga yesifo sikashukela 2, ushukela ophezulu onjalo awunqabile.

Uma usenokuphazamiseka okunjalo, qala ngokufaka i-insulin ngokushesha njenge-bolus yokulungisa, njengoba uvame ukwenza. Bala umthamo wayo ngokwendlela echazwe ngenhla. Kucatshangwa ukuthi usuvele ukuthola ukuthi ingakanani i-insulin eyehlisa ushukela wakho. Linda amahora ama-5, bese ulinganisa ushukela wakho nge-glucometer bese uphinda inqubo. Kusukela okokuqala, ushukela akunakwenzeka ukuthi wehle uye kwesejwayelekile, kepha kusukela ngokwesibili, ngokunokwenzeka, yebo. Bheka isizathu sokuthi ushukela wakho weqe kakhulu, bese ubhekana nakho. Uma uphatha isifo sakho sikashukela ngokuya ngezincomo zesayithi lethu, khona-ke lokhu akufanele kwenzeke nakancane. Icala ngalinye elinjalo lidinga ukuthi liphenyisiswe kahle.

Izifo ezithathelanayo kanye nokulawulwa kwesifo sikashukela

Isifo esithathelwanayo noma esidlulayo yisizathu esivame kakhulu sokuthi ukujova kwe-insulin kubi kakhulu kunokujwayelekile. Hlola isigaba esithi “Izifo Ezithathelwanayo” esihlokweni esithi “Okuthinta Ushukela Wegazi”. Funda nokuthi ungawelapha kanjani umkhuhlane, umkhuhlane, ukugabha nohudo kushukela.

Iziphetho

Ngemuva kokufunda i-athikili, ufunde ukuthi ungabalwa kanjani imithamo ye-insulin emfushane ne-ultrashort yomjovo ngaphambi kokudla, nokuthi ungajwayeza kanjani ushukela uma ukhuphuka. Umbhalo unikeza izibonelo ezinemininingwane zokubala imithamo ye-insulin esheshayo. Imithetho yeziguli ezinesifo sikashukela sohlobo 1 nohlobo 2 sikashukela ihlukile, ngakho izibonelo azifani. Sizamile ukwenza izibonelo zicace ngangokunokwenzeka. Uma okuthile kungacacile - buza imibuzo kumazwana, futhi umphathi wesayithi uzowaphendula ngokushesha.

Isiphetho esifushane:

1. Ukudla okune-carbohydrate ephansi kuyindlela enkulu yokwelapha (control) uhlobo 1 nohlobo 2 sikashukela.
2. Uma ulandela ukudla okune-carbohydrate ephansi, imithamo ye-insulin iyadingeka ephansi. Ngemuva kokushintsha kusuka ekudleni "okunokulinganisela" noma okuphansi kilojoule, bancipha izikhathi ezi-2-7.
3. Ngohlobo 2 sikashukela, aqala ngemijovo ye-insulin uLantus noma iLevemir ebusuku nasekuseni. Imijovo ye-insulin esheshayo ngaphambi kokudla ingezwa kamuva uma kudingeka.
4. Ezigulini ezinesifo sikashukela sohlobo 2, imfundo yezomzimba ngentokozo, ikakhulukazi ukugijimisa, ivamisa ushukela esikhundleni somjovo we-insulin. Isifundo somzimba asisizi kuphela ku-5% wamacala amakhulu asebekhulile. Ku-95% osele, kukuvumela ukuthi wenqabe imijovo ye-insulin ngaphambi kokudla.
5. Uma unamathela ekudleni okuphansi kwe-carbohydrate, khona-ke ngaphambi kokudla, kungcono ukujova i-insulin efushane yomuntu - i-Actrapid NM, Humulin Regular, Insuman Rapid GT, Biosulin R.
6. Izinhlobo ze-Ultrashort ze-insulin - i-Humalog, i-Apidra, i-NovoRapid - zimbi kakhulu ekudleni ngoba zenza ngokushesha okukhulu futhi zibangela ukweqa ushukela.
7. Kusezingeni eliphezulu ukujova i-insulin ebusuku nasekuseni, i-insulin emfushane ngaphambi kokudla, bese ugcine i-Humalog emfushane kakhulu emacala lapho udinga ukwehlisa ushukela omningi ngokushesha.
8. I-insulin sensitivity factor - malini i-UNIT ye-insulin yehlisa ushukela wegazi lakho.
9. I-carbohydrate coeffnty - ingakanani i-carbohydrate yokudla emboza iyunithi eyi-1 ye-insulin.
10. I-insulin sensitivity factor kanye ne-carbohydrate coefficients ongayithola ezincwadini naku-Intanethi ayinembile. Isiguli ngasinye sikashukela sinezabo. Faka ngokuhlola. Ekuseni, ekudleni kwasemini nakusihlwa zihlukile.
11. Ungazami ukufaka imijovo ye-insulin esheshayo ngaphambi kokudla ngemijovo yemithamo emikhulu ye-insulin enwetshiwe!
12. Musa ukudida imithamo ye-insulin emfushane ne-ultrashort. Izinhlobo ze-insulashort ze-insulin zinamandla izikhathi ezingama-1.5-2,5 kunezimfishane, ngakho-ke imithamo yazo kufanele ibe ngaphansi.
13. Funda ukufaka i-insulin. Bheka ukuthi i-insulin emfushane nebucayi ikwenza kanjani kuwe.
14. Funda imithetho yokugcinwa kwe-insulin bese uyilandela.

Ngakho-ke, uthole indlela yokubala umthamo we-insulin emfushane ne-ultrashort yemijovo ezimweni ezihlukile. Ngenxa yalokhu, unethuba lokugcina ushukela wakho ujwayelekile ngokwejwayelekile, njengabantu abanempilo. Kodwa-ke, ulwazi ngezindlela zesifo sikashukela zokujova kwe-insulin akususi isidingo sokudla okuphansi kwe-carbohydrate. Uma ukudla kwesifo sikashukela kugcwele ama-carbohydrate, khona-ke akukho sibalo semithamo ye-insulin esizoyisindisa kuma-ushukela, ukuthuthukiswa kwezinkinga ezibangelwa yisifo somzimba kanye nesibindi.

Kukhona nezinye izinto ezithinta ushukela ezigulini ezinesifo sikashukela. Lezi yizifo ezithathelanayo, izimo ezicindezelayo, isimo sezulu, izinkathi zonyaka ezishintshayo, ukuphuza imithi, ikakhulukazi izidakamizwa ze-hormonal Kwabesifazane, kunezigaba zomjikelezo wokuya esikhathini, ukukhulelwa, ukuya esikhathini. Usuvele wazi ukuthi ungashintsha kanjani umthamo we-insulin ngokuya ngokudla nezinkomba zikashukela. Isinyathelo esilandelayo ukufunda ukwenza ukuhlela kucabangele izinto zesibili. Bheka isihloko esithi “Okuthinta Ushukela Wegazi” ngemininingwane. Kuyisengezo esidingekayo kokuqukethwe odlule kukho.