Iphampu ye-insulin: izinzuzo nezingozi. Ukwelashwa kwe-insulin

Iphampu ye-insulin iyithuluzi lokujova i-insulin emzimbeni wesifo sikashukela, enye indlela yokusebenzisa isirinji namapeni wesirinji. Iphampu ye-insulin ihambisa umuthi njalo, futhi lokhu kuyinzuzo yayo eyinhloko ngaphezulu kwemijovo yendabuko ye-insulin. Ukwelashwa kwe-insulin okwenziwe ngepump kunezinzuzo ezinkulu, kepha futhi nokubi, futhi sizokuchaza konke lokhu ngokuningiliziwe esihlokweni.

Abakhiqizi basebenzisa imizamo emikhulu ukumaketha amaphampu abo e-insulin. Lawa madivayisi anezinzuzo ezimbili eziyinhloko:

• lula ukuphathwa kwansuku zonke kwama-doses amaningi amancane e-insulin;
• susa ngokuphelele isidingo sokujova i-insulin.

Iphampu ye-insulin iyithuluzi lezokwelapha lokuphatha ngokuqhubekayo i-insulin ekwelapheni isifo sikashukela

Iphampu ye-insulin iyithuluzi eliyinkimbinkimbi elihlanganisa:

• iphampu - iphampu yokuhlinzeka nge-insulin, kanye nekhompyutha enohlelo lokulawula;
• isitoreji esibuyiselekayo se-insulin (ibhokisi lokudla, ngaphakathi kwephampu);
• isethi yokufakelwa engaguquki ehlanganisa i-cannula yokulawulwa okungaqondakali kanye nohlelo lwamashubhu okuxhuma isigcini se-cannula;
• amabhethri.

Iphampu ye-insulin ingagcwaliswa nganoma iyiphi i-insulin emfushane (kunconyelwa ukusebenzisa i-ultrashort Humalog, i-NovoRapid noma i-Apidra), okwanele izinsuku eziningana ngaphambi kokuthi udinge ukukhulisa ithangi.

Iphampu yokuqala ye-insulin eyakhiwe kahle yaklanywa emuva ngo-1963 nguDkt Arnold Kadesh elabhorethari yaseWhitehall e-Elkhart, e-USA. Kwakuyinto yokusebenza enesisindo esingaphezu kwama-8 kg. Ngokuqhubekayo walifafaza igazi lesiguli ngebhulokhi elilinganisa ukugxila koshukela. Ngokusekelwe emiphumeleni yalezizilinganiso, i-insulin noma i-glucose yafakwa egazini.

Ngemuva kuka-1978, kwaqala ukuvela amaphampu e-insulin acwebile - ayanda futhi “athuthukile” futhi akhululekile. Isiguli singakwazi ukufaka amanani ahlukene wokuphathwa kwe-"basal" ne "bolus" insulin. Ukwelashwa kwe-insulin okusetshenziselwa iPump sekuvele kunezinzuzo ezinkulu ekwelashweni kwesifo sikashukela ... kepha kusenezinto ezingahambi kahle, ngoba esibuye sincome ukuthi kufakwe i-insulin nge-syringes, ngisho nasezinganeni ezinesifo sikashukela sohlobo 1. Funda imininingwane engezansi.

Esikhathini esizayo esiseduze, kufanele silindele ukuvela kwamaphampu e-insulin emakethe, angavele ngokuzenzakalelayo (ngaphandle kokubamba iqhaza kwesiguli) alondoloze izinga lokubuyiswa kwe-carbohydrate metabolism eduze nelilungele. Amadivayisi anjalo, empeleni, azongena esikhundleni samanyikwe emvelo.

Ngabe isebenza kanjani iphampu ye-insulin

Iphampu ye-insulin yesimanje iyithuluzi elincane elilingana nosayizi we-pager. I-insulin ingena emzimbeni wesifo sikashukela ngohlelo lwama-hoses athambile (i-catheter ephetha nge-cannula). Baxhuma isitoreji ne-insulin ngaphakathi kwephampu ngamafutha angaphansi. I-insulin reservoir kanye ne-catheter kuhlangene kubizwa ngokuthi "uhlelo lokufaka." Isiguli kufanele siyishintshe njalo ezinsukwini ezi-3. Lapho uguqula uhlelo lokufakwa, indawo yokunikezwa kwe-insulin iyashintsha njalo. I-cannula yepulasitiki (hhayi inaliti!) Ibekwa ngaphansi kwesikhumba ezindaweni ezifanayo lapho i-insulin ivame ukujova khona nge-syringe. Lesi yisisu, okhalweni, amabhuzu kanye namahlombe.

Impompo ivame ukulimaza i-analogue ye-insulin efushane noma emfushane ngaphansi kwesikhumba (Humalog, NovoRapid noma i-Apidra). Okungasetshenziswa kakhulu yi-insulin esebenza ngabantu. I-insulin inikezwa ngemithamo emincane kakhulu, emayunithi angama-0,025-0.100 isikhathi ngasinye, kuya ngemodeli yepampu. Lokhu kwenzeka ngejubane elinikeziwe. Isibonelo, ngejubane le-0,60 PIECES ngehora, iphampu izokwengamela ama-0.05 PIECES we-insulin njalo ngemizuzu emi-5 noma ama-0.025 PIECES njalo ngemizuzwana eyi-150.

Iphampu ye-insulin ilingisa ama-pancreas omuntu onempilo ngangokunokwenzeka. Lokhu kusho ukuthi uphatha i-insulin ngezindlela ezimbili: i-basal ne-bolus. Funda kabanzi esihlokweni esithi "Ama-Insulin Therapy Schemes". Njengoba wazi, ngezikhathi ezahlukahlukene zosuku, ama-pancreas afihla i-insal insulin ngejubane elihlukile. Amaphampu we-insulin anamuhla avumela ukuthi uhlele izinga lokuphathwa kwe-insal insulin, futhi ingashintsha esimisweni njalo ngehora. Kuyavela ukuthi ngezikhathi ezahlukahlukene zosuku, i-insulin “yasemuva” ingena egazini ngejubane elihlukile. Ngaphambi kokudla, kuthathwa umthamo we-bolus isikhathi ngasinye. Lokhu kwenziwa yisiguli ngesandla, i.e., hhayi ngokuzenzakalelayo. Futhi, isiguli singanika iphampu “inkomba” yokwengeza ukufaka umthamo owodwa we-insulin uma ushukela wegazi ngemuva kokukhuphuka kakhulu.

Izinzuzo zalo esigulini

Lapho welapha isifo sikashukela ngephampu ye-insulin, kusetshenziswa i-analogue ye-insulin efushane-emfushane esebenza ngokufushane (i-Humalog, NovoRapid noma enye). Ngokuvumelana nalokho, i-insulin esebenza ngokubambela ayisetshenziswa Iphampu ihlinzeka ngesisombululo segazi kaningi, kepha ngemithamo emincane, futhi ngenxa yalokhu, i-insulin ifakwa cishe ngaso leso sikhathi.

Ku-diabetes, ukuguquguquka kushukela wegazi kuvame ukwenzeka ngoba i-insulin ende ingangenwa ngamanani ahlukile. Lapho usebenzisa iphampu ye-insulin, le nkinga iyasuswa, futhi lokhu kuyinzuzo yayo eyinhloko. Ngoba kusetshenziswa i-insulin “emfishane” kuphela, esebenza ngokuxhamazela.

Ezinye izinzuzo zokusebenzisa iphampu ye-insulin:

• Isinyathelo esincane nokunemba okuphakeme metering. Isinyathelo sedosi le-bolus le-insulin kumaphampu wanamuhla singama-0 PIERES kuphela. Khumbula ukuthi amaphenti wesirinji - ama-0.5-1.0 PIECES. Izinga lokuphakelwa kwe-insal insulin lingashintshwa libe ngu-0,025-0.100 PIECES / ihora.
• Isibalo sokufika kwesikhumba sincishiswa izikhathi eziyi-12-15. Khumbula ukuthi uhlelo lokufakwa kwepompo ye-insulin kufanele lushintshe isikhathi esingu-1 ngezinsuku ezi-3. Futhi ngokwelashwa kwendabuko kwe-insulin ngokuya ngohlelo oluqinisiwe, kufanele wenze imijovo engama-4-5 nsuku zonke.
• Iphampu ye-insulin ikusiza ukubala umthamo wakho we-insulin. Ukuze wenze lokhu, abanesifo sikashukela badinga ukuthola futhi bafake imingcele yabo ngamunye kuhlelo (i-carbohydrate coefficient, sensitivity ye-insulin ngezikhathi ezihlukile zosuku, gxila izinga likashukela wegazi). Uhlelo lusiza ukubala umthamo ofanele we-insulin bolus, ngokususelwa emiphumeleni yokulinganisa ushukela egazini ngaphambi kokudla nokuthi mangaki ama-carbohydrate ahlelelwe ukuwadla.
• Izinhlobo ezikhethekile zama-boluses. Iphampu ye-insulin ingashintshwa ukuze umthamo we-bolus we-insulin ungangenwa ngasikhathi sinye, kodwa welule ngokuhamba kwesikhathi. Lesi isici esisebenzayo lapho umuntu onesifo sikashukela edla ama-carbohydrate wokuthambisa kancane, futhi uma kwenzeka edilini elide.
• Ukuqapha okuqhubekayo kwe-glucose yegazi ngesikhathi sangempela. Uma ushukela wegazi ungaphandle kwebanga - iphampu ye-insulin ixwayisa isiguli. Amamodeli wakamuva "athuthukile" angashintsha ngokuzimela isilinganiso sokuphathwa kwe-insulin ukwenza ushukela wegazi ube ngokwejwayelekile. Ikakhulu, bacisha ukugeleza kwe-insulin ngesikhathi se-hypoglycemia.
• Isitoreji selogi ledatha, sizidlulisela kwikhompyutha ukuze ilungiswe futhi ihlaziywe. Amaphampu amaningi we-insulin aligcina kwimemori yawo i-data yedatha ezinyangeni ezi-6 ezedlule. Lolu lwazi yilokho imithamo ye-insulin efakiwe futhi lalingakanani izinga le-glucose egazini. Kungakuhle ukuhlaziya le mininingwane zombili ezigulini uqobo kanye nodokotela ohamba naye.

Uma ukuqeqeshwa kokuqala kwesiguli bekungekuhle, ukushintshela ekusebenziseni iphampu ye-insulin kungenzeka kungaphumeleli. Isifo sikashukela kufanele siqonde ngokucophelela ukuthi singalungiswa kanjani isilinganiso sokuphathwa kwe-insulin ngemodi ye-basal futhi sihlele ukuphathwa kwe-bolus insulin.

Ukwelashwa kwe-insulin: izinkomba

Izinkomba ezilandelayo zihlukaniswa ngoguquko lokupompa ukwelashwa kwe-insulin:

• isifiso sesiguli uqobo;
• akunakwenzeka ukuthola isinxephezelo esihle sesifo sikashukela (inkomba ye-hemoglobin ye-glycated igcinwe ngaphezulu kwe-7.0%, ezinganeni ezingenhla kuka-7.5%);
• izinga le-glucose egazini lesiguli livama ukuguquguquka kakhulu;
• ukubonakaliswa okuvame kwe-hypoglycemia kuyaphawulwa, kufaka phakathi okunzima, kanye nasebusuku;
• ukwenzeka "kokusa kokusa";
• i-insulin ngezinsuku ezihlukene ithinta isiguli ngezindlela ezihlukile (kushiwo ukwehluka kwesenzo se-insulin);
• iphampu ye-insulin iyanconywa ukuthi isetshenziswe ngenkathi kuhlelwa ukukhulelwa, lapho izala, ngesikhathi sokubeletha kanye nesikhathi sokubeletha;
• iminyaka yezingane - e-USA cishe i-80% yezingane ezinesifo sikashukela zisebenzisa amaphampu e-insulin, eYurophu - cishe ama-70%;
• ezinye izinkomba.

Ukwelashwa kwe-insulin okusetshenzelwa ngo-Pump kufanelekile kuzo zonke iziguli ezinesifo sikashukela esidinga i-insulin. Kubandakanya, nesifo sikashukela se-autoimmune ngokuqala sekwephuzile kanye nezindlela zesifo sikashukela. Kepha kune-contraindication kusetshenziswa iphampu ye-insulin.

Contraindication

Amaphampu we-insulin anamuhla enzelwe ukuthi kube lula ukuthi iziguli zikwazi ukuzisebenzisa futhi zizisebenzise. Kodwa-ke, i-insulin yokwelapha esekwe kumpompo idinga ukubamba iqhaza kwesiguli ekwelashweni kwabo. Iphampu ye-insulin akufanele isetshenziswe ezimweni lapho ukubamba iqhaza okunjalo kungeke kwenzeke.

Ukwelashwa kwe-insulin okusekwe ngo-Pump kwandisa ingozi yeziguli ze-hyperglycemia (ukwanda okunamandla ushukela wegazi) kanye nokuthuthukiswa kwesifo sikashukela sikashukela. Ngoba lapho usebenzisa iphampu ye-insulin egazini lomuntu onesifo sikashukela, ayikho i-insulin eyengezekile. Uma kungazelelwe ukuhanjiswa kwe-insulin kufushane, khona-ke izinkinga ezinzima zingavela ngemuva kwamahora ama-4.

Contraindication for pump insulin therapy yizimo lapho isiguli singakwazi noma singafuni ukufunda amaqhinga okuphatha kakhulu isifo sikashukela, isb., Amakhono okuzihlola we-glucose egazini, sibala ama-carbohydrate ngokohlelo lwesinkwa, ukuhlela ukusebenza komzimba, ukubala umthamo we-bolus insulin.

Ukwelashwa kwe-insulin yokwelapha akusetshenziselwa iziguli ezinokugula kwengqondo okungaholela ekusingatheni okwanele kwensiza. Uma umuntu onesifo sikashukela enokwehla okuphawulekile kombono, khona-ke uyoba nezinkinga zokubona okubhalwe esikrinini sephampu ye-insulin.

Esikhathini sokuqala sokwelashwa kwe-pump insulin, ukubhekwa njalo kwezokwelapha kuyadingeka. Uma ingeke inikezwe, ukuguqulelwa ekwelashweni kwe-insulin okusetshenzelwa ngepompo kufanele kuhlehliswe “kuze kube yizikhathi ezingcono”.

Ungayikhetha kanjani iphampu ye-insulin

Okudingayo ukunaka lapho ukhetha iphampu ye-insulin:

1. IVolumu yensimbi. Ingabe ibamba i-insulin eyanele izinsuku ezintathu? Khumbula ukuthi isethi yokumnika kufanele iguqulwe okungenani kanye ezinsukwini ezi-3.
2. Ingabe kufanelekile ukufunda izinhlamvu nezinombolo ezivela esikrinini? Ingabe ukukhanya kwesikrini nokuqhathanisa kulungile?
3. Imithamo ye-bolus insulin. Naka imithamo emincane futhi ephezulu ye-bolus insulin. Baqinisile ngawe? Lokhu kuyiqiniso ikakhulukazi ezinganeni ezidinga imithamo ephansi kakhulu.
4. Okokubala okwakhelwe ngaphakathi. Ingabe iphampu yakho ye-insulin ikuvumela ukuba usebenzise ubuwena bakho? Lokhu kuyisici sokuzwela i-insulin, i-carbohydrate eyanele, isikhathi sesenzo se-insulin, izinga le-glucose egoli. Ngabe ukunemba kwalezi zinto ezilinganayo kwanele? Akufanele yini ukuba zizungeze kakhulu?
5. Alamu Uyayizwa i-alamu noma idlidliza uma kuqala izinkinga?
6. Ukumelana namanzi. Ngabe udinga ipompo elizovimbela ngokuphelele amanzi?
7. Ukuxhumana namanye amadivaysi. Kunamaphampu we-insulin angahlangana ngokuzimela nama-glucometer kanye namadivayisi wokuqapha okuqhubekayo kwe-glucose egazini. Ngabe uyayidinga?
8. Ingabe kufanelekile ukugqoka iphampu empilweni yansuku zonke?

Ukubalwa kwemithamo ye-insulin yokwelapha i-pump insulin

Khumbula ukuthi izidakamizwa zokukhetha i-pump insulin therapy namuhla zingama-insulin an-insulin. Njengomthetho, sebenzisa i-Humalog. Cabanga ngemithetho yokubala imithamo ye-insulin yokuphatha ngepompo ku-basal (ingemuva) nemodi ye-bolus.

Ngabe uphatha i-insulin nini? Ukubala lokhu, udinga ukwazi ukuthi yimiphi imithamo ye-insulin isiguli esiyitholile ngaphambi kokusebenzisa iphampu. Umthamo ophelele we-insulin nsuku zonke kufanele wehliswe ngo-20%. Kwesinye isikhathi kwehliswa ngisho ngo-25-30%. Lapho ukupompa ukwelashwa kwe-insulin ngemodi ye-basal, cishe i-50% yedosi yansuku zonke ye-insulin iyabhalwa.

Cabanga ngesibonelo. Isiguli sathola amayunithi e-insulin angama-55 ngosuku ngemijovo eminingi. Ngemuva kokushintshela kwiphampu ye-insulin, kufanele athole amayunithi angama-55 x 0.8 = amayunithi angama-44 e-insulin ngosuku. Umthamo we-basal we-insulin uyisigamu senani eliphuza nsuku zonke, i.e. amayunithi angama-22. Izinga lokuqala lokuphathwa kwe-insal insulin lizoba amahora angama-22 U / 24 = 0.9 U / ihora.

Okokuqala, iphampu iyaguqulwa ukuze izinga lokugeleza kwe-insal insulin lifane usuku lonke. Bese beguqula lelijubane ngesikhathi sasemini nasebusuku, ngokusho kwemiphumela yezilinganiso eziningi zamazinga kashukela egazini. Isikhathi ngasinye, kunconywa ukuthi kushintshwe izinga lokuphathwa kwe-insal insulin kungadluli i-10%.

Izinga lokulethwa kwe-insulin egazini ebusuku likhethwa ngokuya ngemiphumela yokulawulwa kukashukela wegazi ngesikhathi sokulala, ngemuva kokuvuka naphakathi kobusuku. Izinga lokuphathwa kwe-insal insulin phakathi nosuku lilawulwa yimiphumela yokuziqapha kwe-glucose egazini ngaphansi kwezimo zokudla okweqa.

Umthamo we-bolus insulin, ozothunyelwa kumpompo uye egazini ngaphambi kokudla, uhanjiswa ngesandla yisiguli isikhathi ngasinye. Imithetho yokubala kwayo iyafana nangokwelashwa okuqinisa insulin ngemijovo. Ngokubheka, ukubalwa komthamo we-insulin kuchazwe ngemininingwane enkulu.

Amaphampu we-insulin ayindlela lapho silindele khona izindaba ezinkulu nsuku zonke. Ngoba ukuthuthukiswa kwephampu ye-insulin kuyaqhubeka, okuzosebenza ngokuzimele, njenge-pancreas yangempela. Lapho kuvela into enjalo, kuzoba inguquko ekwelashweni kwesifo sikashukela, okulingana nokuvela kwama-glucometer. Uma ufuna ukwazi ngaso leso sikhathi - bhalisela i-newsletter yethu.

Izinkinga zokwelapha isifo sikashukela ngepompo le-insulin

Ukuntuleka kwe-insulin pump kushoda kushukela:

• Izindleko zokuqala zompompo zibaluleke kakhulu.
• Izindleko zokusetshenziswa ziphezulu kakhulu uma usebenzisa i-insulin syringes.
• Amaphampu awuthembekile kakhulu, ukulethwa kwe-insulin kwabanesifo sikashukela kuvame ukuphazamiseka ngenxa yezinkinga zobuchwepheshe. Lokhu kungaba ukungasebenzi kahle kwesoftware, i-insulin crystallization, i-cannula ivele ngaphandle kwesikhumba nezinye izinkinga ezijwayelekile.
• Ngenxa yokungathembeki kwamaphampu we-insulin, i-ketoacidosis esebusuku ebusuku ezigulini ezinesifo sikashukela sohlobo lwe-1 ezisebenzisayo zenzeka kaningi kunalabo abajova i-insulin ngama-syringes.
• Abantu abaningi abayithandi imibono yokuthi i-cannula namashubhu kuyohlala kunamathele esiswini sabo. Kungcono ukunambitha inqubo yokulimala ngaphandle kwezihlungu nge-insulin.
• Izindawo ze-cannula ezingaphansi komhlaba zivame ukutheleleka. Kukhona nama-thumba adinga ukungenelela okuhlinza.
• Abakhiqizi bathi "ukunemba okukhulu kwe-dosing", kepha ngasizathu simbe i-hypoglycemia etholakala kakhulu phakathi kwabasebenzisi bamaphampu we-insulin kaningi. Kungahle kube ngenxa yokuhluleka kwemishini kwezinhlelo ze-dosing.
• Abasebenzisi be-insulin pump bahlangabezana nezinkinga lapho bezama ukulala, ukugeza, ukubhukuda noma ukuya ocansini.

Amaphutha abucayi

Phakathi kwezinzuzo zamaphampu we-insulin, kukhonjiswa ukuthi banezinyathelo zokuqoqa umthamo we-insulin - ama-0.1 PIECES kuphela. Inkinga ukuthi lo muthi uphathwa okungenani kanye ngehora! Ngakho-ke, isilinganiso esincane se-insulin esingama-2.4 amayunithi ngosuku. Ezinganeni ezinesifo sikashukela sohlobo 1, lokhu kukhulu kakhulu. Ezigulini zabantu abadala abanesifo sikashukela abalandela ukudla okune-carbohydrate ephansi, zingaba ziningi.

Ake sithi isidingo sakho sansuku zonke se-insal insulin amayunithi ayi-6.Usebenzisa iphampu ye-insulin enesinyathelo esinqunyiwe se-0.1 PIECES, kuzofanele uphathe ama-insulin 4.8 PIECES ngosuku noma ama-7.2 PIECES ngosuku. Kuzoholela ekusweleni noma ekugqungeni. Kunamamodeli wanamuhla anesinyathelo esibekiwe samayunithi angama-0.025. Baxazulula le nkinga kubantu abadala, kodwa hhayi izingane ezincane ezilashelwa isifo sikashukela sohlobo 1.

Ngokuhamba kwesikhathi, amafomu ama-suture (fibrosis) ezindaweni zokufaka umjovo we-cannula wangaphansi njalo. Lokhu kwenzeka kubo bonke abanesifo sikashukela abasebenzisa iphampu ye-insulin iminyaka engu-7 noma ngaphezulu. Ukushiswa okunjalo akubheki nje ukujabulisa ubuhle, kepha kulimaza ukumuncwa kwe-insulin. Ngemuva kwalokhu, i-insulin isebenza ngokungalindelekile, futhi nemithamo yayo ephezulu ngeke ikwazi ukubuyisela ushukela wegazi kujwayelekile. Lezo zinkinga zokwelashwa kwesifo sikashukela esizixazulula ngempumelelo sisebenzisa indlela yemithwalo emincane, ukusebenzisa iphampu ye-insulin akunakuxazululwa.

Ukwelashwa kwe-insulin: iziphetho

Uma ulandela uhlelo lokwelapha isifo sikashukela sohlobo lwe-1 noma uhlelo lokwelapha isifo sikashukela sohlobo 2 bese ulandela ukudla okuphansi kwe-carbohydrate, khona-ke ipompo ye-insulin ayinikezeli ukulawulwa kweshukela okungcono kunokusebenzisa isirinji. Lokhu kuzoqhubeka kuze kube yilapho iphampu ifunda ukukala ushukela wegazi kwisifo sikashukela bese ilungisa ngokuzenzakalelayo umthamo we-insulin ngokususelwa emiphumeleni yalezizilinganiso. Kuze kube yilesi sikhathi, asikukhuthazi ukusetshenziswa kwamaphampu we-insulin, kubandakanya nezingane, ngenxa yezizathu ezishiwo ngenhla.

Dlulisela ingane enesifo sikashukela sohlobo 1 ekudleni okune-carb ngokushesha nje lapho usuyeka ukuncelisa ibele. Zama ukumenza akwazi kahle inqubo yemijovo engenayo i-insulin engenalutho nge-syringe ngendlela edlalayo.