Ukwethulwa kwe-insulin njengekhambi lokuphindisela lesifo sikashukela namuhla kuyindlela kuphela yokulawula i-hyperglycemia kusifo sohlobo 1, kanye nasesimweni sikashukela sohlobo lwe-insulin 2.
Ukwelashwa kwe-insulin kwenziwa ngendlela yokuthi kungeniswe isigqi sehomoni egazini njengokuqina komzimba ngangokunokwenzeka.
Ngakho-ke, izidakamizwa zezikhathi ezahlukahlukene zokufakwa emzimbeni wezicubu ezi-subcutaneous ziyasetshenziswa. Ama-insulin amade alingisa ukukhishwa kwe-hormone okuyisisekelo, okungahambisani nokufakwa kokudla emathunjini, futhi ama-insulin amafushane nama-ultrashort asiza ukwehlisa i-glycemia ngemuva kokudla.
I-insulin engokwemvelo neyakhiwe
I-insulin ibhekisela kuma-hormone anomjikelezo wemfundo wezigaba eziningi. Kuqala, kuma-isancancan we-pancreatic, okungukuthi kumaseli we-beta, kwakhiwa uchungechunge lwama-amino acid ayi-110, elibizwa nge-preproinsulin. Amaprotheni esignali ahlukanisiwe nalo, kuvela ama-proinsulin. Le proteni ifakwe emigodini, lapho ihlukaniswe khona nge-C-peptide ne-insulin.
Ukulandelana kwe-amino acid okusondele kakhulu yi-porcine insulin. Esikhundleni se-threonine kuyo, i-chain B iqukethe i-alanine. Umehluko osisekelo phakathi kwe-bovine insulin ne-insulin yabantu yizinsalela ezi-3 ze-amino acid. Ama-antibodies akhiqizwa kuma-insulin ezilwane emzimbeni, okungadala ukumelana nomuthi olungiselelwe.
Ukuhlanganiswa kokulungiswa kwe-insulin yesimanje ezimeni zelebhu kwenziwa kwenziwe kusetshenziswa ubunjiniyela bezakhi zofuzo. I-biosynthetic insulin iyafana ekwakhiweni kwe-amino acid yomuntu, ikhiqizwa kusetshenziswa ubuchwepheshe be-DNA esebenza kabusha. Kunezindlela ezi-2 eziphambili:
- Ukuhlangana kwamagciwane aguqulwe ngofuzo.
- Kusuka ku-proinsulin eyenziwe yi-bacterium modified.
I-Phenol iyisibambiso esivikela ekuvikelweni ekugomeni kwegciwane le-insulin emfushane; i-insulin ende iqukethe i-paraben.
Inhloso ye-Insulin
Ukukhiqizwa kwe-hormone emzimbeni kuyaqhubeka futhi kubizwa ngokuthi ukucwaswa kwe-basal noma ngemuva. Indima yayo ukugcina amazinga evamile eglucose ngaphandle kokudla, kanye nokufakwa kweglucose engenayo evela esibindini.
Ngemuva kokudla, ama-carbohydrate angena egazini evela emathunjini njengeglucose. Ukuyidinga kudinga inani elingeziwe le-insulin. Lokhu kudedelwa kwe-insulin egazini kubizwa ngokuthi i-sec (postprandial) secretion, okuthi, ngemuva kwamahora 1.5-2, i-glycemia ibuyele ezingeni layo lasekuqaleni, futhi ithole ushukela ungena emangqamuzaneni.
Ngohlobo 1 sikashukela, i-insulin ayikwazi ukwakhiwa ngenxa yomonakalo we-autoimmune kumaseli we-beta. Ukubonakaliswa kwesifo sikashukela kwenzeka ngesikhathi sokucekelwa phansi ngokuphelele kwezicubu ze-islet. Ngohlobo lokuqala lwesifo sikashukela, i-insulin ifakwa ezinsukwini zokuqala zesifo kanye nokuphila.
Uhlobo lwesibili sikashukela ekuqaleni lunganxeshezelwa ngamaphilisi, ngenkambiso yesikhathi eside yesifo, i-pancreas ilahlekelwa amandla okwenza i-hormone yayo. Ezimweni ezinjalo, iziguli zifakwa nge-insulin kanye namaphilisi noma njengesidakamizwa esikhulu.
I-insulin nayo ibekelwe ukulimala, ukuhlinzwa, ukukhulelwa, izifo kanye nezinye izimo lapho amazinga kashukela engeke ancishiswe kusetshenziswa amaphilisi. Izinjongo ezitholakala ngokuqaliswa kwe-insulin:
- Jwayela ushukela wegazi osheshayo, futhi uvikele ukwanda kwawo ngokweqile ngemuva kokudla ama-carbohydrate.
- Nciphisa ushukela womchamo.
- Nqamula amakhaza we-hypoglycemia nesifo sikashukela.
- Gcina isisindo somzimba esifanele.
- I-Normal metabolism yamafutha.
- Thuthukisa ikhwalithi yempilo yabantu abanesifo sikashukela.
- Ukuvimbela izinkinga ze-vascular and neurological zesifo sikashukela.
Izinkomba ezinjalo zibonisa inkambo enesifo sikashukela esinxephezelwe kahle. Ngenxephezelo egculisayo, ukuqedwa kwezimpawu eziphambili zesifo, i-hypo- kanye ne-hyperglycemic coma, ne-ketoacidosis kuyaphawulwa.
Ngokuvamile, i-insulin evela kumanyikwe idlula ngohlelo lwe-portal vein engena esibindini, lapho ichithwa khona isigamu, bese inani elisele lisatshalaliswa emzimbeni wonke. Izici zokungeniswa kwe-insulin ngaphansi kwesikhumba zibonakaliswa eqinisweni lokuthi lingena egazini sekwephuzile, nasesibindi nakamuva. Ngakho-ke, ushukela wegazi uphakanyiswa isikhathi esithile.
Kulokhu, kusetshenziswa izinhlobo ezahlukahlukene ze-insulin: i-insulin esheshayo, noma i-insulin esebenza ngokushesha, okudingeka uyijove ngaphambi kokudla, kanye namalungiselelo we-insulin osebenza isikhathi eside (insulin ende), osetshenziswe amahlandla ama-1 noma amabili ukuthola i-glycemia ezinzile phakathi kokudla.
Ngabe isebenza kanjani i-insulin?
Ukulungiswa kwe-insulin, njengama-hormone emvelo, kubopha kuma-receptors kulwelwesi lweseli bese kungena kuwo. Esitokisini, ngaphansi kwethonya le-hormone, kuqalwa ukusungulwa kwezinto eziphilayo. Ama-receptor anjalo atholakala kuzo zonke izicubu, futhi kumaseli okuhlosiwe kukhona amashumi ezikhathi awo ngaphezulu. Ukuze uncike kuma-insulin kufaka phakathi amaseli wesibindi, ama-adipose nezicubu zomzimba.
I-insulin nemithi yayo ilawula cishe zonke izixhumanisi ze-metabolic, kepha umphumela ushukela wegazi uyinto ephambili. I-hormone ihlinzeka ukunyakaza kwe-glucose ngokusebenzisa ulwelwesi lweseli futhi ikhuthaza ukusetshenziswa kwayo ngendlela ebaluleke kakhulu yokwenza amandla - glycolysis. IGlycogen yakhiwa kusuka kushukela kusibindi, kanti nokuqanjwa kwamangqamuzana amasha nakho kuncishisiwe.
Le miphumela ye-insulin ibonakala eqinisweni lokuthi izinga le-glycemia liba eliphansi. Ukulawulwa kokuhlanganiswa kwe-insulin kanye nokugcinwa secretion kusekelwa ukugxila kwe-glucose - kukhuphuka izinga le-glucose, futhi eliphansi livimbele ukufihla. Ngaphezu kwe-glucose, ukwakheka kuthinteka kokuqukethwe kwama-hormone egazini (i-glucagon ne-somatostatin), i-calcium nama-amino acid.
Umphumela we-metabolic we-insulin, kanye nezidakamizwa ngokuqukethwe kwawo, uboniswa ngale ndlela:
- Ivimbela ukwephulwa kwamafutha.
- Inqanda ukwakheka kwemizimba ye-ketone.
- Ama-acid angaphansi kwamafutha angena egazini (andisa ingozi ye-atherosulinosis).
- Emzimbeni, ukwephulwa kwamaprotheni kuvinjelwe futhi ukuvela kwawo kusheshisiwe.
I-insorption kanye nokusatshalaliswa kwe-insulin emzimbeni
Amalungiselelo e-insulin afakwa emzimbeni. Ukuze wenze lokhu, sebenzisa amasirinji abizwa ngokuthi ama-insulin, amasirinji, ipompo le-insulin. Ungafaka izidakamizwa ngaphansi kwesikhumba, ungene emqubeni futhi ungene emthanjeni. Ukulawulwa kwe-intravenous (esimweni sethambo), ama-insulin (ama-ICD) amafushane kuphela, futhi indlela evamile isetshenziswa.
I-pharmacokinetics ye-insulin incike kusayithi lomjovo, umthamo, ukuhlangana kwento esebenzayo nomuthi. Futhi, ukuphuma kwegazi endaweni yomjovo, ukusebenza kwemisipha kungathinta isilinganiso sokungena egazini. Ukumuncwa ngokushesha kuhlinzekwa ngomjovo odongeni lwangaphakathi lwesibeletho, umuthi ofakwe kufakwa enkingeni noma ngaphansi kobuhlalu bamahlombe umunca kakhulu.
Egazini, i-04-20% ye-insulin iboshelwa ama-globulins, ukubonakala kwama-antibodies kumuthi kungadala ukusabela okuthuthukile kokusebenzisana namaphrotheni, futhi, ngenxa yalokho, ukumelana ne-insulin. Ukumelana ne-hormone kungenzeka uma kungabekwa ingulube noma i-insulin ye-bovine.
Iphrofayili yomuthi ayikwazi ukufana ezigulini ezahlukahlukene, ngisho nakumuntu oyedwa kuncike ekushintshashintsheni.
Ngakho-ke, lapho kunikezwa idatha yesikhathi sokusebenza nokuqedwa kwesigamu sempilo, ama-pharmacokinetics abalwa ngokusho kwezinkomba ezimaphakathi.
Izinhlobo ze-insulin
Ama-insulin ezilwane, ahlanganisa i-porcine, i-bovine, i-bovine, i-insulin, ayengasetshenziswa kakhulu ekwenzeni izidakamizwa zokwenziwa - ama-analogues we-insulin yomuntu. Ngokusho kwamapharamitha amaningi, okuyinhloko okuyi-allergenicity, i-insulin enhle kakhulu yakhiwe ngofuzo.
Isikhathi sokusebenza kwamalungiselelo we-insulin sehlukaniswe ngama-ultrashort nama-insulin amafushane. Zikhiqiza kabusha ukucashunwa kwama-hormone okuvuselelwa ukudla. Imithi yesikhathi esiphakathi, kanye nemisipha emide ukulingisa ukucashelwa kwe-hormone okuyisisekelo. I-insulin emfushane ingahlanganiswa ne-insulin ende kumalungiselelo wokuhlanganiswa.
Yikuphi i-insulin enhle kakhulu - okufishane, okuphakathi noma okude, kunqunywa ngohlobo lomuntu ngamunye wokulashwa kwe-insulin, okuncike eminyakeni yobudala besiguli, izinga le-hyperglycemia kanye nokuba khona kwezifo ezihambisanayo kanye nezinkinga zikashukela.
Iqembu lama-insulin e-ultrashort libonakaliswa ukuqala kokuqala kokusebenza - ngemuva kwemizuzu eyi-10-20, ushukela wehla ngokusemandleni ngemuva kwamahora we-1-2,5, ubude besikhathi somphumela we-hypoglycemic amahora angama-3-5. Amagama izidakamizwa: Humalog, NovoRapid and Apidra.
I-insulin emfushane isebenza ngemuva kwemizuzu engama-30-60, umphumela wayo uhlala amahora angama-6-8, kanti okuphezulu kuyabonakala amahora angama-2-3 ngemuva kokuphatha. Kuyadingeka ukufaka umjovo wokulungiselela i-insulin emfushane imizuzu engama-20 kuya kwengama-30 ngaphambi kokudla, ngoba lokhu kuzonikeza inani eliphakeme le-hormone esegazini esikhathini lapho ushukela ufinyelela inani lawo eliphakeme kakhulu.
I-insulin efushane iyatholakala ngaphansi kwamagama omkhiqizo alandelayo:
- I-Actrapid NM, i-Rinsulin R, i-Humulin Regular (ukulungiswa kofuzo lwe-genulin)
- I-Khumudar R, i-Biogulin R (i-insulin eyenziwe nge-insulin).
- I-Actrapid MS, iMonosuinsulin MK (ingulule ingulube).
Yikuphi i-insulin okungcono ukuyikhetha kulolu hlu kunqunywa ngudokotela ohamba phambili ebheka ukuthambekela kokungezwani komzimba, ukuqokwa kwezinye izidakamizwa. Uma usebenzisa ama-insulin we-durations ahlukene ndawonye, kungcono uma ukhetha umakhi owodwa. Intengo yemikhiqizo ehlukahlukene ye-insulin inqunywa ngumenzi.
I-insulin esebenza ngokushesha iboniswa ukuphathwa kwansuku zonke ngaphambi kokudla main, kanye nokwelashwa kwe-coma sikashukela ngesikhathi sokungenelela kokuhlinzwa. Kwimithamo emincane, lo muthi usetshenziselwa abasubathi ukwakha izicubu zomzimba, ngokuphelelwa ngamandla, i-thyrotooticosis, i-cirrhosis.
Imithi yesikhathi esiphakathi nendawo kanye nesenzo eside isetshenziselwa ukugcina i-standardoglycemia lapho i-insulin emfushane noma ye-ultrashort ingasebenzi.
Imiyalo yokusebenzisa iqukethe imiyalo ethile ebangeni lokuphathwa kwezidakamizwa ezinjalo, imvamisa kudingeka ukuthi ihlatshwe izikhathi ezi-1 noma ezi-2 ngosuku, kuye ngezinga le-glycemia.
Ukubalwa kwamthamo we-insulin
Ukukhetha okulungile kokulashwa kuvumela iziguli ezinesifo sikashukela i-mellitus ukuthi zingayeki ukudla eziyithandayo, ngaphandle kwemikhiqizo equkethe ushukela nofulawa omhlophe. Ukunambitheka okumnandi kungatholwa kusetshenziswa kuphela oshukela.
Ukuze uqonde ukuthi ungabalwa kanjani umthamo, ongcono kune-insulin, uwusebenzisa kanjani kahle ama-insulin, le mishanguzo iyachithwa ikhumbula okuqukethwe amayunithi wesinkwa ajwayelekile (i-XE). Iyunithi elilodwa lithathwa lilingana ne-10 g yama-carbohydrate. Amayunithi esinkwa, abalwa ngokuya ngamatafula ohlobo oluthile lomkhiqizo, anqume ukuthi yiliphi idosi le-insulin okufanele liphathwe ngaphambi kokudla.
Cishe i-1 IU ye-insulin ikhishwa nge-XE ngayinye. Umthamo uyanda ngokumelana komuntu ngamunye nomuthi, kanye nokuphathwa kanyekanye kwama-hormone e-steroid, izindlela zokuvimbela inzalo, iHeparin, antidepressants kanye nezinye izindlela zokushintshashintsha komzimba.
Umphumela we-hypoglycemic we-insulin ukhuliswa ngemithi enciphisa ushukela kumathebulethi, ama-salicylates, ama-anabolic steroid, ama-androgens, i-furazolidone, i-sulfonamides, i-theophylline, izidakamizwa ezine-lithium, i-calcium.
I-Ethanol ivimbela ukwakheka kwe-glucose esibindini. Kulokhu, ukusetshenziswa kophuzo oludakayo ngemuva kolwelwesi lwe-insulin kuholela esimweni esinamandla se-hypoglycemic. Kuyingozi kakhulu ukuphuza utshwala esiswini esingenalutho.
Izincomo zokunquma umthamo omaphakathi we-insulin:
- Ukubalwa kwenziwa nge-1 kg yesisindo. Ngobuningi obwedlulele, ukuqina kuncipha ngo-0,1, ngokuntula - ngokwanda okungu-0,1.
- Ezigulini ezinesifo sohlobo lwe-1 mellitus esisanda kutholwa, amayunithi angama-0.4-0,5 nge-1 kg.
- Ngohlobo 1 sikashukela, ngesinxephezelo esingaguquki noma ukubola, umthamo unyuswa waba ngu-0.7-0.8 U / kg.
Umthamo we-insulin uvame ukwanda kwabasakhulayo ngenxa yokuqunjelwa ngokweqile kwe-hormone yokukhula nama-hormone ocansi egazini. Ngesikhathi sokukhulelwa ku-semester yesithathu, ngenxa yethonya lamahhala we-placental kanye nokuthuthukiswa kokumelana ne-insulin, umthamo womuthi uvuselelwa phezulu.
Ezigulini ezinqunywe i-insulin, imfuneko yokulungiswa komuthi, kucatshangelwa ukuqapha ushukela wegazi njalo. Uma izinga le-glycemia ngemuva kokudla lidlula okwejwayelekile, khona-ke ngosuku olulandelayo umthamo we-insulin ukhuphuka iyunithi elilodwa.
Kunconywa kanye ngesonto ukudweba igrafu yezinguquko kushukela wegazi, ukukala ngaphambi nangemva kokudla okuyinhloko, naphambi kokulala. Imininingwane eku-glycemia yansuku zonke, inani lamayunithi esinkwa asetshenzisiwe, umthamo we-insulin inj injele uzosiza ukulungisa kahle irejimeni yokwelapha ye-insulin ukuze ulondoloze impilo yesiguli esinesifo sikashukela.
I-insulin emfushane ne-ultrashort ichazwa kuvidiyo kule ngxenye.
