I-insulin eyengeziwe, i-basal ne-bolus: kuyini?

IGlucose ingumthombo oyinhloko wamandla womzimba wonke. Nge-glucose enganele, umuntu angaba nobuthakathaka obukhulu, ukusebenza kwengqondo okungasebenzi kahle kanye nokwanda kwezinga le-acetone egazini, okuholela ekukhuleni kwe-ketoacidosis.

Inani elikhulu lama-carbohydrate umuntu alithola ngokudla, ukudla izithelo, imifino, okusanhlamvu okuhlukahlukene, isinkwa, i-pasta, futhi, amaswidi. Kodwa-ke, ama-carbohydrate ajwayele ukungeniswa ngokushesha futhi ngenxa yalokho, phakathi kokudla, izinga le-glucose emzimbeni liqala ukwehla futhi.

Ukuvimbela ukwehla okubukhali koshukela egazini, umuntu usiza isibindi, esikhipha i-glycogen ekhethekile yezinto, lapho ingena egazini, iguqulwa ibe ushukela omsulwa. Ngokufakwa kwayo okuvamile, ama-pancreas ahlala ekhiqiza inani elincane le-insulin, elisiza ukugcina ukulingana kwamandla emzimbeni.

I-insulin enjalo ibizwa ngokuthi i-basal, kanti i-pancreas iyifaka ngomshini amayunithi angama-24-28 ngosuku, okungukuthi, iyunithi elilodwa. ngehora. Kepha ngale ndlela lokhu kwenzeka kuphela kubantu abanempilo, ezigulini ezinesifo sikashukela, i-insal insulin noma ngabe ayifihlwa ndawo zonke, noma ayibonwa izicubu zangaphakathi ngenxa yokuqalwa kokulwa ne-insulin.

Ngalesi sizathu, abanesifo sikashukela badinga ukujova nsuku zonke kwe-insal insulin ukusiza ukudonsa i-glycogen nokuvikela ukwanda koshukela wegazi. Into ebaluleke kunazo zonke ukukhetha isilinganiso esifanele se-insal insulin futhi uhambise ukusetshenziswa kwayo ngama-insulin amafushane nangesikhathi eside.

Izakhiwo zamalungiselelo we-basal insulin

I-Basal noma, njengoba ibizwa nangokuthi, ama-insulin angasemuva izidakamizwa zezenzo eziphakathi noma ezinde. Zitholakala njengokumiswa okuhloselwe ukujova okufakwayo kuphela. Ukwethula i-insal insulin emthanjeni kuyadangala.

Ngokungafani nama-insulin asebenza ngamafuphi, ama-insalin ama-basal awabonakali lutho futhi abukeka njengoketshezi olunamafu. Lokhu kungenxa yokuthi aqukethe ukungcola okuhlukahlukene, okufana ne-zinc noma i-protamine, okuphazamisa ukumuncwa ngokushesha kwe-insulin futhi ngaleyo ndlela kwandise isenzo sayo.

Ngesikhathi sokugcina, lokhu kungcola kungachaza, ngakho-ke ngaphambi kokujova kumele kuhlanganiswe ngokufana nezinye izakhi zomuthi. Ukuze wenze lokhu, gingqa ibhodlela entendeni yesandla sakho noma ulivule kaningi phansi. Ukushushumbisa umuthi akuvunyelwe ngokuphelele.

Izidakamizwa zesimanje kakhulu, ezibandakanya uLantus noLevemir, zinokuvumelana okusobala, ngoba azinakho ukungcola. Isenzo salezi zinto zokuhlanza sasiqhubeka isikhathi eside ngenxa yezinguquko ekwakhekeni kwesidakamizwa, esingabavumeli ukuthi bangeniswe ngokushesha okukhulu.

Ukulungiselela i-insal insulin kanye nesikhathi sokwenza kwawo:

Inani lemijovo ye-basal insulin ngosuku kuya ngohlobo lomuthi olusetshenziswa yiziguli. Ngakho-ke lapho usebenzisa i-Levemir, isiguli sidinga ukwenza imijovo emibili ye-insulin ngosuku - ebusuku nesikhathi esisodwa phakathi kokudla. Lokhu kusiza ukugcina amazinga we-insal insulin emzimbeni.

Ukulungiswa kwe-insulin engemuva kwesikhathi eside, okufana neLantus, kunganciphisa inani lemijovo yokujova eyodwa ngosuku. Ngenxa yalesi sizathu, iLantus isidakamizwa esidumile esisebenza isikhathi eside phakathi kwabanesifo sikashukela. Cishe isigamu seziguli ezitholakala zinesifo sikashukela ziyasisebenzisa.

Ungasibala kanjani isilinganiso se-insal insulin

I-basal insulin idlala indima ebalulekile ekuphathweni ngempumelelo kwesifo sikashukela. Ukuntuleka kwe-insulin yasemuva okuvame ukudala izinkinga ezinzima emzimbeni wesiguli. Ukuvimbela ukuthuthukiswa kwama-pathologies angaba khona, kubalulekile ukukhetha isilinganiso esifanele somuthi.

Njengoba kuphawuliwe ngenhla, umthamo wansuku zonke we-insal insulin kufanele ube ukusuka kuma-24 kuye kwangama-28 amayunithi. Kodwa-ke, umthamo owodwa we-insulin yangasemuva ofanele zonke iziguli ezinesifo sikashukela awukho. Isifo sikashukela ngasinye kufanele sinqume inani elifanelekile lomuthi ngokwakhe.

Kulokhu, kufanele kubhekwe izici eziningi ezahlukahlukene, ezinjengobudala besiguli, isisindo, ushukela wegazi nokuthi uneminyaka emingaki onesifo sikashukela. Kulesi simo kuphela, zonke izindlela zokwelapha ushukela zizosebenza ngempela.

Ukubala umthamo ofanele we-insal insulin, isiguli kufanele kuqala sinqume inkomba yesisindo somzimba wayo. Lokhu kungenziwa kusetshenziswa ifomula elandelayo: Inkomba yobunzima bomzimba = isisindo (kg) / ukuphakama (m²). Ngakho-ke, uma ukukhula kwesifo sikashukela kungama-1.70 m futhi isisindo singama-63 kg, khona-ke inkomba yesisindo somzimba wakhe izoba: 63 / 1.70² (2.89) = 21.8.

Manje isiguli sidinga ukubala isisindo somzimba esifanele. Uma inkomba yesisindo sangempela somzimba wayo ibanga ukusuka ku-19 kuye ku-25, khona-ke ukubala isisindo esifanele, udinga ukusebenzisa inkomba 19. Lokhu kumele kwenziwe ngokuya ngefomula elandelayo: 1.70² (2.89) × 19 = 54.9≈55 kg.

Kuyiqiniso, ukubala umthamo we-insal insulin, isiguli singasebenzisa isisindo saso sangempela somzimba, noma kunjalo, lokhu akufanelekile ngenxa yezizathu eziningana:

• I-insulin ibhekisela kuma-anabolic steroid, okusho ukuthi kuyasiza ukwandisa isisindo somuntu. Ngakho-ke, lapho sikhulu umthamo we-insulin, isiguli singalulama ngokwengeziwe;
• Amanani amaningi e-insulin ayingozi ukwedlula ukuntuleka kwawo, ngoba angadala i-hypoglycemia enkulu. Ngakho-ke, kungcono ukuqala ngemithamo ephansi, bese uyandisa kancane kancane.

Imithamo ye-basal insulin ingabalwa kusetshenziswa ifomula eyenziwe lula, okuyile: Isisindo somzimba esifanelekile i-0,0, i.e. 55 × 0,2 = 11. Ngakho-ke, umthamo wansuku zonke we-insulin yangemuva kufanele ube amayunithi ayi-11. Kodwa ifomula enjalo ayivamisile ukusetshenziswa ngabanesifo sikashukela, ngoba inephutha eliphakeme kakhulu.

Kukhona enye ifomula eyinkimbinkimbi kakhulu yokubala umthamo we-insulin yasemuva, osiza ukuthola umphumela onembile kunayo yonke. Ukuze uthole lokhu, isiguli kufanele kuqala ukubala umthamo wawo wonke ama-insulin nsuku zonke, okuyisisekelo ne-bolus.

Ukuthola inani le-insulin ephelele edingwa yisiguli ngosuku olulodwa, udinga ukwengeza isisindo somzimba esifanele ngokuthile okuhambelana nesikhathi sokugula kwakhe, okungukuthi:

1. Kusuka kunyaka owodwa kuya eminyakeni emi-5 - coefflements of 0.5;
2. Kusuka eminyakeni emi-5 kuye kweyi-10 - 0,7;
3. Ngaphezu kweminyaka eyi-10 - 0,9.

Ngakho-ke, uma isisindo somzimba esifanele sesiguli singama-55 kg, futhi kade sigula isifo sikashukela iminyaka engu-6, khona-ke ukubala isilinganiso sayo sansuku zonke se-insulin kuyadingeka: 55 × 0.7 = 38.5. Umphumela otholakele uzohambisana nomthamo ofanele we-insulin ngosuku.

Manje, kusuka kumthamo ophelele we-insulin, kuyadingeka ukukhipha ingxenye okufanele ibalwe yi-insal insulin. Lokhu akunzima ukwenza, ngoba njengoba wazi, lonke ivolumu ye-basal insulin akufanele idlule i-50% yedosi ephelele yamalungiselelo e-insulin. Futhi okungcono kakhulu uma kungaba ngu-30-40% womthamo wansuku zonke, kanti amanye angama-60 asele azothathwa yi-bolus insulin.

Ngakho-ke, isiguli kudingeka senze izibalo ezilandelayo: 38,5 ÷ 100 × 40 = 15.4. Ukususa umphumela ophelile, isiguli sizothola umthamo ophelele kakhulu we-insal insulin, okungamayunithi ayi-15. Lokhu akusho ukuthi le ndlela yedosi ayidingi ukulungiswa, kepha isondele kakhulu ngezidingo zomzimba wayo.

Ungayilungisa kanjani isilinganiso se-insal insulin

Ukubheka umthamo we-insulin yangemuva ngesikhathi sokwelashwa kwesifo sikashukela sohlobo 1, isiguli kudingeka senze ukuhlolwa okukhethekile kwe-basal. Njengoba isibindi sakha i-glycogen ubusuku nemini, umthamo ofanele we-insulin kumele uhlolwe imini nobusuku.

Lokhu kuhlolwa kwenziwa kuphela esiswini esingenalutho, ngakho-ke ngesikhathi sesiguli kufanele senqabe ngokuphelele ukudla, ukweqa ibhulakufesi, isifungo noma isidlo sakusihlwa. Uma ukuguquguquka kushukela wegazi ngesikhathi sokuhlolwa kunganikeli ngaphezulu kwe-1.5 mmol futhi isiguli singakhombisi zimpawu ze-hypoglycemia, khona-ke umthamo onjalo we-insal insulin ubhekwa njengowanele.

Uma isiguli sinokwehla noma ukwanda koshukela wegazi, umthamo we-insulin yangemuva udinga ukulungiswa okuphuthumayo. Khuphula noma unciphise umthamo kumele kancane kancane ungabi ngaphezu kwama-2 amayunithi. ngesikhathi futhi kungabi ngaphezu kwezikhathi ezi-2 ngesonto.

Olunye uphawu lokuthi insulin ehlala isikhathi eside isetshenziswa yisiguli kumthamo ofanele ushukela wegazi ophansi ngesikhathi sesheke lokulawula ekuseni nakusihlwa. Kulokhu, akufanele wedlule umkhawulo ophezulu we-6.5 mmol.

Ukwenza ukuhlolwa kwe-basal ebusuku:

• Ngalolu suku, isiguli kufanele sidle isidlo sakusihlwa ngangokunokwenzeka. Kungcono uma isidlo sokugcina singekho ngaphambi kuka-6 pm. Lokhu kuyadingeka ukuze ngesikhathi sokuhlolwa, isenzo se-insulin esifushane, esilawulwa esidlweni sakusihlwa, siphele ngokuphelele. Njengomthetho, lokhu kuthatha okungenani amahora ayi-6.
• Ngo-12 a.m., umjovo kufanele unikezwe ngokuphatha ngokungafani naphakathi (Protafan NM, InsumanBazal, Humulin NPH) noma insulin ende (Lantus).
• Manje udinga ukukala ushukela wegazi njalo emahoreni amabili (ngehora lesibili, 4:00, 6:00 no-8:00), uphawula ukuguquguquka kwawo. Uma zingeqi ku-1.5 mmol, khona-ke umthamo ukhethwe kahle.
• Kubalulekile ukuthi ungaphuthelwa umsebenzi ophakeme we-insulin, okwenzeka kuwo izidakamizwa eziphakathi nendawo ngemuva kwamahora ayisithupha. Ngomthamo ofanele ngalesi sikhathi, isiguli akufanele sokwehla okukhulu kwamazinga kashukela kanye nokuthuthukiswa kwe-hypoglycemia. Uma usebenzisa i-Lantus, le nto ingakweqa, ngoba ayinawo umsebenzi ophakeme.
• Ukuhlolwa kufanele kukhanselwe uma, ngaphambi kokuba kuqala, isiguli sine-hyperglycemia noma izinga le-glucose likhuphuke ngaphezu kwe-10 mmol.
• Ngaphambi kokuhlolwa, akunakufanele wenze imijovo ye-insulin emfushane.
• Uma phakathi nokuhlolwa isiguli sihlaselwe yi-hypoglycemia, kufanele imiswe, nokuhlolwa kumele kumiswe. Uma ushukela wegazi, kunalokho, ukhuphukele ezingeni eliyingozi, udinga ukwenza umjovo omncane we-insulin emfushane bese uhlehlisa ukuhlolwa kuze kube usuku olulandelayo.
• Ukulungiswa okulungile kwe-insal insulin kungenzeka kuphela ngesisekelo sohlolo olunjalo ezintathu.

Ukwenza ukuhlolwa kwe-basal phakathi nosuku:

• Ukuze wenze lokhu, isiguli sidinga ukumisa ngokuphelele ukudla ekuseni futhi esikhundleni se-insulin esifushane, faka i-insulin esezingeni eliphakathi nendawo.
• Manje isiguli sidinga ukuhlola izinga kashukela wegazi njalo ngehora ngaphambi kwasemini. Uma iwile noma ikhuphuka, umthamo womuthi kufanele ulungiswe; uma uhlala unjalo, gcina ngokufana.
• Ngosuku olulandelayo, isiguli kufanele siphuze isidlo sasekuseni njalo senze imijovo ye-insulin emfushane nephakathi.
• Ilantshi nokunye ukudutshulwa kwe-insulin emfushane kufanele kweqiwe. Ngemuva kwamahora ama-5 ngemuva kokudla kwasekuseni, udinga ukubheka ushukela wakho wegazi okokuqala.
• Ngokulandelayo, isiguli kudingeka sihlole izinga le-glucose emzimbeni njalo ngehora kuze kube yisikhathi sokudla. Uma kungekho okuphambukayo okubalulekile okubonwe, umthamo ulungile.

Ezigulini ezisebenzisa i-insulin Lantus yesifo sikashukela, asikho isidingo sokwenza ukuhlolwa nsuku zonke. Njengoba iLantus iyi-insulin ende, kufanele inikezwe isiguli kanye kuphela ngosuku, ngaphambi kokulala. Ngakho-ke, kuyadingeka ukuhlola ukwanela komthamo wayo kuphela ebusuku.

Imininingwane yezinhlobo ze-insulin inikezwe kuvidiyo ekulesi sihloko.