Ukwelashwa kwesifo sikashukela kusesimweni sokwelashwa okuthatha indawo. Njengoba i-insulin yakho ingeke isize ukumunca ushukela egazini, kwethulwa i-analogue yakhe yokufakelwa. Njengoba unesifo sikashukela sohlobo 1, lena ukuphela kwendlela yokugcina impilo yeziguli.
Njengamanje, izinkomba zokwelashwa ngamalungiselelo we-insulin sezandisile, ngoba ngosizo lwabo kungenzeka ukwehlisa izinga likashukela ngohlobo olubi lwe-2 sikashukela, ngezifo ezihlobene, ukukhulelwa nokungenelela kokuhlinzwa.
Ukwenza i-insulin therapy kufanele kufane nokukhiqizwa kwemvelo nokukhululwa kwe-insulin kumanyikwe. Ngale njongo, asisetshenziswa kuphela ama-insulin asebenza ngokufushane nje kuphela, kodwa futhi nalawo aphakathi nesikhathi, kanye ne-insulin esebenza isikhathi eside.
Imithetho yokwelashwa kwe-insulin
Ngokukhipha okwejwayelekile kwe-insulin, kuba khona egazini njalo ngesimo se-basal (ingemuva) lebanga. Kwenzelwe ukunciphisa umphumela we-glucagon, nawo okhiqiza amaseli we-alpha ngaphandle kokuphazamiseka. Ukufihlwa kwesendlwana kuncane - cishe indawo engu-0.5 noma eyi-1 njalo ngehora.
Ukuqinisekisa ukuthi lelo zinga le-insulin elinjalo liyakhiwa ezigulini ezinesifo sikashukela, kusetshenziswa izidakamizwa ezisebenza isikhathi eside. Lokhu kufaka i-insulin Levemir, uLantus, Protafan, Tresiba nabanye. I-insulin ekhululwayo ikhishwa kanye noma kabili ngosuku. Uma ihanjiswa kabili, isikhawu amahora angama-12.
Umthamo womuthi ukhethwa ngawodwana, ngoba isidingo se-insulin ebusuku singase sibe ngaphezulu, khona-ke umthamo wakusihlwa uyanda, uma kunesidingo sokwehla okungcono ngesikhathi sosuku, khona-ke umthamo omkhulu udluliselwa emahoreni okusa. Umthamo ophelele wesidakamizwa esihanjiswa kuxhomeke kwesisindo, ekudleni, ekusetshenzisweni komzimba.
Ngaphezu koku secretion kwangemuva, ukukhiqizwa kwe-insulin yokudla ukudla nakho kuyenziwa kabusha. Lapho izinga likashukela wegazi likhuphuka, ukwakheka okusebenzayo kanye nokufihla kwe-insulin kuqala ukudonsa ama-carbohydrate. Ngokuvamile, ama-12 g ama-carbohydrate adinga amayunithi we-insulin angu-1-2.
Esikhundleni se-insulin "yokudla", esehlisa i-hyperglycemia ngemuva kokudla, kusetshenziswa izidakamizwa ezisebenza ngamafuphi (i-Actrapid) ne-Ultra-Short (Novorapid). Ama-insulin anjalo aphathwa izikhathi ezingama-3-4 ngosuku ngaphambi kokudla ngakunye ngakunye.
I-insulin emfishane idinga umthamo ngemuva kwamahora ama-2 isikhathi sokuphakama kwesenzo. Okusho ukuthi, ngesingeniso esiyizikhathi ezi-3, udinga ukudla okunye amahlandla ama-3. Ukulungiswa kwe-Ultrashort akudingi isidlo esiphakathi. Isenzo sabo esiphakeme sikuvumela ukuthi udonse ama-carbohydrate atholwe ngokudla okuyinhloko, ngemuva kwalokho isenzo sabo siyaphela.
Izinhlobo zokuqala zokuphathwa kwe-insulin zifaka:
- Ngokwesiko - okokuqala, isilinganiso se-insulin sibalwa, bese ukudla, ama-carbohydrate akulo, ukusebenza ngokomzimba kuyalungiswa ukuze kulingane. Usuku luhlelelwe ngokuphelele ihora. Akukho okungashintshwa kukho (inani lokudla, uhlobo lokudla, isikhathi sokwamukelwa).
- Kuqinisiwe - i-insulin ivumelanisa nombuso wosuku futhi inikeze inkululeko yokwakha isheduli yokuphathwa kwe-insulin kanye nokudla.
Uhlobo olunzulu lwe-insulin therapy lusebenzisa ngemuva ngemuva - okunwetshiwe nge-insulin kanye noma kabili ngosuku, futhi okufushane (i-ultrashort) ngaphambi kokudla ngakunye.
I-Levemir Flexpen - izakhiwo nezimpawu zohlelo lokusebenza
I-Levemir Flexpen yenziwa yinkampani yezamayeza uNovo Nordisk. Ifomu lokukhishwa luketshezi olungenamibala, okuhloselwe kuphela ukujova ngokungenamikhawulo.
Ukwakheka kwe-insulin i-Levemir Flexpen (i-analog ye-insulin yabantu) kufaka phakathi into esebenzayo - ukubulala. Umuthi wakhiqizwa ngonjiniyela bezakhi zofuzo, okwenza sikwazi ukukunikeza iziguli ezinokungezwani ne-insulin yemvelaphi yezilwane.
Ku-1 ml ye-Levemir insulin iqukethe ama-PIECES ayi-100, isisombululo sibekwa esibayeni sesirinji, esino-3 ml, okuyi-300 PIECES. Esiphaketheni samapulasitiki ayi-5 anokulahlwa. Intengo yeLevemir FlekPen ingaphezulu kancane kunezidakamizwa ezithengiswa kuma-cartridgege noma emabhodleleni.
Imiyalo yokusebenzisa i-Levemir ikhombisa ukuthi le insulin ingasetjenziswa iziguli ezinohlobo lokuqala nolwesibili lwe-mellitus yesifo sikashukela, futhi nokuthi kuhle ukwelashwa okufaka okunye esikhundleni kwabesifazane abakhulelwe abanesifo sikashukela.
Ucwaningo lwethonya lomuthi osezingeni lokutholwa kwesisindo kweziguli selwenziwe. Lapho ihanjiswa kanye ngosuku ngemuva kwamasonto angama-20, isisindo seziguli sanda ngama-700 g, futhi iqembu lokuqhathanisa elithole i-insulin-isophan (Protafan, Insulim) ukwanda okuhambisanayo bekuyi-1600 g.
Yonke insulini ihlukaniswe ngamaqembu ngokuya ngesikhathi sokusebenza:
- Ngomphumela wehlisela ushukela we-ultrashort - ukuqala kwesenzo ngemizuzu engu-10-15. Aspart, Lizpro, Khmumulin R.
- Isenzo esifushane - qala ngemuva kwemizuzu engama-30, inani eliphakeme ngemuva kwamahora ama-2, isikhathi esiphelele - amahora ama-4-6. I-Actrapid, Farmasulin N.
- Isikhathi esijwayelekile sokusebenza - ngemuva kwamahora we-1.5 uqala ukwehlisa ushukela wegazi, sifinyelela inani eliphakeme ngemuva kwamahora angama-4 - 11, umphumela uhlala amahora angama-12 kuye kwangama-18. Insuman Rapid, Protafan, Vozulim.
- Isenzo esihlanganisiwe - umsebenzi uzibonakalisa ngemuva kwemizuzu engama-30, inani lokugxila kusuka emahoreni amabili kuya kwayi-8 kusukela esikhathini sokuphatha, kuthatha amahora angama-20. IMikstard, iNovomiks, iPulasulin 30/70.
- Isenzo eside saqala ngemuva kwamahora angama-4-6, inani eliphakeme - amahora angama-10-18, ubude besikhathi sokukwenza kuze kufike ngosuku. Leli qembu lifaka iLevemir, Protamine.
- I-insulin ye-Ultra-ende isebenza amahora angama-36-42 - iTresiba insulin.
I-Levemir yi-insulin esebenza isikhathi eside futhi enephrofayili eyisicaba. Iphrofayili yesenzo salo muthi ayihlukile uma iqhathaniswa ne-isofan-insulin noma i-glargine. Isenzo eside seLevemir kungenxa yokuthi ama-molecule ayo enza ukwakheka endaweni yomjovo futhi abopha ne-albhamuin. Ngakho-ke, le insulin idonswa kancane kancane kuthishu.
Isofan-insulin yakhethwa njengesibonelo sokuqhathanisa, futhi kwafakazelwa ukuthi iLevemir inokungena okungena umfaniswano egazini, okuqinisekisa isenzo esiqhubekayo usuku lonke. Indlela yokunciphisa i-glucose ihlotshaniswa nokwakhiwa kwe-insulin receptor eyinkimbinkimbi kulolwitho lweseli.
I-Levemir inomphumela onjalo ezinqubweni ze-metabolic:
- Isheshisa ukwakheka kwama-enzymes ngaphakathi kweseli, okufaka nokwakheka kwe-glycogen - glycogen synthetase.
- Yenza kusebenze ukuhamba kweglucose esitokisini.
- Kusheshisa ukuthathwa kwezicubu zamangqamuzana kashukela egazini elijikelezayo.
- Ishukumisa ukwakheka kwamafutha kanye ne-glycogen.
- Inqanda ukuvela koshukela esibindini.
Ngenxa yokuntuleka kwedatha yokuphepha ekusetshenzisweni kweLevemir, akunconywa ezinganeni ezingaphansi kweminyaka engu-2 ubudala. Lapho isetshenziswa kwabesifazane abakhulelwe, akukho mphumela omubi enkambweni yokukhulelwa, impilo yosana olusanda kuzalwa, kanye nokuvela kokungalungi.
Akukho datha onomphumela wezinsana ngesikhathi sokuncelisa, kepha njengoba kungokwesigaba samaprotheni abhujiswa kalula emgodini wokugaya futhi adonswe ngamathumbu, kungathathwa njengokuthi akungena ebeleni lamabele.
Ungasifaka kanjani isicelo seLevemir Flexpen?
Inzuzo yeLevemir ingukuqina kokuqina kwomuthi osegazini kuyo yonke inkathi yesenzo. Uma imithamo ye-0,2-0.4 IU i-1 kg yesisindo sesiguli ilawulwa, khona-ke umphumela omkhulu wenzeka ngemuva kwamahora ama-3-4, ifinyelela ethafeni futhi ihlala kuze kube ngamahora ayi-14 ngemuva kokuphatha. Isikhathi sonke sokuhlala egazini amahora angama-24.
Inzuzo yeLevemir ukuthi ayinayo inani eliphakeme lesenzo, ngakho-ke, uma yethulwa, akunangozi yokuba noshukela wegazi ophakeme ngokweqile. Kwatholakala ukuthi ubungozi be-hypoglycemia phakathi nosuku kwenzeka ngaphansi kwama-70%, kanti ukuhlaselwa ebusuku ngo-47%. Ucwaningo lwenziwa iminyaka emi-2 ezigulini.
Naphezu kweqiniso lokuthi i-Levemir iyasebenza phakathi nosuku, kunconywa ukuyiphatha kabili ukuze wehlise futhi ugcine amazinga kashukela egazi azinzile. Uma i-insulin isetshenziselwa ukuhlanganiswa nama-insulin amafushane, khona-ke ilawulwa ekuseni nakusihlwa (noma ngesikhathi sokulala) ngekhefu lamahora ayi-12.
Ukwelashwa kwesifo sikashukela sohlobo 2, i-Levemir inganikezwa kanye kanyekanye uthathe amathebulethi ngehlisela ushukela. Umthamo wokuqala weziguli ezinjalo ngamayunithi angama-0.1-0.2 nge-1 kg yesisindo somzimba. Imithamo yesiguli ngasinye ikhethiwe ngokuhlukile, ngokusekelwe kuzinga le-glycemia.
I-Levemir ihanjiswa ngaphansi kwesikhumba sobuso obungaphandle bethanga, ihlombe, noma isisu. Indawo yomjovo kumele ishintshwe ngaso sonke isikhathi. Ukuphatha umuthi kuyadingeka:
- Sebenzisa isikhethi somthamo ukukhetha inombolo oyifunayo yamayunithi.
- Faka inaliti ku-crease yesikhumba.
- Chofoza inkinobho ethi "Qala".
- Linda 6 - 8 imizuzwana
- Susa inaliti.
Ukulungiswa kwedosi kungadingeka ezigulini esezikhulile ezinokwehla kokusebenza kwezinso noma kwesibindi, ngokungezelelwa kwezifo ezihambisanayo, izinguquko ekudleni, noma ngokomzimba owandayo. Uma isiguli sidluliselwa e-Levemir sisuka kwamanye ama-insulin, khona-ke kukhethwa umthamo omusha nokulawulwa kwe-glycemic ejwayelekile.
Ukuphathwa kwama-insulin asebenza isikhathi eside, okubandakanya i-Levemir, akwenziwa kahle ngenxa yengozi yezinhlobo ezinzima ze-hypoglycemia. Ukwethulwa kwe-intramuscularly, ukuqala kwesenzo sikaLevemir kuziveza ngaphambili kunokuthi kube nomjovo we-subcutaneous.
Umuthi awuhloselwe ukusetshenziswa kumapompo e-insulin.
Ukuphendula okungafani nokusetshenziswa kweLevemir Flexpen
Imiphumela emibi ezigulini ezisebenzisa i-Levemir Flexpen ixhomeke kakhulu kumthamo futhi ithuthuke ngenxa yesenzo se-insulin semithi yokwelapha. I-Hypoglycemia phakathi kwabo ivela kaningi kakhulu. Imvamisa kuhlotshaniswa nokukhethwa komthamo okungafanele noma ukungondleki.
Ngakho-ke inqubo ye-hypoglycemic isenzo se-insulin eLevemir ingaphansi kunasemithini efanayo. Uma i-glucose ephansi egazini iqhubeka, khona-ke lokhu kuhambisana nesiyezi, umuzwa owengeziwe wendlala, nobuthakathaka obungavamile. Ukwanda kwezimpawu kungabonakala ekuqwashisweni okungasebenzi kahle nasekuthuthukisweni kwe-hypoglycemic coma.
Ukuvela kwendawo kwenzeka endaweni yomjovo futhi kungokwesikhashana. Kaningi, ubomvu nokuvuvukala, ukulunywa kwesikhumba. Uma imithetho yokuphatha umuthi kanye nemijovo ejwayelekile ingagcinwa endaweni efanayo, i-lipodystrophy ingaqhamuka.
Ukuphendula okujwayelekile ekusebenzeni kweLevemir kwenzeka kaningi futhi kuwukubonakaliswa kwe-hypersensitivity yomuntu ngamunye. Lokhu kufaka phakathi:
- U-Edema ezinsukwini zokuqala zomuthi.
- I-Urticaria, imivimbo esikhunjeni.
- Ukuphazamiseka Kwesisu
- Ubunzima bokuphefumula.
- Ukulunywa okujwayelekile kwesikhumba.
- I-Angioneurotic edema.
Uma umthamo uphansi kunesidingo se-insulin, khona-ke ukwanda koshukela wegazi kungaholela ekuthuthukisweni kwe-ketoacidosis yesifo sikashukela.
Izimpawu zanda kancane kancane ngaphezulu kwamahora noma izinsuku ezimbalwa: ukoma, isicanucanu, ukukhuphula umchamo, ukozela, ubomvu kwesikhumba kanye nephunga le-acetone elisuka emlonyeni.
Ukusetshenziswa okuhlangene kwe-levemir nezinye izidakamizwa
Imithi ekhulisa izindawo ezokwehlisa iLevemir kushukela wegazi ifaka amaphilisi we-antidiabetic, Tetracycline, Ketoconazole, Pyridoxine, Clofibrate, Cyclophosphamide.
Umphumela we-hypoglycemic ukhuliswa ukuphathwa ngokuhlanganyela kwemithi ethile ye-antihypertensive, ama-anabolic steroid, kanye nemithi equkethe i-ethyl alcohol. Futhi, utshwala beshukela bungenza ukwanda okungalawulwa isikhathi eside kwehle ushukela wegazi.
I-Corticosteroids, izindlela zokuvimbela inzalo ngomlomo, izidakamizwa eziqukethe i-heparin, ama-antidepressants, ama-diuretics, ikakhulukazi ama-thiazide diuretics, i-morphine, i-nicotine, i-clonidine, i-hormone yokukhula, ama-calcium blockers angawenza buthaka umphumela weLevemir.
Uma i-reserpine noma i-salicylates, kanye ne-octreotide, isetshenziswa ndawonye neLevemir, khona-ke iba nomphumela we-multidirectional, futhi kungenza buthaka noma kuthuthukise izakhiwo zamakhemikhali zeLevemir.
Ividiyo ekulesi sihloko inikeza isibuyekezo se-insulin Levemir Flexpen.
