Kusukela kutholakale i-hormone ebhekele amazinga kashukela egazi, isikhathi sidlulile, ngakho-ke kuye kwavela izinhlobo ezahlukahlukene ze-insulin. Ziyahluka esikhathini sokusebenza, isilinganiso sokuqala komphumela, indlela yokuphatha nokunye. Cabanga ukuthi yikuphi i-insulin okungcono nokuthi yini okudingeka uyazi ngokusetshenziswa kwezidakamizwa ezimfishane nezisebenza isikhathi eside.
Ukuhlukaniswa kweHormone
I-insulin elula ikhishwe kuma-pancreas ezilwane cishe isigamu seminyaka eyedlule. Kusukela lapho, ibisetshenziswa ekwelapheni isifo sikashukela kuze kube namuhla. Manje ososayensi bayakwazi ukuzenzela ngokwabo amalungiselelo e-insulin, ngaphandle kokuthola ukukhishwa kwe-hormone kumanyukunyuku ezilwane. Lawa ma-ejenti abizwa ngokuthi ama-recombinant agents. Ngalesi sikhathi, kuye kwenziwa izinhlobo eziningi zale mishanguzo ye-hormonal. Banesikhathi esihlukile sokwenza, ukwakheka nezinye izici.
Ama-insulin asebenza ngokufushane ahlukaniswe izinhlobo ezimbili:
- Ukulungiswa kwe-insulin emfushane - i-Actrapid NM, Humodar R, Monodar, Biogulin R, Actrapid MS, Monosuinsulin MK, njll.
- I-Ultrashort insulin - iHumalog ne-Apidra.
Ngokuqondene ne-insulin ende, zifaka ama-insulin aphakathi nesikhathi amade kakhulu. Lezi yi-insulin-zinc, insulin-isophan nezinye izidakamizwa.
Ukusetshenziswa kwezidakamizwa ezithatha isikhathi esifushane sikashukela
I-insulin ebambela amafushane ithathwa isigamu sehora ngaphambi kokudla. Lapho kwethulwa, isiguli kufanele sidle, ngaphandle kwalokho izinga loshukela wegazi lizokwehla kakhulu, okungaholela ngisho nasekulahlekelweni ukwazi. Isiguli ngasinye sinquma isikhathi sokuphathwa kwe-insulin emfushane ngokuzimela, kuya ngohlelo lokudla.
Ngenxa yokuthi i-insulin emfushane inesikhathi esicwathiwe somsebenzi, kubaluleke kakhulu ukuyiphatha ukuze lesi siqongqo sifane nenani elikhulu likashukela wegazi ngemuva kokudla ukudla. Uma i-hormone ingeniswa ngenani elinganele, kuzoba ne-hyperglycemia (okweqile ushukela egazini), uma ngokweqile - i-hypoglycemia (ngokulandelana, ukuntuleka). Zombili lezi zimo ziyingozi esigulini.
Odokotela banquma imijovo ye-insulin emfushane kulabo abanesifo sikashukela abanokukhuphuka okukhulu koshukela wegazi ngemuva kokudla. Ukusetshenziswa kwalolu hlobo lwe-hormone kufanele kube nesibopho, ngoba ukulungiswa kwe-insulin okufushane kuhlala isikhathi eside kunesigaxa emazingeni kashukela egazini. Futhi lokhu kusho ukuthi ngemuva kwamahora ambalwa ngemuva kokuthatha okuthile okunye ukudla nokuqeda ukubonakaliswa kwe-hypoglycemia.
Izimiso Zokusebenzisa Insulin Okufushane
Kunemithetho ethile yokusetshenziswa kwe-insulin ultrashort isenzo (noma esifushane). Lokhu kungokulandelayo:
- ukuphuza ama-hormone kufanele kwenziwe ngaphambi kokudla okuyinhloko;
- I-insulin ye-ultrashort isebenza kangcono kakhulu lapho ithathwa ngomlomo;
- faka ukugcotshwa kwendawo yomjovo ngaphambi kokungeniswa kwayo, ngoba lokhu kungavimbela ukumukelwa kwehomoni okungalingani;
- inani lamayunithi e-insulin esigulini ngasinye libalwa ngokwahlukile kuhla lwe-8-24 kubantu abadala kuze kufike ku-8 ezinganeni ngosuku.
Umthamo we-hormone ngokwakho kulula kakhulu ukubala. Ukuze wenze lokhu, udinga ukwazi ukuthi ingakanani i-glucose eseqiwe ngesikhathi sendlala, nokuthi zingaki izitho zesinkwa ezizoba khona ekudleni okuzodliwa. Isibonelo, uma isiguli sinezinga le-glucose lika-11.4 mmol / l elinesisu esingenalutho, kudingeka ukuthi athathe amayunithi ama-2 e-insulin ukubuyisa ushukela kokujwayelekile, kanye namanye amayunithi ambalwa wokucubungula ushukela ekudleni.
Izinhlobo ze-Insulin ezimfushane
Emakhemisi, ungathenga ama-insulin amafushane ahlukahlukene. Lezi yiHumulin, i-Actrapid, i-Insuman Rapid, i-Homoral kanye nezidakamizwa ezichazwe ngenhla. Bonke banezimpawu zabo okumele zibhekwe lapho ukhetha umuthi othize. Ngakho-ke, amalungiselelo we-pancreas yengulube abangela imiphumela emibi ngenxa yokwenqena komkhiqizo lo mkhiqizo.
Ukuze unciphise imiphumela emibi, kufanele ufake umthamo ocacile womuthi, ungaphuthelwa isikhathi sokuphatha, khetha amasayithi amasha womjovo bese ugcina i-hormone ngokwayo kahle.
Ungayisebenzisa kanjani i-insulin efushane uma ushukela ukhuphuka
Kunezizathu ezahlukahlukene zokwanda kweglucose yegazi. Kunoma yikuphi, uma esigulini esinesifo sikashukela i-mellitus leli zinga lingaphezu kwe-10 mmol / l, kudingeka i-insulin emfushane. Kulula kakhulu ukubala umthamo odingekayo wesidakamizwa ezingeni likashukela elingama-10 mmol / L; iyunithi eli-1 liphathisiwe, ezikhungweni eziyi-11 mmol / L - 2, njll.
Kodwa ukwenza izinqumo ngokuxhamazela nokuphatha ngokungahambi kahle i-hormone akukufanele. Kuyadingeka ukuqonda ukuthi kungani ushukela wegazi ukhuphukile, bese uphatha umuthi kancane futhi kumthamo ngqo. Ngaphandle kwalokho, uma kunenqwaba yayo egazini, izonciphisa kakhulu inani le-glucose, bese iphinda ikhuphuke kakhulu. Ukugxuma okunje ngeke kuholele kunoma yini enhle.
Inani eliphezulu lamayunithi angafakwa ngu-7, noma ngabe izinga likashukela lingaphezu kwe-16 mmol / L. Ngemuva kwamahora amane, ukuhlaziywa kuyaphindwa futhi, uma kunesidingo, okusele kwehomoni kuyaphinda futhi kuphathwe. Uma ungekho umphumela wokwelapha (uma isikhathi eside, ngaphandle kokufakwa kwezidakamizwa, izinkomba zikashukela zisephezulu), udinga ukuxhumana nesibhedlela, lapho bazokwenza khona ukuhlaziya izidumbu ze-ketone. Ungaqhuba nohlaziyo olucacisa usebenzisa imicu yokuhlola i-Uriket ne-Uriglyuk.
I-insulin emfushane ne-acetone yomchamo
Uma umzimba uthola ama-carbohydrate ambalwa, kufanele uwathole emafutheni. Ngalesi sikhathi sokuguqulwa kwezinto eziphilayo, kwakheka i-acetone, ebese itholwa umchamo. Akukhathalekile ukuthi leliphi izinga lama-carbohydrate abonwa egazini. Imvamisa uyehliswa.
Esimweni lapho kutholakala khona i-acetone kumchamo bese ushukela wegazi uphakanyisiwe, kwenziwa isiphetho ngokuntuleka kwe-insulin. Iphinde iphathwe ngesilinganiso sama-20% womthamo wansuku zonke wefomu elifushane le-hormone. Ngemuva kwamahora amathathu, ukuhlaziya kuyaphindwa, futhi uma konke kusekhona, yenza inqubo futhi.
Njengoba wazi, i-acetone iyawathinta kabi amangqamuzana aleli hormone. Uyababhubhisa futhi abavimbele ekusebenzeni. Futhi uma ushukela wehla ngesikhathi somjovo ungabhekwa, kukhishwa kuze kube yilapho izinkomba zijwayelekile. Kuyadingeka futhi ukulinda kuze kube yilapho i-acetone ishiya umzimba. Kepha ngasikhathi sinye bayaqhubeka nokubheka izinkomba zikashukela ukuze zivame.
Ingabe izinga lokushisa eliphakeme liyayithinta imithamo yomuthi?
Lapho isiguli esinesifo sikashukela sikhuphuka emazingeni okushisa angaphezu kwama-37,5 degrees, kuyadingeka ukulungisa ukwelashwa okubuyisela esikhundleni. Ukuze wenze lokhu, ulinganise izinga le-glucose, ubale inani elifunekayo lomuthi, ukhulisa umthamo ngo-10%. Lokhu kwenziwa ngaphambi kokudla ngakunye, kuze kube yilapho izinga lokushisa lomzimba selenziwejwayelekile.
Uma kungazelelwe izinga lokushisa lomzimba likhuphuka kakhulu (ngokwesibonelo, lifinyelela kuma-degree angama-39), khona-ke umthamo ulungiswa ngokuqinile, ukwandisa ngo-20-25%. Bayeka nokuhambisa izidakamizwa zemishuwalensi emide, ngoba ngamazinga okushisa aphezulu bazomane bawe.
Umthamo obaliwe usatshalaliswa ngokulingana ngaphezulu kwemithamo engama-3-4 usuku lonke, uhlanganisa ukuphathwa kwezidakamizwa ngqo ekutholeni ama-carbohydrate angagaywa kalula. Ukwelashwa okunjalo kuyaqhutshwa kuze kufike lapho izinga lokushisa lifinyelela. Uma ngemuva kwalokhu kunokweqile kwama-acetones egazini, bashintshela ezindleleni ezikhethekile ezikhonjisiwe ngenhla.
Ungabala kanjani umthamo ngesikhathi sokuvivinya umzimba
Ukuzivocavoca kunomthelela ekwandeni koshukela wegazi. Imisipha idinga amandla amaningi, ngakho isibindi sikhipha ama-molecule eglucose bese siwafaka egazini. Ngakho-ke, uma uhlaziyo lukhombisa ubukhona beshukela ekuhlanganweni kwe-16 mmol / L noma ngaphezulu, noma imuphi umthwalo unqatshelwe kuze kube yilapho inkomba ibuyiselwa kokujwayelekile. Futhi emva kwalapho kuphela ongakwenza okuthile.
Uma izinga likashukela lingaphansi kwe-10 mmol / L, ukuzivocavoca kungasiza ngisho nasekunciphiseni inani laso. Lapha futhi udinga ukubheka isilinganiso ukuze ungenzi isimo se-hypoglycemia. Uma ukusebenza komzimba kufushane, awukwazi ukulungisa umthamo. Ukuze wenze lokhu, kwanele ukondla umzimba ngama-carbohydrate asheshayo njalo ngemizuzu engama-30.
Endabeni yokuzivocavoca isikhathi eside, umthamo we-hormone uncishiswa ngo-10-50% ngokwesikhathi sokuzivocavoca nobunzima bomthwalo. Kwesinye isikhathi zibuye zilungise umthamo wama-insulin amade.
Amalungiselelo we-insulin amade owaziwayo
Iqembu lesibili lama-hormone aphathiselwa abanesifo sikashukela maningi ama-insulin amade. Isingeniso sabo sibaluleke kakhulu. Ngemuva kwakho konke, umzimba ngokwemvelo uyabona ukuthi ukwelashwa, okufana nomsebenzi wokuphila kwemvelo. I-Hormone emzimbeni ophile kahle ayakhiqizwa ngasikhathi sinye - izinga layo esegazini ligcinwa ezingeni elifanele. I-insulin esebenza isikhathi eside ikuvumela ukuthi wengeze amathuba wokulashwa okwenzeka endaweni yalokhu. Abanesifo sikashukela baphinde babize le nhloso ibinzana elithi "gcina izinga lesizinda."
I-insulin ende
Ngakho-ke, kusetshenziswa i-insulin isikhathi eside ukuze kuhlanganiswe ukulingiswa komzimba, kube sengathi kunguye uqobo owakha leli hormone. Kuze kube manje, kuye kwenziwa amathuluzi amaningi avumela ukufeza umphumela ofanayo. Okokuqala, lawa ngamalungiselelo we-insulin wesikhathi sokusebenza (kufika emahoreni ayi-16). Lokhu kufaka phakathi:
- Biosulin N;
- I-Humulin NPH;
- IGensulin N;
- I-Insuman Bazal, njll.
Okunye okuthengiswayo yi-insulin esebenza isikhathi eside, isikhathi sayo sisebenza singaphezu kwamahora ayi-16. Lona nguLantus, Tresiba, Levemir. Le mishanguzo ibingeyokugcina ukukhiqizwa futhi yinhle impela. Ngakho-ke, wonke amanye ama-hormone akucaci kahle, ngakho-ke i-ampoule enawo isongwe ezintendeni zezandla ukuze kuvuswe ikhambi. I-insulin efanayo enwetshiwe ibonakala ngokuphelele futhi ayiqukethe i-inclusions engenza kube namafu.
Insulin ezimaphakathi nazo zibhekwa njengesiqongo, njengoba zinjalo zimfushane. Kodwa i-insulin ayinalo inani eliphakeme kakhulu. Ngakho-ke, lapho ubala umthamo womuthi, le nto kufanele icatshangelwe. Ngaphandle kwalokho, ukusetshenziswa kwawo wonke ama-hormone, kunemithetho ejwayelekile okufanele ilandelwe.
Kubalulekile!I-insulin esebenza isikhathi eside iphathwa kumthamo okuvumela ukuthi ugcine amazinga evamile eglucose usuku lonke lapho ukudla kungathathwanga. Ukuphambuka kusuka kokujwayelekile akunakuba ngaphezu kwe-1-1.5 mmol / L. Okusho ukuthi, uma konke kukhethwe kahle, inani loshukela kufanele lihlale lingaphansi kwemikhawulo ebekiwe, lingazidluli futhi linganciphisi. Ukuqina kungenye yezindlela ezibalulekile zokwelashwa okuphumelelayo esikhundleni soshukela.
I-insulin yesikhathi eside ivame ukujova ezinkalweni nasemathangeni, uma kungeniswa amafomu amafushane ahlanganiswe engalweni noma esiswini. Ezinye izindawo azikufanelekeli ukukhetha, ngoba kusukela ebhulokeni umuthi uzosabalala emzimbeni wonke ngokulinganayo, uhlinzeka ngomphumela obushelelezi. Kepha izinhlobo eziphakeme zama-hormone zifakwa esiswini ukuze zingene egazini cishe ngasikhathi sinye nokudla.
Ukukhetha komthamo we-insulin ebusuku
Uma ukhonjiswa ukusetshenziswa kwama-insulin amade, kufanele ukhethe kuqala umthamo wobusuku. Ukuze wenze lokhu, udinga ukuthola ukuthi i-glucose esegazini iziphatha kanjani ngalesi sikhathi. Inqubo ilula, kepha ayinampilo, ngoba njalo emahoreni ama-3, kusukela ngo-21: 00, udinga ukuvuka uthathe izilinganiso zikashukela kuze kube ngu-6 ekuseni.
Kulesi sonke lesi sikhathi, izinga loshukela egazini ngokwethulwa kohlobo olude lwehomoni kufanele lifane. Uma noma yikuphi ukushintshashintsha kubonakala, kubalulekile ukuguqula umthamo ohlangothini lokwenyuka noma ukwehla.
Naka isigaba sesikhathi lapho ukuphambuka kwenzeke khona. Isibonelo, lapho isiguli silala, izinga likashukela liyi-6 mmol / L, phakathi kwamabili - 6.5 mmol / L, kepha ngo-03: 00 usevele ukhuphukela ku-8.5 mmol / L. Lokhu kusho into eyodwa kuphela - kuncane kakhulu okuye kwajova khona ebusuku, kanti isiguli sizovuka ngamanani omfutho ngokweqile. Ngakho-ke, umthamo kufanele ulungiswe phezulu. Kepha kukhona okuhlukile.
Kwezinye izimo, ukwanda kwamazinga we-carbohydrate kungenzeka kungakhombisi nakancane ukuntuleka kwama-hormone alawula izinga labo. Kwenzeka ukuthi ukuvuza okunjalo kuhlotshaniswe ne-hypoglycemia, ngakho-ke ebusuku umzimba uzama ukudlala emuva kwaleso simo futhi ukhuphule izinga le-glucose ukunxenxa ukungabikhona kwalo ngesinye isikhathi.
Kulokhu, amathiphu ambalwa aziveza:
- Uma ungabaza izizathu zokwanda ushukela ebusuku, kungakuhle ukuthi uphinde uhlole isikhathi esithile (kithi, 24: 00–3: 00), kepha ngomvamisa wokuhlaziya kwehora eli-1. Uma kulesi sikhathi kunezikhathi lapho ukucindezelwa kwe-glucose kwehlela ngaphansi kwezinga elizinzile, kungenzeka impela ukuthi uphethe ngokuthi umzimba uzama ukubuyela emuva. Ngemuva kwalokho inani lamahomoni kufanele lehliswe.
- Kuyadingeka ukubheka ukudla obekudliwe ngosuku, ngoba kuthinta ukusebenza kahle kwezindlela zokwelashwa ngezindlela ezinde ze-hormone.
- Ukuhlolwa okuyikho kokusabela kwegazi kusihlwa se-insulin, ukuba khona kwe-insulin emfushane ne-glucose eyizinsalela ekudleni akufakiwe kuyo. Ukufeza lokhu, kungcono ukweqa isidlo sakusihlwa noma ukusisebenzisa kusenesikhathi kunokujwayelekile.
- Kunconywa ukusetha imenyu yokudlela ngendlela yokuthi ifaka kuphela ukudla okuqukethe ama-carbohydrate, ngoba ukuba khona kwamafutha nenqwaba yamaprotheni kungathinta imiphumela yocwaningo. Njengoba wazi, umzimba wamafutha namaprotheni uncipha kakhulu kunowama-carbohydrate, ngakho-ke ukuba khona kwawo egazini kungakhuphula amazinga kashukela futhi kwenziwe ukuhlolwa kokusebenza kwezinhlobo ezandisiwe ze-insulin zingamanga.
Ukukhetha umthamo wansuku zonke we-insulin ende
Umthamo wansuku zonke we-basal (eside) i-insulin unqunywa ngendlela efanayo nobusuku. Kulokhu, balamba usuku lonke futhi bayihlaziya njalo ngehora. Ngenxa yale ndlela, ungathola ukuthi kukuphi isikhathi lapho kukhona khona ukuhlukunyezwa kwamanani kashukela, futhi lapho - ukwehla.
Kepha kuneziguli (ngokwesibonelo, izingane ezincane) ezingafakwa ocwaningweni olunje. Ngemuva kwalokho abadli indlala, negazi lithathwa kubo ngezikhathi ezithile ezithile. Isibonelo, ngolunye usuku ungakwazi ukweqa ukudla kwasekuseni uthathe izilinganiso zasekuseni, ngakolunye - kwasemini, bese kolwesithathu - isidlo sakusihlwa.
Ukufakwa insulin isikhathi eside kuvame ukuphathwa amahlandla ama-2 ngosuku, kanti umuthi wanamuhla wesidakamizwa iLantus - kanye kuphela.
Njengoba sekushiwo, iningi lemishanguzo liyinqaba. Lokhu kusho ukuthi emahoreni angama-6-8 ngemuva komjovo osegazini kuzoba nethamo eliphezulu laleli-hormone, ngakho-ke kuyadingeka ukuthi udle okuthile ngenani leyunithi lesinkwa ukuze i-hypoglycemia ingakhuli.
Kufanele kukhunjulwe ukuthi uma ngasizathu simbe umthamo we-insal insulin udinga ukushintshwa, izifundo ziyaphindwa ukuze uqiniseke ukuthi zonke izibalo ziyenziwa futhi uqiniseke ukuthi leli yi-umthamo odingwa umzimba. Ngokushesha nje lapho kukhethwe inani lohlobo olude lwe-hormone, umthamo wezindlela ezimfushane unqunywa.
Ngakho-ke, izinhlobo ezimbili ze-insulin zenziwe - ezinde nezinfishane. Esokuqala siyadingeka ukuze kugcinwe njalo amazinga e-hormone egazini asezingeni elifanele. Okwesibili ukuthi umzimba ubhekane ngokushesha nokuhlinzwa kweglucose ngemuva kokudla. Kuzona zozimbili lezi zinhlaka, kubalulekile ukukhetha umthamo ofanele, ukwenza lokhu ngokuhlolwa. Lesi sinyathelo sibaluleke kakhulu, ngoba ukugcina amazinga eglucose ebangeni elijwayelekile kuyisiqinisekiso sokuthi isifo sikashukela ngeke sikhule futhi sibe sibi kakhulu.
