Izindlela ezisezingeni eliphakeme kakhulu zokwelapha isifo sikashukela sohlobo 1 zihlanganisa ukwelashwa kwe-insulin. Kuhlanganisa izindlela okuhloswe ngazo ukunxephezela ukuphazamiseka kwe-carbohydrate metabolism kushukela ngokuphatha amalungiselelo we-insulin.
Ukwelashwa kwe-insulin yesifo sikashukela i-mellitus kanye nezinye izifo zengqondo kukhombisa imiphumela emihle yomtholampilo.
ake sibheke ukuthi le ndlela isetshenziswa kuphi
- Ukwelashwa kweziguli okuxilongwa yisifo sikashukela esincike ku-insulin.
- Izindlela zesikhashana ekwelashweni kwesifo sikashukela sohlobo 2. Kuvame ukubekelwa lapho isiguli sihlinzwe ngenxa yokuqhamuka kwezifo ezibangelwa yigciwane lokuphefumula kanye nezinye izifo.
- Ukwelashwa kweziguli ezinesifo sikashukela sohlobo 2, uma izidakamizwa ezinciphisa ushukela zingenakho ukusebenza kahle.
- I-ketoacidosis yesifo sikashukela (inkinga yesifo sikashukela) kubantu abanesifo sikashukela ihlala ibonwa.
- Ukwelashwa kweSchizophrenia.
Ngaphezu kwalokho, usizo lokuqala lwe-coma yesifo sikashukela lungadingeka.
Izikimu zokwelapha i-insulin zingafundwa encwadini ethi "Virtuoso Insulin Therapy" nguJorge Kanales. Ukushicilelwa kufake yonke imininingwane ngalesi sifo esaziwa namuhla, imigomo yokuxilongwa neminye imininingwane eminingi ewusizo.
Le folio inconyelwa ukufundela iziguli ezinesifo sikashukela, ukuze laba bantu babe nomqondo wendlela efanelekayo yokwelapha izifo zabo futhi bazi imithetho eyisisekelo nezici ekwelashweni kwamalungiselelo e-insulin.
Izinhlobo ze-Insulin Therapy
Uma isiguli singenazinkinga ngokukhuluphala ngokweqile futhi singazitholi ngokweqile ngokomzwelo, i-insulin ibekwe prescribed - 1 iyunithi le-1 ngosuku ngosuku ngokuya nge-1 kg yesisindo somzimba. Ngasikhathi sinye, ukwelashwa kwe-insulin okunamandla kusebenza njengemoto yokuqothuka kwemvelo kwe-hormone.
Imithetho yokwelashwa kwe-insulin idinga ukufezeka kwalezi zimo:
- umuthi kufanele ulethwe esigulini ngesilinganiso esanele sokusebenzisa ushukela;
- ama-insulin angaphandle alimale kufanele kube ukulingisa okuphelele kokucasulwa kwe-basal, okungukuthi, ukuthi ama-pancreas akhiqiza (kufaka phakathi iphoyinti eliphakeme kakhulu le-excretion ngemuva kokudla).
Izidingo ezibalwe ngenhla zichaza ama-insulin therapy regimens, lapho umthamo wansuku zonke uhlukaniswa khona ngama-insulin isikhathi eside noma omfushane.
Ama-insulin amade avame ukuphathwa ekuseni nasekuseni futhi alingisa ngokuphelele umkhiqizo womzimba wokusebenza kwamanyikwe.
Ukuthatha i-insulin emfushane kufanelekile ngemuva kokudla okune-carbohydrate eningi. Umthamo walolu hlobo lwe-insulin unqunywa ngokuhlukile futhi kunqunywa ngenani lama-XE (amayunithi esinkwa) ekudleni okunikezwe.
Ukwenza ukwelashwa kwendabuko kwe-insulin
Indlela ehlanganisiwe yokwelashwa kwe-insulin ifaka ukuhlangana kwayo yonke i-insulin ngomjovo owodwa futhi ibizwa ngokuthi i-insulin therapy yendabuko. Inzuzo enkulu yale ndlela ukunciphisa inani lemijovo ibe ubuncane (1-3 ngosuku).
Ububi bokwelashwa kwe-insulin yendabuko ukungabi khona kokulingiswa okuphelele komsebenzi we-pancreas wemvelo. Lokhu kusilela akuvumeli ukunxephezela ngokuphelele i-carbohydrate metabolism yesiguli esinohlobo 1 sikashukela, ukwelashwa kwe-insulin kuleli cala akusizi.
Isikimu esihlanganisiwe sokwelashwa kwe-insulin ngasikhathi sinye sibukeka ngokufana nalokhu: isiguli sithola imijovo eyi-1-2 ngosuku, ngasikhathi sinye silungiswa ngamalungiselelo e-insulin (lokhu kufaka nokufaka insulin okufushane nokwesikhathi eside).
Isikhathi esiphakathi sifaka i-akhawunti cishe 2/3 yenani eliphelele lezidakamizwa, 1/3 ye-insulin emfushane isasele.
Kuyadingeka futhi ukusho ngepompo ye-insulin. Iphampu le-insulin luhlobo lwedivaysi ye-elekthronikhi enikeza ukuphathwa kwe-insulin kokujikeleza kwe-insulin ngemithamo emincane isikhathi esifushane noma esifushane sokwenza.
Le ndlela ibizwa ngokuthi i-pump insulin therapy. Iphampu ye-insulin isebenza ngezindlela ezihlukile zokulawulwa kwezidakamizwa.
Izindlela Zokusebenzisa i-Insulin Therapy:
- Ukuhlinzekwa okuqhubekayo kwe-pancreatic hormone nge-microdoses simulating ijubane lomzimba.
- Ijubane leBolus - isiguli singakwazi ukufaka umthamo nemvamisa yokuphathwa kwe-insulin ngezandla zakhe.
Lapho kusetshenziswa irejimeni yokuqala, ukufihlwa kwe-insulin kokungemuva kwenziwa, okwenza ukuthi ngokomthetho ukwazi ukusebenzisa ukusetshenziswa kwezidakamizwa ezinde. Ukusetshenziswa kwerejimeni yesibili kunconywa ngokushesha ngaphambi kokudla noma ngalezo zikhathi lapho inkomba ye-glycemic ikhuphuka.
Lapho i-regimen ye-bolus icishiwe, ukwelashwa okususelwa kumpompo kunikeza amandla okuguqula i-insulin yezinhlobo ezahlukahlukene zezenzo.
Kubalulekile! Ngokuhlanganiswa kwalezi zindlela ezingenhla, ukulingiswa okulinganiselwe okuphelele kokuqashelwa ngokomzimba kwe-insulin yi-pancreas enempilo kutholakala. I-catheter kufanele ishintshe okungenani isikhathi esingu-1 ngosuku lwe-3.
Ukusetshenziswa kwezindlela zokwelapha i-insulin zohlobo 1 sikashukela
Indlela yokwelashwa yeziguli ezinesifo sikashukela sohlobo loku-1 ihlinzekela ukwethulwa komuthi we-basal izikhathi ezi-1-2 ngosuku, futhi ngokushesha ngaphambi kokudla - i-bolus. Ohlelweni lwesifo sikashukela sohlobo 1, ukwelashwa kwe-insulin kufanele kuthathe indawo ngokuphelele yokukhiqizwa ngokomzimba kwehomoni ekhiqiza amanyikwe omuntu onempilo.
Ukuhlanganiswa kwalezi zindlela zombili kubizwa ngokuthi yi- "base-bolus therapy", noma irejimeni elinemijovo eminingi. Enye yezinhlobo zalolu hlobo lokwelashwa nje ye-insulin.
Isikimu nomthamo, kucatshangelwa izici zomzimba nezinkinga zempilo, isiguli kufanele sikhethe udokotela waso. Umuthi we-basal uvame ukuthatha ama-30-50% womthamo wansuku zonke. Ukubalwa kwenani le-insulin edingekayo kungumuntu ngamunye.
Thayipha ukwelashwa kwe-insulin yesifo sikashukela
Ukwelashwa kwesifo sikashukela sohlobo 2 kudinga uhlelo oluthile. Umnyombo walokhu kwelashwa ukuthi imithamo emincane ye-insal insulin yengezwa kancane kancane emithini esehlisa ushukela yesiguli.
Ngokokuqala ngqa ukubhekana nokulungiswa kwe-basal, okwethulwa ngendlela ye-analogue engenamdlandla ye-insulin esebenza isikhathi eside (ngokwesibonelo, i-insulin glargine), iziguli kufanele zime ngomthamo we-10 IU ngosuku. Ngokuncono, imijovo inikezwa ngasikhathi sinye sosuku.
Uma isifo sikashukela siqhubeka nokuthuthuka futhi ukuhlanganiswa kwezidakamizwa ezokwehlisa ushukela (ifomu lethebhulethi) ngemijovo ye-basal insulin akuholeli emiphumeleni oyifunayo, kuleli cala, udokotela uthatha isinqumo sokudlulisa isiguli ngokuphelele esimeni somjovo.
Ngasikhathi sinye, ukusetshenziswa kwemithi eyejwayelekile yendabuko kuyakhuthazwa, kepha noma yimuphi wayo kumele uvunyelwe ngudokotela ohambelayo.
Izingane ziyiqembu elikhethekile leziguli, ngakho-ke ukwelashwa kwe-insulin uma kwenzeka isifo sikashukela sabantwana ngaso sonke isikhathi kudinga indlela yomuntu ngamunye. Kaningi, ekwelapheni izinsana, kusetshenziswa amasu izikhathi ezingama-2-3 ukuphathwa kwe-insulin. Ukwehlisa inani lemijovo ezigulini ezincane, kuhlanganiswa inhlanganisela yezidakamizwa ezinezikhathi zokuvezwa okufushane naphakathi.
Kubaluleke kakhulu ukufeza uhlelo olulula kakhulu, lapho isinxephezelo esihle sizotholwa. Isibalo semijovo ye-insulin ayithinti ukuphuculwa koshukela wegazi. Izingane ezineminyaka engaphezu kwengu-12 ubudala zinquma ukwelashwa okuqinile kwe-insulin.
Ukuzwela kwezingane i-insulin kuphakeme kunaleziguli ezindala, ngakho-ke ukulungiswa komthamo umuthi kufanele kwenziwe ngezigaba. Uhla lwezinguquko kumthamo we-hormone kumele ufakwe kumayunithi angama-1-2 ngasikhathi. Umkhawulo wesikhathi esisodwa ovunyelwe kakhulu ngamayunithi ama-4.
Nakani! Kuzothatha izinsuku ezimbalwa ukuqonda nokuzwa imiphumela yoshintsho. Kepha odokotela ngokwezigaba abancomi ngasikhathi sinye ukuguqula isilinganiso somuthi nse kusihlwa somuthi.
Ukwelashwa kwe-insulin ngesikhathi sokukhulelwa
Ukwelashwa kwesifo sikashukela ngesikhathi sokukhulelwa kuhloselwe ukugcina ukunakekelwa koshukela egazini, okufanele ngabe:
- Ekuseni ngesisu esingenalutho - 3.3-5.6 mmol / l.
- Ngemuva kokudla, 5.6-7.2 mmol / L.
Ukunqunywa koshukela wegazi izinyanga ezimbili kukuvumela ukuthi uhlole ukusebenza kwezindlela zokwelashwa. I-metabolism emzimbeni wowesifazane okhulelwe inyakaze ngokwedlulele. Leli qiniso lidinga ukulungiswa njalo kwe-regimen (irejimeni) yokwelashwa kwe-insulin.
Kwabesifazane abakhulelwe abanesifo sikashukela sohlobo loku-1, ukwelashwa kwe-insulin kubekwe ngokulandelayo: ukuvikela i-ekuseni ne-postprandial hyperglycemia, isiguli sidinga okungenani imijovo emi-2 ngosuku.
I-insulin emfushane noma ephakathi ihanjiswa ngaphambi kwesidlo sasekuseni sokuqala nangaphambi kokudla kokugcina. Imithamo ehlanganisiwe nayo ingasetshenziswa. Umthamo ophelele wansuku zonke kufanele usatshalaliswe kahle: 2/3 wevolumu yonke ihloselwe ekuseni, nengxenye engu-1/3 - ngaphambi kokudla kwakusihlwa.
Ukuvimbela i-hyperglycemia yasebusuku nasekuseni, umthamo "ngaphambi kwesidlo sakusihlwa" ushintshwa umjovo owenziwe ngaphambi nje kokulala.
I-insulin ekwelapheni ukuphazamiseka kwengqondo
Ngokuvamile, i-insulin ekwelashweni kwezifo zengqondo isetshenziselwa ukwelapha i-schizophrenics. Ekuseni ngesisu esingenalutho, isiguli sinikezwa umjovo wokuqala. Umthamo wokuqala amayunithi ama-4. Nsuku zonke lenyuswa kusuka kumayunithi amane kuya kwayi-8. Lolu hlelo lunesici: ngezimpelasonto (ngoMgqibelo, ngeSonto) musa ukujova.
Esigabeni sokuqala, ukwelashwa kususelwa ekugcineni isiguli sisesimweni se-hypoglycemia cishe amahora amathathu. Ukwenza izinga leshukela lifane ngokwejwayelekile, isiguli sinikezwa itiye elifudumele elimnandi, eliqukethe okungenani amagremu ayi-150 kashukela. Ngaphezu kwalokho, isiguli sinikezwa ibhulakufesi elinothile i-carbohydrate. Izinga likashukela wegazi kancane kancane libuyele kokujwayelekile futhi isiguli sibuyele kokujwayelekile.
Esigabeni sesibili sokwelashwa, umthamo womuthi ophathwe uyakhuphuka, ohambisana nokukhuphuka kwezinga lokunqunyelwa kokuqaphela kwesiguli. Kancane kancane, ukubabazeka kukhula kube yisidlakela (ukwazi ukucindezelwa). Ukuqedwa kwe-hypoglycemia kuqala cishe imizuzu engama-20 ngemuva kokuqala kokukhula kwesibindi.
Isiguli silethwa esimweni esejwayelekile sine-dropper. Ujova ngaphakathi nge-20 ml yesisombululo sikashukela esingu-40%. Lapho isiguli siphaphama, sinikezwa isiraphu ushukela (150-200 g womkhiqizo ngengilazi yamanzi afudumele), itiye elimnandi nesidlo sasekuseni esinenhliziyo.
Isigaba sesithathu sokwelashwa ukuqhubeka nokwanda kwansuku zonke komthamo we-insulin, okuholela ekwakhiweni kwesimo esivumelana phakathi kwe-stupor ne-coma. Lesi simo asikwazi ukuhlala ngaphezu kwemizuzu engama-30, ngemuva kwalokho ukuhlaselwa kwe-hypoglycemia kufanele kumiswe. Uhlelo lokuhoxa luyafana nolwangaphambili, okungukuthi, olusetshenziswe esigabeni sesibili.
Inkambo yalokhu kwelapha ihlanganisa izikhathi ezingama-20-30 lapho kutholakala khona ikoma comorbid. Ngemuva kokuthi isibalo esidingekayo salezi zimo ezibucayi sesifinyelelwe, umthamo wansuku zonke we-hormone uncishiswa kancane kancane, kuze kube yilapho ukhanseliwe ngokuphelele.
Iphathwa kanjani i-insulin
Ukwelashwa kwe-insulin kwenziwa ngokwecebo elilandelayo:
- Ngaphambi kokwenza umjovo ongama-subcutaneous, isayithi lomjovo ligaxwe kancane.
- Ukudla ngemuva komjovo akufanele kuqhubeke ngaphezu kwengxenye yehora.
- Umthamo omkhulu ungeqi emayunithi angama-30.
Esimweni ngasinye, isheduli eqondile yokwelashwa kwe-insulin kufanele ibe ngudokotela. Muva nje, amapeni we-insulin asetshenziselwe ukwenza umsebenzi wokwelapha, ungasebenzisa isirinji evamile ye-insulin ngenaliti ebonda kakhulu.
Ukusetshenziswa kwamapeni wesirinji kunengqondo ngokwengeziwe ngezizathu eziningi:
- Ngenxa yenaliti ekhethekile, izinhlungu ezivela ngomjovo ziyancishiswa.
- Ukusebenziseka kalula kwensiza ikuvumela ukuthi wenze imijovo noma kuphi nanoma nini.
- Amanye amapeni wesirinji afakwe izimbotshana ze-insulin, ezivumela ukuhlanganiswa kwezidakamizwa kanye nokusetshenziswa kwezinhlelo ezahlukene.
Izakhi zohlobo lwe-insulin zohlobo 1 nohlobo 2 lwesifo sikashukela yilezi ezilandelayo:
- Ngaphambi kokudla kwasekuseni, isiguli kufanele siphathe umuthi wesenzo esifushane noma eside.
- Ukujova kwe-insulin ngaphambi kwasemini kufanele kube nehomoni esebenza ngokushesha.
- Umjovo owandulela ukudla kwakusihlwa ufaka i-insulin efushane.
- Ngaphambi kokulala, isiguli kufanele silungiselele isikhathi eside ukulungiselela.
Kunezindawo eziningana zokuphatha emzimbeni womuntu. Izinga lokufakwa kwesidakamizwa endaweni ngayinye lihlukile. Isisu sithathwa kalula yile nkomba.
Njengoba kunendawo ekhethwe ngendlela engafanele ukuphatha, ukwelashwa kwe-insulin kungenzeka kunganikeli imiphumela emihle.
Izinkinga ze-Insulin Therapy
Ukwelashwa kwe-insulin, njenganoma yikuphi okunye, kungaba ne-contraindication kanye nezinkinga. Ukuvela kokuphendula kokungezwani komzimba ezindaweni zomjovo kuyisibonelo esicacile sokuxinaniswa kokulashwa kwe-insulin.
Imvamisa, ukwenzeka kokubonakaliswa komzimba kuhlotshaniswa nokwephula ubuchwepheshe nokwazisa umuthi. Lokhu kungaba ukusetshenziswa kwezinalithi ezibucayi noma obukhulu, ukubanda kakhulu kwe-insulin, indawo yomjovo engalungile, nezinye izinto.
Ukwehla kwegazi likashukela egazini nokukhula kwe-hypoglycemia yizimo ze-pathological, eziboniswa yizimpawu ezilandelayo:
- umuzwa onamandla wendlala;
- ukujuluka;
- ukuzamazama kwemilenze;
- tachycardia.
Lesi simo singacasulwa yi-overdose ye-insulin noma indlala ende. Imvamisa, i-hypoglycemia iba nemvelaphi yenjabulo yengqondo, ukucindezelwa, noma ukusebenza ngokweqile komzimba.
Enye inkinga yokwelashwa kwe-insulin yi-lipodystrophy, ehambisana nokunyamalala kwengqimba yamafutha angaphansi kwesayithi lomjovo. Ukugwema lesi simo, isiguli kufanele siguqule indawo yomjovo, kepha kuphela uma lokhu kungaphazamisi ukusebenza kwelashwa.
