I-insulin isidakamizwa esibalulekile, siguqule izimpilo zabantu abaningi abanesifo sikashukela.
Kuwo wonke umlando wezokwelapha nowekhemisi wangekhulu lama-20, mhlawumbe kuneqembu elilodwa kuphela lemithi elibaluleke ngendlela efanayo - le yimithi elwa namagciwane. Bona, njenge-insulin, bangene emithini yezokwelapha ngokushesha futhi basiza ukusindisa izimpilo zabantu abaningi.
Usuku Lwesifo Sikashukela lugujwa ngokuqalwa kweWorld Health Organisation njalo ngonyaka, kusukela ngonyaka ka 1991 ngosuku lokuzalwa lukasolwazi wezempilo lomzimba waseCanada, uFun Bunting, othole i-insulin ye-hormone noJ. J. Macleod. Ake sibheke ukuthi lenziwa kanjani leli hormone.
Uyini umehluko phakathi kwamalungiselelo e-insulin
- Izinga lokuhlanzwa.
- Umthombo wokuthola irayisi, ingulube, i-insulin yabantu.
- Izingxenye ezingeziwe ezifakiwe kusixazululo somuthi zingokulondolozwa, ama-prolonger ezenzo, nabanye.
- Ukugxila.
- pH yesisombululo.
- Amandla wokuxuba izidakamizwa ezimfishane nezisebenza isikhathi eside.
I-insulin yi-hormone ekhiqizwa amaseli akhethekile kuma-pancreas. Iprotheyini enemigqa emibili, ifaka ama-amino acid angama-51.
Cishe amayunithi ayi-6 ezigidigidi zama-insulin adliwa minyaka yonke emhlabeni (iyunithi elilodwa lama-micrograms angama-42). Ukukhiqizwa kwe-insulin kungubuchwepheshe obuphakeme futhi kwenziwa kuphela ngezindlela zezimboni.
Imithombo ye-insulin
Njengamanje, kuya ngomthombo wokukhiqiza, i-insulin yezingulube kanye namalungiselelo e-insulin yabantu ayahlukaniswa.
I-insulin yengulube manje inezinga eliphakeme kakhulu lokuzihlanza, inomphumela omuhle we-hypoglycemic, futhi akukho lutho olungaphenduki ngalo.
Ukulungiswa kwe-insulin yomuntu kuhambisana ngokuphelele nokwakheka kwamakhemikhali ne-hormone yomuntu. Imvamisa kukhiqizwa yi-biosynthesis isebenzisa ubuchwepheshe be-genetic engineering.
Izinkampani ezinkulu zokukhiqiza zisebenzisa izindlela zokukhiqiza eziqinisekisa ukuthi imikhiqizo yazo ihlangabezana nawo wonke amazinga ekhwalithi. Akukho mehluko omkhulu esenzweni se-insulin yabantu ne-porcine monocomponent insulin (i .e., Ehlanjululwe kakhulu); maqondana namasosha omzimba, ngokocwaningo oluningi, umehluko mkhulu.
Izakhi ezisizayo ezisetshenziselwa ukwenziwa kwe-insulin
Ebhodleleni elinezidakamizwa kuqukethe isixazululo esingaqukethe i-insulin kuphela, kodwa nezinye izidakamizwa. Ngamunye wabo udlala indima ethile:
- ukwelula umuthi;
- ukungabonwa magciwane kwekhambi;
- ukuba khona kwezindawo ezi-buffer zesisombululo nokugcina i-pH engathathi hlangothi (ibhalansi ye-acid-base).
Isandiso se-insulin
Ukwakha i-insulin esebenza ngokungeziwe, enye yezinhlanganisela ezimbili, i-zinc noma i-protamine, yengezwe kwikhambi le-insulin ejwayelekile. Ngokuya ngalokhu, yonke insulin ingahlukaniswa ngamaqembu amabili:
- ama-protamine insulin - i-protafan, i-insuman basal, i-NPH, i-humulin N;
- ama-zinc-insulin - ama-insulin-zinc-ukumiswa kwe-mono-tard, itepi, i-humulin-zinc.
I-Protamine iprotheni, kepha ukusabela okubi ngendlela yokungezwani nakho kuyaqabukela.
Ukwakha i-medium solution engathathi hlangothi, i-phosphate buffer yengezwe kuyo. Kufanele kukhunjulwe ukuthi i-insulin equkethe ama-phosphates ayenqatshelwe ngokuphelele ukuhlanganisa nokumiswa kwe-insulin-zinc (ICS), ngoba i-zinc phosphate inikezela kuleli cala, futhi isenzo se-zinc-insulin sifinyeziwe ngendlela engalindeleki.
Izinto zokubulala amagciwane
Eminye yemikhakha ethi, ngokuya ngezinqubo zokwelapha kanye nezobuchwepheshe, okufanele ingeniswe kulungiselelo, ibe nomphumela wokungagculisi. Lokhu kufaka i-cresol ne-phenol (bobabili banephunga elithile), kanye ne-methyl parabenzoate (methyl paraben), lapho kungekho khona iphunga.
Ukwethulwa kwanoma yikuphi kwalokhu kugcinwa kungukuhogela iphunga elithile lamalungiselelo athile e-insulin. Yonke imihuzuko enani elitholakala ngalo kumalungiselelo e-insulin ayinamphumela omubi.
I-Protamine insulins ngokuvamile ifaka i-cresol noma i-phenol. I-Phenol ayikwazi ukungezwa kuzixazululo ze-ICS ngoba iguqula isimo esingokwenyama sezinhlayiya ze-hormone. Le mishanguzo ifaka i-methyl paraben. Futhi, ama-ion e-zinc kusixazululo anomphumela we-antimicrobial.
Ngenxa yalesi sigaba sokuvikela i-antibacterial esinezigaba eziningi, izithako zokuvikela izifo zisetshenziselwa ukuvimba ukuthuthuka kwezinkinga ezingenzeka ezingabangelwa ukungcoliswa kwamagciwane lapho inaliti ifakwa kaninginingi ku-vial yesisombululo.
Ngenxa yokuba khona kwendlela yokuvikela enjalo, isiguli singasebenzisa isirinji efanayo yokujova isithasiselo somuthi izinsuku ezi-5 kuye kweziyi-7 (inqobo nje uma isebenzisa isirinji). Ngaphezu kwalokho, izinto zokugcina izidumbu zenza ukuthi kungabikhona ukusebenzisa utshwala ukwelapha isikhumba ngaphambi kokujova, kodwa futhi kuphela uma isiguli sizilimaza ngesirinji ngenalithi emincane (insulin).
I-Insulin Syringe Calibration
Kumalungiselelo okuqala we-insulin, iyunithi elilodwa kuphela le-hormone elalikhona kwi-ml eyodwa yesisombululo. Kamuva, ukugxila kwandiswa. Amalungiselelo amaningi we-insulin emabhodleleni asetshenziswa eRussia aqukethe amayunithi angama-40 ku-1 ml wesisombululo. Izilwane ezifuywayo zivame ukumakwa uphawu lwama-U-40 noma ama-40 amayunithi / ml.
Isirinji ye-insulin yokusetshenziswa okubanzi ihloselwe i-insulin enjalo futhi ukulinganisa kwabo kwenziwa ngokwemigomo elandelayo: lapho isirinji ligcwele isixazululo esingu-0.5 ml, umuntu uthola amayunithi angama-20, u-0,35 ml uhambelana amayunithi ayi-10 njalonjalo.
Umaki ngamunye kwisirinji ulingana nevolumu ethile, futhi isiguli sivele sazi ukuthi mangaki amayunithi aqukethwe kule ivolumu. Ngakho-ke, ukulinganiswa kwama-syringes kungukuthweswa iziqu ngevolumu yomuthi, kubalwa ngokusetshenziswa kwe-insulin U-40. Amayunithi ama-4 we-insulin aqukethe ku-0,1 ml, amayunithi ama-6 - ku-0.15 ml yesidakamizwa, njalonjalo kuze kube amayunithi angama-40, ahambelana ne-1 ml yesisombululo.
Amanye amamayela asebenzisa i-insulin, eyi-1 ml equkethe amayunithi ayi-100 (U-100). Ezidakamizweni ezinjengalezi, kukhiqizwa amasirinji akhethekile e-insulin, afanayo nalawo okuxoxwe ngawo ngenhla, kodwa kufakwe i-calibration ehlukile.
Kubheka lokhu kugxila okuthile (kuphindeke ka-2,5 kunokwejwayelekile). Kulokhu, umthamo we-insulin esigulini, kusobala, uhlala unjalo, ngoba wanelisa isidingo somzimba senani elithile le-insulin.
Okusho ukuthi, uma ngaphambili isiguli sisebenzise umuthi u-40 futhi sihambisa amayunithi angama-40 ngosuku, khona-ke kufanele athole amayunithi afanayo angama-40 lapho ejova i-insulin U-100, kodwa kufanele awuphathe ngesilinganiso izikhathi eziphindwe ka-2,5. Lokho wukuthi, amayunithi afanayo angama-40 azotholakala ku-0,4 ml wesisombululo.
Ngeshwa, akubona bonke odokotela futhi ikakhulukazi labo abanesifo sikashukela abakwaziyo lokhu. Ubunzima bokuqala buqale lapho ezinye zeziguli zishintshela ekusebenziseni ama-insulin injens (amapeni wesirinji), asebenzisa ama-penfill (ama-cartridges akhethekile) aqukethe i-insulin U-40.
Uma ugcwalisa isirinji nekhambi elibhalwe U-100, ngokwesibonelo, kufinyelela kumaki wamayunithi angama-20 (isb. 0.5 ml), khona-ke leli nani lomuthi liqukethe amayunithi afinyelela kwangama-50.
Isikhathi ngasinye, ukugcwalisa ama-syringes nge-U-100 ngama-syringe ajwayelekile futhi ubheka ukusikwa kwama -unithi, umuntu uzothola umthamo ophindwe izikhathi ezi-2,5 kunalokho kukhonjiswe ezingeni lalolu phawu. Uma ngabe udokotela noma isiguli singaliqapheli leli phutha, khona-ke amathuba okuthola i-hypoglycemia ephezulu kuphezulu ngenxa yokusetshenziswa ngokweqile komuthi, okwenzeka kaningi lapho kwenzeka.
Ngakolunye uhlangothi, kwesinye isikhathi kukhona ama-insulin ama-insulin alinganiswe ngokuqondile ngomuthi u-100. Uma isirinji enjalo igcwaliswe ngephutha ngesisombululo esijwayelekile se-U-40, khona-ke umthamo we-insulin esitokisini uzoba ngaphansi kwezikhathi ezingama-2,5 kunalowo olotshwe eduze kwophawu oluhambisanayo kwisirinji.
Ngenxa yalokhu, ukwanda okungacaciswanga kweglue glucose kungenzeka ekuqaleni kokuqala. Eqinisweni, empeleni, konke kunengqondo impela - ekuhlushweni ngakunye kwesidakamizwa kubalulekile ukusebenzisa isirinji esifanele.
Kwamanye amazwe, njengeSwitzerland, icebo lacatshangelwa ngokucophelela, ngokusho kwalapho kwenziwa inguquko efanelekile kumalungiselelo e-insulin ngokubekwa uphawu kwe-U-100. Kepha lokhu kudinga ukuxhumana okusondelene nabo bonke abathintekayo: odokotela bezindlela eziningi, iziguli, abahlengikazi abavela kunoma imiphi iminyango, osokhemisi, abakhiqizi, iziphathimandla.
Ezweni lethu, kunzima kakhulu ukushintshela zonke iziguli ekusebenziseni i-insulin U-100 kuphela, ngoba, kungenzeka kakhulu, lokhu kuzoholela ekwandeni kwenani lamaphutha ekunqumeni umthamo.
Ukusetshenziswa okuhlangene kwe-insulin emfushane nehlala isikhathi eside
Ezokwelapha zesimanje, ukwelashwa kwesifo sikashukela, ikakhulukazi uhlobo lokuqala, kuvame ukwenzeka kusetshenziswa izinhlobo ezimbili ze-insulin - isenzo esifushane nesesikhathi eside.
Kungaba lula kakhulu ezigulini uma izidakamizwa ezinokuqina okuthe xaxa zingahlanganiswa kusirinji esisodwa futhi ziphathwe kanyekanye ukugwema ukubhoboza isikhumba kabili.
Odokotela abaningi abazi ukuthi yini enquma ikhono lokuxuba ama-insulin ahlukahlukene. Isisekelo salokhu ngukuhlobana kwamakhemikhali ne-galenic (okunqunywa ukwakheka) ukuhambisana kwama-insulin anwebayo afushane futhi amafushane.
Kubaluleke kakhulu ukuthi lapho kuxuba izinhlobo ezimbili zemithi, ukuqala ngokushesha kwesenzo kwe-insulin emfushane akunwebeki noma kunyamalale.
Sekufakazelwe ukuthi umuthi obambela amafushane ungahlanganiswa nomjovo owodwa ne-protamine-insulin, kuyilapho ukuqala kwe-insulin esebenza ngokubambezelayo kungabambezeki, ngoba i-insulin enganyakazi ayibophisi i-protamine.
Kulokhu, umenzi wesidakamizwa akanandaba. Isibonelo, i-insulin Actrapide ingahlanganiswa ne-humulin H noma i-protafan. Ngaphezu kwalokho, ukuxubeka kwalawa malungiselelo kungagcinwa.
Mayelana namalungiselelo we-zinc-insulin, sekuyisikhathi eside kusungulwa ukuthi i-insulin-zinc-ukumiswa (i-crystalline) ayinakuhlanganiswa ne-insulin emfushane, ngoba ibopha ama-ion e-zinc ngokweqile futhi iguqulwa ibe yi-insulin ende, kwesinye isikhathi ngokwengxenye.
Ezinye iziguli ziqala ngokuphatha umuthi obambela amafushane, lapho-ke, ngaphandle kokususa inaliti ngaphansi kwesikhumba, ziguqule kancane ukuqondisa kwaso, bese kuthi-ke i-zinc-insulin ifakwe kuso.
Ngokusho kwale ndlela yokuphatha, kwenziwa izifundo ezimbalwa zesayensi, ngakho-ke akunakucaciswa ukuthi kwezinye izikhathi ngale ndlela yokujova ingxube ye-zinc-insulin kanye nomuthi obambela amafushane ungakheka ngaphansi kwesikhumba, okuholela ekungeneni kokulimala kokunye.
Ngakho-ke, kungcono ukuphatha i-insulin emfushane ngokuphelele ngokwahlukana ne-zinc-insulin, ukwenza imijovo emibili ehlukene ezindaweni zesikhumba ezitholakala okungenani 1 cm ngaphandle komunye nomunye. Lokhu akulula, ungasasho umthamo ojwayelekile.
I-insulin ehlanganisiwe
Manje imboni yezemithi ikhiqiza amalungiselelo ahlanganayo aqukethe i-insulin efushane ngokubambisana ne-protamine-insulin engxenyeni echazwe ngokuqinile yamaphesenti. Le mishanguzo ifaka:
- i-mixtard
- I-Actrafan
- insuman comb.
Inhlanganisela ephumelela kakhulu yilezo lapho isilinganiso se-insulin esifushane ukuya esikhathini eside singama-30: 70 noma ama-25: 75. Lesi silinganiso sihlala sikhonjiswa kwimiyalo yokusebenzisa umuthi ngamunye othize.
Izidakamizwa ezinjalo zilungele kangcono abantu abalandela ukudla okungapheli, ngokuzivocavoca umzimba njalo. Isibonelo, zivame ukusetshenziswa yiziguli esezikhulile ezinesifo sikashukela sohlobo 2.
Ama-insulin ahlanganisiwe awalungele ukwenziwa kwe-insulin yokwelapha okubizwa ngokuthi "eguquguqukayo", lapho kuba nesidingo sokushintsha njalo umthamo we-insulin esebenza ngokufushane.
Isibonelo, lokhu kufanele kwenziwe lapho kuguqulwa inani lama-carbohydrate ekudleni, ukunciphisa noma ukukhulisa ukusebenza komzimba, njll. Kulokhu, isilinganiso se-basal insulin (isikhathi eside) asiguquki.
Isifo sikashukela yisifo sesithathu esivelele kunazo zonke emhlabeni. Ihlala ngemuva kwezifo zenhliziyo kanye ne-oncology kuphela. Ngokusho kwemithombo ehlukahlukene, inani leziguli ezinesifo sikashukela emhlabeni lisuka kwizigidi ezingama-120 liya ezi-180 (cishe i-3% yabo bonke abakhileyo eMhlabeni). Ngokusho kokunye ukubikezela, inani leziguli lizophindeka kabili ngenani njalo eminyakeni eyi-15.
Ukwenza ukwelashwa okusebenzayo kwe-insulin, kwanele ukuba nomuthi owodwa kuphela, i-insulin esebenza isikhathi esifushane, kanye ne-insulin eyodwa yesikhathi eside, bavunyelwe ukuhlanganiswa ndawonye. Futhi kwezinye izimo (ikakhulukazi ezigulini esezikhulile) kunesidingo somuthi ohlanganayo wesenzo.
Izincomo zamanje zinquma izindlela ezilandelayo zokukhetha amalungiselelo e-insulin:
- Izinga eliphakeme lokuhlanzwa.
- Amathuba okuxubana nezinye izinhlobo ze-insulin.
- I-pH engathathi hlangothi
- Amalungiselelo avela esigabeni sama-insulin anwetshiwe kufanele abe nesikhathi sokusebenza kusuka emahoreni ayi-12 kuye kwayi-18, ukuze anele ukuwaphatha izikhathi ezi-2 ngosuku.
