I-insulin yomuntu ibhekisa kuma-hormone akha ema-pancreas. Isetshenziselwa ukwelapha isifo sikashukela. Ukuze ulingise umsebenzi ojwayelekile wama-pancreas, isiguli sifakwa nge-insulin:
- umthelela omfushane;
- ithonya elihlala njalo;
- ubude besikhathi besenzo.
Uhlobo lomuthi lunqunywa ngokususelwa enhlalakahleni yesiguli kanye nohlobo lwesifo.
Izinhlobo ze-insulin
I-insulin yenziwa okokuqala kumanyikwe ezinjeni. Ngemuva konyaka, i-hormone isivele isetshenzisiwe. Kwadlula eminye iminyaka engama-40, futhi kwenzeka ukuthi i-insulin ihlanganiswe ngamakhemikhali.
Ngemuva kwesikhashana, kwenziwa imikhiqizo yokuzihlanza ephezulu. Ngemuva kweminye iminyaka embalwa, ochwepheshe baqala ukuthuthukiswa kokuhlanganiswa kwe-insulin yomuntu. Kusukela ngo-1983, i-insulin yaqala ukukhiqizwa ngezimboni zezimboni.
Ngisho eminyakeni engu-15 edlule, isifo sikashukela sasiphathwa ngemikhiqizo eyenziwe ezilwaneni. Namuhla, kuvinjelwe. Kumakhemisi, ungathola kuphela amalungiselelo wobunjiniyela bezakhi zofuzo, ukwenziwa kwalezi zimali kuncike ekufakweni komkhiqizo wezakhi zofuzo kuseli ye-microorganism.
Ngale njongo, asetshenziswa imvubelo noma uhlobo lwezinhlobo zamagciwane we-Escherichia coli. Ngenxa yalokho, ama-microorganisms aqala ukukhiqiza i-insulin kubantu.
Umehluko phakathi kwawo wonke amadivayisi ezokwelapha atholakalayo namuhla yile:
- ngesikhathi sokuvezwa, ama-insulin asebenza isikhathi eside, abasebenza ngokungathathi isikhathi esifushane kanye ne-insulin esebenza ngokufushane.
- ngokulandelana kwe-amino acid.
Kukhona nezidakamizwa ezihlanganisiwe ezibizwa nge- "amamiksi", ziqukethe kokubili i-insulin esebenza isikhathi eside futhi esebenza ngokubambelela. Zonke izinhlobo ezi-5 ze-insulin zisetshenziselwa injongo yazo ebekiwe.
Isikhashana se-insulin
Ama-insulin amafushane, kwesinye isikhathi ama-ultrashort, ayizisombululo ze-zinc-insulin eziyinkimbinkimbi ngohlobo lwe-pH olungathathi hlangothi. Lezi zimali zinomphumela osheshayo, noma kunjalo, umphumela wezidakamizwa uhlala isikhathi esifushane.
Njengomthetho, imali enjalo iphathwa ngokungahambi kahle imizuzu engama-30-45 ngaphambi kokudla. Umuthi ofanayo ungahanjiswa ngokuqinisa ngaphakathi nangaphakathi emzimbeni kanye ne-insulin esebenza isikhathi eside.
Lapho i-ejenti ye-ultrashort ingena emithanjeni, ushukela we-plasma wehla ngokunamandla, umphumela ungabonakala ngemuva kwemizuzu engama-20-30.
Kungekudala, igazi lizohlanzwa kulo muthi, futhi ama-hormone afana ne-catecholamines, i-glucagon ne-STH azokwenyusa inani le-glucose liye ezingeni lasekuqaleni.
Ngokuphulwa kokukhiqizwa kwama-hormone we-contra-hormonal, izinga likashukela wegazi alikhuphuki amahora amaningi ngemuva kokujova komkhiqizo wokwelapha, ngoba kunomthelela emzimbeni nangemva kokukhishwa egazini.
I-hormone ebamba ngokufushane kumele ifakwe emithanjeni:
- ngesikhathi sokuvuselela kanye nokunakekelwa okukhulu;
- iziguli ezine-ketoacidosis yesifo sikashukela;
- uma umzimba usishintsha ngokushesha isidingo sawo se-insulin.
Ezigulini ezinenkambo ezinzile yesifo sikashukela, izidakamizwa ezinjalo zivame ukuthathwa zihambisana nemiphumela yesikhathi eside kanye nesikhathi esiphakathi sokwenza.
I-insulin efakwa ngokushesha nge-Ultra ingumuthi ohlukile isiguli esingaba nawo naye kudivayisi ekhethekile yokusabalalisa.
Ukushaja i-dispenser, kusetshenziswa imikhiqizo ebanjiwe. Lokhu akuvumeli i-insulin ukuthi ikhule ngaphansi kwesikhumba ku-catheter ngesikhathi sokulawula okuhamba kancane.
Namuhla, ihomoni yethonya elifushane yethulwa ngendlela yama-hexamers. Ama-molecule ale nto angama-polymers. Ama-Hexamers amunzwa kancane, angavumeli ukufinyelela ezingeni lokuhlushwa kwe-insulin ku-plasma yomuntu ophilile ngemuva kokudla.
Lesi simo bekuyisiqalo sokukhiqizwa kwamalungiselelo okwenziwa kancane kancane:
- amamitha
- ama-monomers.
Izilingo eziningi zomtholampilo zenziwa, ngenxa yalokho, amathuluzi aphumelela kakhulu, amagama abadumile
- Aspart insulin;
- I-Lizpro-insulin.
Lezi zinhlobo ze-insulin zithathwa zisuka ngaphansi kwesikhumba amahlandla ama-3 ngokushesha ngokuqhathaniswa ne-insulin yomuntu. Lokhu kuholela ekutheni izinga eliphakeme kakhulu le-insulin egazini lifinyelelwa ngokushesha, futhi ikhambi lokwehlisa ushukela lishesha ngokushesha.
Ngokwazisa kwamalungiselelo emisynthetic imizuzu engu-15 ngaphambi kokudla, umphumela uyoba ngokufana nangomjovo we-insulin kumuntu imizuzu engama-30 ngaphambi kokudla.
Ama-hormone anjalo wethonya elisheshayo afaka i-lyspro-insulin. Kukhishwa i-insulin yomuntu etholakala ngokushintshanisa i-proline ne-lysine emaketangeni angama-28 no-29 B.
Njengase-insulin yomuntu, kumalungiselelo enzelwe, i-lyspro-insulin ikhona ngohlobo lwama-hexamers, noma kunjalo, ngemuva kokuthi i-ejenti ingene emzimbeni womuntu, iphenduka ibe ngama-monomers.
Ngenxa yalesi sizathu, i-lipro-insulin inomphumela osheshayo, kepha umphumela uhlala isikhathi esifushane. ILipro-insulin iwina uma uyiqhathanisa nezinye izidakamizwa zalolu hlobo kulezi zinto ezilandelayo:
- kwenza ukuthi kuncishiswe usongo lwe-hypoglycemia ngo-20-30%;
- ukukwazi ukunciphisa inani le-A1c glycosylated hemoglobin, elibonisa ukwelashwa okusebenzayo kwesifo sikashukela.
Ekwakhekeni kwe-insulin insulin, ingxenye ebalulekile inikezwa ukufaka esikhundleni lapho i-aspartic acid ithathelwa indawo yiPro28 emgqeni weB. Njengaku-lyspro-insulin, lesi sidakamizwa, esangena emzimbeni womuntu, ngokushesha sihlukaniswa sibe ngama-monomers.
Izakhiwo ze-Pharmacokinetic ze-insulin
Ku-mellitus yesifo sikashukela, izakhiwo ze-insulin zingahluka. Isikhathi esiphakeme samazinga we-insulin we-plasma nomphumela omkhulu kakhulu wokwehlisa ushukela ungahluka ngo-50%. Ubungako bokushintshashintsha okunjalo kuya ngesilinganiso esihlukile sokutholwa umuthi osuka ezicutshini ezingaphansi. Noma kunjalo, isikhathi se-insulin ende futhi esifushane sihluke kakhulu.
Imiphumela enamandla kunama-hormone wesikhathi esiphakathi nomphumela wesikhathi eside. Kepha muva nje, ochwepheshe bathole ukuthi izidakamizwa ezisebenza ngokufushane zinendawo efanayo.
Ngokuya nge-insulin, kuyadingeka ukujova njalo i-hormone kwezicubu ezi-subcutaneous. Lokhu kusebenza futhi nakulezo ziguli ezingakwazi ukunciphisa inani le-glucose ku-plasma ngenxa yokudla nezidakamizwa ezisehlisa ushukela, kanye nakwabesifazane abanesifo sikashukela ngesikhathi sokukhulelwa, iziguli isifo ezakhe kuso lesi sifo ngesisekelo se-pacreatectomy. Lapha singasho ukuthi amaphilisi okunciphisa ushukela wegazi awanikezi njalo umphumela olindelekile.
Ukwelashwa kwe-insulin kuyadingeka ezifweni ezinjenge:
- i-hyperosmolar coma;
- isifo sikashukela sikashukela;
- ngemuva kokuhlinzwa kweziguli ezinesifo sikashukela,
- ngenkathi ukwelashwa kwe-insulin kusiza ukuguqula inani likashukela ku-plasma,
- Ukuqedwa kwezinye izindlela ze-metabolic.
Umphumela omuhle kakhulu ungatholakala ngezindlela eziyinkimbinkimbi zokwelashwa:
- imijovo;
- ukusebenza komzimba;
- ukudla.
Isidingo sansuku zonke se-insulin
Umuntu onempilo enhle nomzimba ojwayelekile ukhiqiza amayunithi angama-18- 40 ngosuku, noma amayunithi angama-0,2-0,5 / kg we-insulin ende. Cishe ingxenye yengxenye yale ivolumu is secretion gastric, okusele kudalulwe ngemuva kokudla.
I-hormone ikhiqizwa amayunithi angama-0.5-1 ngehora. Ngemuva kokuba ushukela ungene egazini, izinga lokukhuphuka kwe-hormone lenyuka laba amayunithi ayi-6 ngehora.
Abantu abakhuluphele futhi abanokungamelana ne-insulin abangahlushwa isifo sikashukela banokukhiqizwa kwe-insulin izikhathi ezine ngokushesha emva kokudla. Kukhona ukuxhumana kwe-hormone eyakhiwa uhlelo lwe-portal lwesibindi, lapho ingxenye eyodwa ibhujiswa futhi ingafiki egazini.
Ezigulini zohlobo lwe-1 mellitus yesifo sikashukela, isidingo sansuku zonke se-insulin ye-hormone sehlukile:
- Ngokuyisisekelo, le nkomba iyahlukahluka kusuka kumayunithi angama-0.6 kuya kwayi-0.7 / kg.
- Ngesisindo esiningi, isidingo se-insulin siyakhuphuka.
- Lapho umuntu edinga amayunithi / kg angama-0,5 kuphela ngosuku, ukhiqizwa ngokwanele ama-hormone noma isimo somzimba esihle kakhulu.
Isidingo se-insulin ye-hormone sezinhlobo ezi-2:
- post-prandial;
- basal.
Cishe ingxenye yesidingo sansuku zonke ingefomu le-basal. Le hormone ibandakanyeka ekunqandeni ukuqhekeka kashukela esibindini.
Ngefomu le-post-prandial, isidingo sansuku zonke sinikezwa ngemijovo ngaphambi kokudla. I-hormone ibandakanyeka ekufakweni kwezakhi zomzimba.
Kanye ngosuku, isiguli sinikezwa umjovo we-insulin ubude besikhathi sokusebenza, noma kusetshenziswa i-ejenti yokuhlanganisa ehlanganisa i-insulin nesikhathi esifushane ne-hormone ende. Ukugcina i-glycemia isezingeni elijwayelekile, lokhu kungenzeka kunganele.
Ngemuva kwalokho irejimeni yokwelashwa isetshenziswa iyinkimbinkimbi ngokwedlulele, lapho i-insulin esebenza isikhathi esijana ne-insulin esebenza kambalwa noma i-insulin esebenza ngokufushane ngokubamba okufushane isetshenziswa ngokuhlanganiswa.
Imvamisa isiguli selashwa ngokuya ngerejimendi yokuxubha ehlanganisiwe, lapho iphatha umjovo owodwa ngesikhathi sokudla kwasekuseni, kanti esisodwa ngesikhathi sokudla kwakusihlwa. I-hormone kuleli cala iqukethe i-insulin yesikhathi esifushane nesikhathi esiphakathi.
Lapho uthola umthamo wakusihlwa we-hormone NPH noma i-insulin, itheyiphu ayinikezi isilinganiso esidingekayo se-glycemia ebusuku, khona-ke umjovo uhlukaniswe izingxenye ezimbili: ngaphambi kokudla kwakusihlwa, isiguli sifakwa ngomjovo we-insulin omfushane, futhi ngaphambi kokulala sinikezwa i-NPH insulin noma i-insulin tape.
Inani le-insulin linqunywa ngawodwana, ngokususelwa kuzinga likashukela egazini. Ngokuqala kwama-glucometer, manje sekulula ukukala izinga le-hemoglobin ye-glycosylated ku-plasma, futhi kuye kwaba lula ukubona ubukhulu behomoni, okuncike kulezo zinto:
- izifo ezihlangene;
- indawo nokujula komjovo;
- umsebenzi wezicubu endaweni yokulimala;
- ukuhamba kwegazi;
- ukondleka;
- ukusebenza komzimba;
- uhlobo lomuthi;
- inani lomuthi.
