I-insulin esebenza ngokushesha: indlela yokujova izidakamizwa zesintu

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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:

  1. ngesikhathi sokuvuselela kanye nokunakekelwa okukhulu;
  2. iziguli ezine-ketoacidosis yesifo sikashukela;
  3. 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

  1. Aspart insulin;
  2. 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:

  1. i-hyperosmolar coma;
  2. isifo sikashukela sikashukela;
  3. ngemuva kokuhlinzwa kweziguli ezinesifo sikashukela,
  4. ngenkathi ukwelashwa kwe-insulin kusiza ukuguqula inani likashukela ku-plasma,
  5. 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:

  1. Ngokuyisisekelo, le nkomba iyahlukahluka kusuka kumayunithi angama-0.6 kuya kwayi-0.7 / kg.
  2. Ngesisindo esiningi, isidingo se-insulin siyakhuphuka.
  3. 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.

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