Thayipha 1 bese uthayipha i-2 insulin therapy

Isikhathi sokuqala i-insulin sasebenza ngempumelelo ekwelapheni isifo sikashukela emuva ngo-1922. Kusukela lapho, ukwelashwa nge-insulin kusindise izimpilo zezigidi zabantu. Minyaka yonke, amalungiselelo, izindlela nezindlela zokuphatha kwabo ziyenziwa ngcono. Manje sekukhiqizwa izinhlobo ezingaphezu kwe-50 ze-insulin, futhi ukuthuthukiswa okusha, okusebenzayo kakhudlwana kuyaqhubeka.

Umgomo wokwelapha i-insulin ukugcina umzimba we-carbohydrate osezingeni eliseduze nalelo elinikezwe yimvelo. Ukuze lokhu kwenzeke, akudingeki nje ukuletha umthamo wamalungiselelo we-insulin egazini ngokusondele ngangokunokwenzeka ekusithekeni okungokwemvelo kwaleli hormone, kodwa futhi nokugcina izinkomba ezinhle isikhathi eside, kaningi amashumishumi eminyaka.

Kukuziphi izimo lapho ukwelashwa kwe-insulin kudingekile?

Ukwelashwa kwe-insulin akusetshenziswa kuphela lapho i-insulin uqobo isiguli ingekho ngokuphelele, kodwa futhi lapho i-pancreas inganele, nezidakamizwa ezokwehlisa ushukela zingasebenzi. Okwesikhashana, i-insulin ibekelwe isikhathi sokwanda kwesidingo samahomoni. Njengamanje, cishe i-30% yabantu abanesifo sikashukela bazifaka ngokwabo i-insulin.

Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule

• Ukwehlela ushukela -95%
• Ukuqedwa kwe-vein thrombosis - 70%
• Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
• Ukuqeda umfutho wegazi ophakeme - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%

Izinkomba zokwelashwa kwe-insulin:

1. Uhlobo lwe-1 sikashukela, kungakhathalekile ubude bokugula nobudala isiguli.

2. Izinkinga ze-hyperglycemic acute (i-ketoacidosis ebukhali, ikoma).

3. Uhlobo 2 sikashukela lapho ukwelashwa okujwayelekile kungenzeki:

• uma ukungasebenzi kokudla okuphansi kwe-carb nama-hypoglycemic kuma-doses aphezulu avumelekile kuqinisekisiwe;
• uma kukhona ama-contraindication wokuthatha izidakamizwa ezinciphisa ushukela: ukusabela komzimba, ukungalingani kwe-renal kanye ne-hepatic, izifo zegazi;
• ngesikhathi sokukhulelwa nokuncelisa.

4. Ukuhlanganiswa kwesifo sikashukela nezinye izifo:

• ukuncipha kwesisindo esijwayelekile, kungakhathalekile ukuthi ibangelwa yini;
• izifo zokugaya nge-malabsorption;
• izifo ezinzima zokuvuvukala, ikakhulukazi i-purulent;
• ukubuyela kwezifo ezingamahlalakhona;
• infarction myocardial;
• ukungenelela kokuhlinzwa.

5. Izinkinga ezinzima zesifo sikashukela:

• i-neuropathy yesifo sikashukela, ehambisana nobuhlungu obukhulu futhi yehlise kakhulu izinga lempilo;
• isifo sikashukela sonyawo esinezilonda ezibanzi noma i-gangrene;
• i-angiopathy, ephazamisa ukusebenza okujwayelekile kwanoma isiphi isitho, kuze kufinyelele ekungaphelelini kwayo;
• i-triglycerides ephezulu (> 5.6) ngokuhlanganiswa ne-hyperglycemia ejwayelekile.

Ukuvuselelwa kwe-pancreatic uma amaseli we-beta ethinteka kakhulu.

Yini inzuzo yokwelashwa kwe-insulin

Imvamisa, ukwelashwa kwe-insulin okuphoqelekile kwesifo sikashukela sohlobo 1 akuphikiswa yiziguli, ngoba njengamanje ukuphela kwendlela yokwelashwa. Lolu hlobo lwesifo lubonakala ngokuntuleka okuphelele kokuhlanganiswa kwe-insulin emzimbeni, ngaphandle kwaleli hormone, ushukela ovela egazini awunakungena emangqamuzaneni. Ngenxa yalokhu, izicubu ziyafa yindlala, nokwakheka kwegazi kuguquka kakhulu, okuholela ngokushesha ekuholekeni, imvamisa ketoacidotic.

Zonke ezinye izindlela ezikhangisiwe, ezinjenge-soda noma i-stem cell, azikwazi ukubangela ukukhiqizwa kwe-insulin. Izindlela zokwelapha zikashukela ezethembisayo zibandakanya ukutshala kumaseli we-beta akhulayo kanye nokufakelwa kwepancreatic. Manje azisetshenziswa emphakathini, ngoba zingaphansi kwentuthuko.

Kuhlobo 2 sikashukela i-mellitus, lapho sibona isifo, ukwelashwa kwe-insulin kudinga ama-5-10% wabantu abanesifo sikashukela, ngemuva kweminyaka eyi-10 - 80%. Ngeshwa, ukulungiselela kwe-insulin kubangela ukwesaba ezigulini, ngakho-ke bazama ngawo wonke amandla abo ukubambezela ukuqala kwemijovo. Imvamisa lokhu kwenzeka ngenxa yempilo yomuntu. Kwasungulwa ukuthi kuyadingeka ukuthi ushintshele ku-insulin uma i-glycated hemoglobin iyi> 7 usebenzisa izindlela zendabuko zokwelapha.

Ukuqokwa kwe-insulin ngalesi sikhathi kunganciphisa kakhulu ingozi yezinkinga ezingapheli zesifo sikashukela, kanye nokuyeka, futhi ngezinye izikhathi kubuye kubuye emuva, ukuqhubeka kwabo. Iziguli ekwelashweni kwe-insulin mancane amathuba okuba zivezwe ukubonakaliswa okunamandla kwe-hyperglycemia, zihlale zisebenza futhi zisebenza isikhathi eside. Ukuphendula kumalungiselelo we-insulin, ukugcwala kwabo kwehomoni yabo kuyathuthukiswa.

Ukusetshenziswa okunekhono kwezidakamizwa zesimanje kwenza ukuthi kufinyelele ushukela wegazi ojwayelekile, kugweme i-hypoglycemia, futhi kwandise isisindo somzimba. Amapeni wesirinji nezinaliti ezimfishane ezikuvumela ukuba wenze umjovo ngaphandle kobuhlungu. Ukufakwa akudingeki ukuthi kwenziwe kaningi njengoba isifo sikashukela sohlobo 1, imijovo eyi-1-2 ye-insulin ngosuku yanele.

Yiziphi izinhlobo

Namuhla, izindlela ezi-2 zokuphathwa kwe-insulin zivamile: kwendabuko nokuqina, noma ngokomzimba, kuyaqina.

Ukwelashwa kwe-insulin yendabuko kusekelwe kumthamo womuthi, obalwa futhi olungiswa udokotela. Isiguli singangena kuphela inani elifanele lemithi ngesikhathi. Angalawula ushukela wegazi kuphela ngosizo lokudla: anciphise inani lama-carbohydrate ukunciphisa ushukela, anda nge-hypoglycemia. Njengomthetho, umphumela wokulawulwa okunjalo kwesifo sikashukela ukude nezinhloso zegazi. Njengamanje, le ndlela yokuphatha i-insulin kubhekwe kungasebenzi futhi kusebenza kuphela kulezi ziguli ezingakwazi noma ezingafuni ukubala umthamo ngokwazo.

Imiphumela yokwelashwa kwe-insulin ebanzi ingcono kakhulu. Isibonelo, ubungozi be-retinopathy buncishiswa ngama-76%, i-neuropathy - 60%. Lokhu kungenxa yokuthi kusondele kakhulu ekukhiqizweni kwendalo kwehomoni. Umnyombo wokukhiqizwa kwe-insulin eningi imijovo eminingi ilingisa ukukhiqizwa kwehormone njalo futhi kwandise ukwakheka ekuphenduleni i-glucose engena egazini, futhi nokuhlola njalo ushukela nge-glucometer kuyadingeka. Ukudla nge-insulin Therapy akudingekile.

Indlela yesimanjemanje yokuletha i-insulin egazini kushukela sinepampu ye-insulin. Lesi yisisetshenziswa esingazingenisa ngokuzimele i-hormone ngaphansi kwesikhumba kuma-microdoses, enemvamisa ethile. Ngayo, isiguli singangena inani elifanele lomuthi ngaphambi kokudla. Amadivaysi anamuhla ayakwazi ukubheka izinga likashukela uqobo futhi axwayise lapho kudlulela ngalokujwayelekile. Ukwelashwa kwe-insulin okuqinisiwe kuhlinzeka isinxephezelo sikashukela esingcono ngokuqhathaniswa nezinye izindlela, kepha kudinga ukuphathwa ngokucophelela kwento nokulawulwa okwengeziwe kweglucose. Ukuphazamiseka kungabangelwa nenaliti yokuhlinzeka nge-insulin njalo emzimbeni.

• Isihloko sethu sendlela yokubala umthamo we-insulin - funda lapha

Izici zokusebenzisa nokwelapha

Amarejimenti wokulapha we-insulin ajwayelekile awasetshenziswa kuwo wonke amacala. Ekwelashweni kwezingane nabesifazane abakhulelwe, umthamo, imigomo yokwazisa nokulawulwa kwe-glycemia yehlukile. Kula maqembu, umuzwa we-insulin ushintsha njalo, ngakho-ke iziguli zidinga ukubhekwa eduze kwezokwelapha. Inezimpawu zayo kanye nokusetshenziswa kwe-insulin yeziguli ezigula ngengqondo.

Ezinganeni

Ezinganeni, isici esiyinhloko sesifundo sikashukela ukuthambekela kwe-hypoglycemia ekwelapheni i-insulin. Ngaphezu kwalokho, amaconsi kashukela ajwayelekile ayingozi kakhulu kubo kunabantu abadala, ngoba aphazamisa ukukhula kwengqondo okujwayelekile, isimo somzimba esibi, ukuphazamisa ukuhlangana kokunyakaza, nokuphazamisa ukufunda nokuxhumana nontanga.

Ukuze unciphise inani le-hypoglycemia, kutholwe imigomo ephakeme ku-diabetesology yezingane: izinga likashukela ≤ 8 mmol / L, glycated hemoglobin <8.

Isidingo se-insulin ngegilogremu ngayinye isisindo somntwana ngamunye futhi ingahluka cishe izikhathi ezi-2 ngezikhathi ezahlukahlukene zokukhula kwayo: incane ebuntwaneni nasebudaleni, ngaphezulu ngesikhathi sokuthomba okusebenzayo.

Izingane ezingaphansi kweminyaka emi-2 ubudala zinqunywa ukwelashwa kwendabuko kwe-insulin. Uma inika imiphumela emihle, ukusetshenziswa kwayo kunganwetshwa esikhathini sokuthomba. Kusukela eneminyaka eyi-12, kunconywa uhlobo olunamandla. Kancane kancane, izingane zifunda ukufaka umjovo wazo ama-hormone, zikala ushukela futhi zibala nomthamo. Kulokhu, ukulawulwa ngabazali kuyadingeka.

Ngesikhathi sokukhulelwa

Ushukela omningi kwabesifazane abakhulelwe uholela ekuthini fetus fetus, okubandakanya i-pathologies yezitho zangaphakathi, amasistimu ezinzwa, kanye ne-metabolism. Ukuthuthukiswa okujwayelekile kwengane kungenzeka kuphela nge-mellitus enxephezelwe kahle sikashukela, ngakho-ke, izinkomba ezihlosiwe zamazinga kashukela kwabesifazane abakhulelwe ziqine: 3.3-5.1, ubukhulu be-5.6 mmol / L.

Ngabe ukwelashwa kwe-insulin kushintsha kanjani ngesikhathi sokukhulelwa:

• Uhlobo olu-1. Ukuguquguquka okuvame kwezidingo ze-insulin kuyabonakala, ngakho-ke ushukela ojwayelekile ungatholakala kuphela ngokuqapha ngokucophelela nokulungiswa kwamthamo ejwayelekile. Ukwelashwa ngokuqinile kwe-insulin kuyathandwa.
• 2 uhlobo. Uhlobo lokwelashwa lushintsha ngokuyisisekelo, ngoba ngesikhathi sokukhulelwa izidakamizwa ezinciphisa ushukela ziyaphulwa. Okuwukuphela kwekhambi eliphephile ngalesi sikhathi insulin. Kaningi kunalokho, uhlelo lwendabuko lwanele ukunxeshezelwa okujwayelekile. Kungcono ukushintshela ekwelashweni kwe-insulin ngesikhathi sokuhlela.
• Isifo sikashukela sokutholwa kwesisu. Lapho kunqunywa ukwelashwa, izinga lokukhuphuka ushukela liyabhekwa. Imijovo ngaphambi kokudla imvamisa yanele, kepha ezimweni ezinzima, ukwelashwa kwe-insulin okunamandla kungasetshenziswa. Funda kabanzi ngesifo sikashukela sokuthambisa lapha - //diabetiya.ru/pomosh/gestacionnyj-saharnyj-diabet-pri-beremennosti.html

Ukuqondisa kwezengqondo

Ngo-1933, lapho i-insulin iqala ukusetshenziswa kuyo yonke indawo, kwaphawuleka ukuthi inkambo yezifo ezithile zengqondo yaba lula ngemuva kokuba isiguli sathola ukukhohlakala kwe-hypoglycemic. Bazifaka enkomeni ngemijovo ephindaphindwe ye-hormone, ngaphansi kokuqashwa njalo kodokotela. Indlela yokwelashwa kwe-insulin shock, njengoba yayibizwa kanjalo, yayiba yingozi enkulu esigulini (ukufa 2-5%). Ngokuqala kwezidakamizwa ze-psychotropic, isidingo sokwelashwa kwe-insulin sesiphelile, ngaphezu kwalokho, izifundo eziningi azikuqinisekanga ukusebenza kwawo. ENtshonalanga, ukwelashwa kwe-psychosis nge-insulin okwamanje akwenziwa.

E-Russia, ukusetshenziswa kwe-insulin therapy nakho bekulinganiselwe. Okwamanje, kuvunyelwe ukusebenzisa lolu hlobo lokwelapha kuphela kwiziguli ezine-schizophrenia ezinomlando omfishane walesi sifo, ezingakwazi ukwelashwa ngezinye izindlela. Indlela inohlu olukhulu kakhulu lwe-contraindication futhi icishe isetshenziswe.

Imithetho yokwelashwa kwe-insulin

Ukuze uthole isinxephezelo esizinzile soshukela i-mellitus ngosizo lwe-insulin therapy, kufanele ulandele imithetho ethile:

1. Amarejista okuthola ukwelashwa nemithamo yokuqala enqunywa ngudokotela kuphela.
2. Isiguli kufanele siqeqeshelwe futhi sibhekane nemithetho yokubala amayunithi wesinkwa ne-insulin.
3. Ngaphambi kokwethulwa kwe-insulin, udinga ukufunda imiyalo yomuthi, uthole ukuthi yiluphi uhlobo lokuhlushwa, isikhathi esingakanani ngaphambi kokudla kudinga ukulimunwa.
4. Bheka ukuthi isirinji ilungele i-insulin yini. Bona ukuthi inaliti ende kangakanani futhi ulungise indlela yokuphatha umuthi ngokuya ngalolu lwazi.
5. Kala ushukela ngemuva kwamahora ama-2. Okwamanje, awukwazi ukufaka imithamo eyengeziwe yomuthi.
6. Kubalulekile ukugcina idayari lapho kuboniswa khona ubukhulu kanye nesikhathi se-XE, isilinganiso kanye nohlobo lwe-insulin, nezinkomba ze-glycemic.
7. Shintsha indawo yomjovo njalo, ungayihlikihli noma ungayifudumisi.

Yini engaba yizinkinga

Izinkinga ezivame kakhulu ukusetshenziswa kwe-insulin zingama-overdoses kanye ne-hypoglycemia elandelayo. Ngokuhamba konyaka, ama-10% abantu abanesifo sikashukela bathola ukwehla kakhulu koshukela kwezigaba ezilinganiselwe noma ezinzima ze-hypoglycemia. Lezi ikakhulukazi yiziguli ezinokungazizwa kahle kwe-glucose ephansi noma nge-neuropathy, okwenza kube nzima ukuzwa izimpawu. Banconywa ukuthi basebenzise imitha kaningi, kwezinye izikhathi bandisa amatshe okuthola ushukela bese behlisa umthamo we-insulin.

I-hypoglycemia emnene inganqunywa yizimpawu ezilandelayo:

• isicanucanu
• ukuthuthumela emilenzeni;
• ukuthuthumela noma umuzwa wokucwila;
• indlala
• ubuqili;
• ukungakwazi ukugxila.

Akunzima ukuyeka ukuhlaselwa okunjalo, vele uphuze itiye elimnandi noma udle amaswidi ambalwa. Into esemqoka ukumbona ngesikhathi.

Ngaphezu kwe-hypoglycemia, ukwelashwa kwe-insulin kungadala: