Iziguli ezinenkinga yokushoda kwe-insulin yazo zidinga imijovo yokuphila konke yemithi equkethe le hormone. I-insulin esebenza ngokufushane isetshenziswa njengengxenye ebalulekile yokwelashwa okuyinkimbinkimbi yesifo sikashukela. Uma imishanguzo, imithamo kanye nesikhathi sokuphatha kukhethwe kahle, ushukela wegazi ungenziwa ngokujwayelekile isikhathi eside, okugwema izinkinga eziningi zesifo "esimnandi".
Futhi, i-insulin emfushane ingasetshenziselwa ukumisa ushukela ezigulini ngezikhathi zokwanda kwama-hormone: nge-ketoacidosis, izifo ezingathi sína nokulimala. Lapho usebenzisa iphampu ye-insulin, kungaba ukuphela kwesidakamizwa esinqunyelwe.
Uhlobo luni lwe-insulin olufushane
I-insulin emfushane yenzelwe ukuphindaphinda ukucashelwa ngokomzimba kwehomoni ukuphendula ukwanda kweglucose yegazi. Imvama ukumkhotha isigamu sehora ngaphambi kokudla. Ngalesi sikhathi, uphatha ukungenisa igazi kusuka kwezicubu ezinamafutha bese uqala umsebenzi ukunciphisa ushukela. I-molecule ye-insulin emfushane inesakhiwo esifanayo ne-hormone ekhiqizwa emzimbeni, ngakho-ke leli qembu lezidakamizwa libizwa ngokuthi i-insulin yabantu. Azikho izengezo ebhodleleni ngaphandle kokulondolozwa. I-insulin emfushane iboniswa ngomphumela osheshayo, kodwa ophila isikhashana. Lapho nje umuthi ungena egazini, ushukela wegazi wehla kakhulu, emva kwalokho i-hormone ibhujiswe.
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%
Isifo sikashukela sisebenzisa i-insulin emfushane ngokungagudluki, sisuka lapho singenelwa egazini. Ekuvuseleleni, kusetshenziswa ukuphathwa kwe-intravenous. Le ndlela ikuvumela ukuthi umise ngokushesha izinkinga ezinzima zesifo sikashukela futhi uphendule ngesikhathi isidingo esishintsha ngokushesha sehomoni ngesikhathi sokululama.
Izinkomba zokuphathwa kwe-insulin emfushane
Ngokujwayelekile, i-insulin emfushane ihlanganiswa nezidakamizwa eziphakathi nendawo ezihlala isikhathi eside: okufushane kuyabhalwa ngaphambi kokudla, futhi isikhathi eside - ekuseni nangaphambi kokulala. Isibalo semijovo ye-hormone asinqunyelwe futhi kuncike kuphela kwizidingo zesiguli. Ukunciphisa ukulimala kwesikhumba, okujwayelekile imijovo emi-3 ngaphambi kokudla ngakunye kanye nenani lemijovo emi-3 yokulungisa i-hyperglycemia. Uma ushukela ukhuphuka ngaphambi nje kokudla, ukuphathwa kokulungiswa kuhlanganiswa nomjovo ohlelwe.
Lapho udinga i-insulin emfushane:
- 1 uhlobo lwesifo sikashukela.
- Uhlobo lwe-2 lwesifo lapho izidakamizwa ezinciphisa ushukela zingasasebenzi ngokwanele.
- Isifo sikashukela sokutholwa esinamazinga aphezulu kashukela. Esigabeni esilula, imijovo eyi-1-2 ye-insulin ende ivame ukwanela.
- Ukuhlinzwa kwe-pancreas, okwaholela ekulimaleni i-hormone synthesis.
- Ukwelashwa kwezinkinga ezinzima zesifo sikashukela: iketoacidotic ne-hyperosmolar coma.
- Izikhathi zokwanda kwe-insulin: izifo ezinamazinga okushisa aphezulu, ukushaya kwenhliziyo, ukulimala kwesitho, ukulimala kanzima.
Pharmacokinetics of Short Insulin
Indlela efanelekile yokusebenzisa i-insulin ekwelashweni kwanshukela kwansuku zonke i-subcutaneous. Ijubane nokuphelela kokufakwa emzimbeni kuleli cala kusengaphambili kakhulu, okuvumela ukuthi unqume ngokunembile inani elifanele lomuthi. Umphumela wehlisela ushukela ubonwa ngokushesha uma umjovo wenziwa esiswini, kancane kancane ehlombe nasethangeni, futhi uncipha ngisho nasezinkingeni.
Ama-insulin amafushane aqala ukusebenza isigamu sehora ngemuva kokuphatha, ukusebenza okuphezulu kungamahora ama-2. Ngemuva kokuphakama, isenzo sitholakala ngokushesha. Umphumela wezinsalela kuncike kumthamo owodwa olungiselelwe. Uma amayunithi we-4-6 wezidakamizwa engena egazini, ukuncipha kweshukela kubhekwa kungakapheli amahora ayi-6. Ngethamo lamayunithi angaphezu kwe-16, isenzo singafinyelela emahoreni angama-9.
I-insulin ivunyelwe ngesikhathi sokukhulelwa nokuncelisa ibele, ngoba akungeni ukungena kwegazi nobisi lwebele.
Ngemuva kokwenza imisebenzi yayo, i-insulin emfushane iyabhidlizwa ngokwakhiwa kwama-amino acid: ama-60% ama-hormone alahlwa ezinso, ezingama-40% esibindini, ingxenye encane ingena kumchamo ungashintshiwe.
Amalungiselelo amafushane we-insulin
I-insulin efushane itholakala ngezindlela ezimbili:
- Ngokwezakhi zofuzo, i-hormone lenziwa ngamagciwane.
- Ukwenza okwenziwe ngomzimba, kusetshenziswa ukuguqulwa kwama-enzyme kwehomoni yezingulube.
Zombili lezi zinhlobo zomuthi zibizwa ngokuthi zezomuntu, ngoba ngokwakhiwa kwazo i-amino acid ziphinda ngokuphelele i-hormone eyakhelwe kumanyikwe.
Izidakamizwa ezejwayelekile:
| Iqembu | Amagama Ezidakamizwa | Isikhathi sokwenza ngokuya ngemiyalo | ||
| Qala, imizuzu | Amahora | Isikhathi, amahora | ||
| ubunjiniyela bezakhi zofuzo | I-Actrapid NM | 30 | 1,5-3,5 | 7-8 |
| Gensulin r | 30 | 1-3 | kufika ku-8 | |
| I-Rinsulin P | 30 | 1-3 | 8 | |
| Humulin Njalo | 30 | 1-3 | 5-7 | |
| I-Insuman Rapid GT | 30 | 1-4 | 7-9 | |
| okwenziwe ngokwedlule | I-Biogulin P | 20-30 | 1-3 | 5-8 |
| I-Humodar R | 30 | 1-2 | 5-7 | |
I-insulin emfushane ikhishwa ngendlela yesisombululo esinezifo eziyi-100, ngokuvamisile amayunithi angama-40 kumamililitha ngamunye. Ngomjovo osebenzisa isirinji, umuthi ufakelwa emabhodleleni engilazi ngesivalo senjoloba, ukuze sisetshenziswe emapeni wesirinji - emabhokisini endawo.
Kubalulekile: Ungayigcina kanjani i-insulin emfushane ekhaya, endleleni futhi ngasiphi izinga lokushisa, sichaze imininingwane lapha.
I-Ultrashort insulin
Uma kuqhathaniswa ne-hormone eyenziwe emzimbeni, i-insulin emfushane iboniswa ukuqala kwesikhathi nesikhathi eside esenziwa. Ukuqeda lokhu kushiyeka, kwenziwa amalungiselelo e-ultrashort. I-molecule yalawa ma-insulin ayashintshwa, ihlukile kubantu ekuhlelweni kwama-amino acid.
Izinzuzo ze-insulin ye-ultrashort:
- umphumela we-hypoglycemic osheshayo.
- ukuphatha ngokushesha ngaphambi kokudla.
- amathuba okusebenzisa ngokushesha ngemuva kokudla. Lokhu kubaluleke kakhulu ekwelashweni kwesifo sikashukela sabantwana, ngoba akwaziwa kusengaphambili ukuthi ingane izodlula yonke ingxenye.
- kusiza ukwenziwa kwejwayelekile kwe-glycemia ezimweni ezingejwayelekile.
- amandla okukhulisa inani lama-carbohydrate asheshayo ekudleni kwakho ngaphandle kokuyekethisa ushukela.
- kunciphise amathuba we-hypoglycemia.
- ushukela ongcono ngemuva kokudla.
Iziguli ezinesifo sikashukela esibolile, ukuthambekela kwe-hypoglycemia yasesikhathini sidluliselwa ku-insulin ye-ultrashort. Kunconyelwe futhi nezingane ezincane ngokushintsha kwesifiso sokudla kanye nentsha ngesikhathi sokushintsha kwamahomoni okusebenzayo.
Amagama we-Insulin amafushane kakhulu we-Insulin:
| Uhlobo lwe-insulin | Isici | Ukulungiselela | Isikhathi sokwenza | ||
| Qala, imizuzu | Peak, h. | Isikhathi h | |||
| lizpro | Ingena ngokushesha egazini futhi ifinyelele ekugxileni okuphezulu, isikhathi sokusebenza asincikile kumthamo, okunciphisa ingozi ye-hypoglycemia. | Isi-Humalogue | 15 | 0,5-1 | 2-5 |
| i-aspart | Ikuvumela ukuthi ulawule kangcono i-glycemia ngemuva kokudla, kunciphisa kakhulu ukuguquguquka kwe-glucose yansuku zonke, akunikele ekuzuzeni isisindo. | I-NovoRapid Penfill | 10-20 | 1-3 | 3-5 |
| I-NovoRapid Flexpen | |||||
| glulisin | ILyspro ifana ne-insulin, iphulwe kalula, okuvumela ukuthi isetshenziswe isikhathi eside ngaphandle kokulimaza impilo. | I-Apidra | 15 | 1-1,5 | 3-5 |
Izindlela zokubala i-insulin emfushane
Inani le-insulin efushane edingekayo ukunciphisa ushukela lube ejwayelekile ngemuva kokudla kuncike kokuqukethwe kwe-carbohydrate esitsheni. Ukuze kube lula ukubala, kwethulwa umqondo we- "unit unit". Leli nani lilingana nama-12 g ama-carbohydrate noma cishe ucezwana owodwa wesinkwa. Umthamo we-insulin wokunxephezela i-XE eyodwa ungumuntu ngamunye. Iyashintsha phakathi nosuku. Ekuseni, isidingo siphezulu kakhulu: kumayunithi we-1 XE - 1.5-2.5 womuthi. Imini nobusuku, kuyancipha futhi kufinyelela kumayunithi ayi-1-1.3. Ama-coefficients angokoqobo esiguli esithile angakhethwa kuphela ngokunamandla.
- Indatshana yethu ekubalweni komthamo - //diabetiya.ru/lechimsya/insulin/raschet-dozy-insulina-pri-diabete.html
Isibonelo sokubalwa: ngesikhathi sokudla kwasekuseni, kuhlelwa ukuthi kudle ama-200 g wephalishi, okuzodinga okungama-40 g we-oatmeal nesamishi sangamasawoti, ucezu lwesinkwa lube nesisindo esingu-25 g. Ku-100 g kakolweni - 60 g wama-carbohydrate, ku-40 - 24 g = 2 XE. Ku-100 g yesinkwa, ama-50 g ama-carbohydrate, ku-25 - 12,5 g = 1 XE. I-Ham cishe ayinazo i-carbohydrate, ngakho-ke asiyinaki. Ukulungisa ushukela ngokwejwayelekile, udinga amayunithi ama-3 XE * 2 = 6 womuthi.
Ukubalwa okungenhla kukuvumela ukuthi unxephezele ukukhula kwe-glycemia ngemuva kokudla. Uma ushukela ngaphambi kokudla uphakeme kunokwejwayelekile, umthamo we-insulin omfushane kufanele ukhuphuke. Kukholelwa ukuthi iyunithi le-1 eyengeziwe le-hormone liyadingeka ukwehlisa ushukela nge-2 mmol / L.
Isibonelo sokubalwa: Kudingeka amayunithi ayi-6 ukuze kunxephezelwe ibhulakufesi. umuthi. I-Glycemia ngaphambi kokudla i-9 mmol / L, okujwayelekile ngu-6 mmol / L. Udinga ukufaka (9-6) / 2 = 1.5 amayunithi awengeziwe we-insulin, amayunithi angama-7,5 kuphela.
Ukubalwa okunembe kakhudlwana kwedosi yokulungiswa, ungasebenzisa ifomula yeForsham. Ukuguqula i-mmol / L ibe ngu-mg%, badinga ukuphindaphindeka ngo-18.
| IGlucose Glumg% | Ifomula | Isibonelo Sokubalwa |
| I-150 <Glu <216 | (Glu-150) / 5 | Lapho ushukela ungama-9 mmol / L (9 * 18 = 162 mg%), i-insulin iyadingeka (162-150) / 5 = 2.4, zizungeze amayunithi ayi-2,5. |
| Glu ≥ 216 | (Glu-200) / 10 | Lapho ushukela ungama-15 mmol / L (15 * 18 = 270 mg%), i-insulin iyadingeka (270-200) / 10 = 7 amayunithi. |
Umthamo wansuku zonke we-insulin
Umthamo omkhulu ovunyelwe we-insulin nsuku zonke awukasungulwa. Izindlela ezisezingeni eliphakeme zokwelashwa okufanele kwesifo sikashukela ushukela ojwayelekile wokuzila kanye ne-glycated hemoglobin, kunokuba inani lamahomoni adingekayo kulokhu.
| Cishe isilinganiso sansuku zonke ngekhilogremu yesisindo sesiguli, amayunithi | Isimo sesimo |
| 0,1-0,2 | Ngemuva kokuqala kokwelashwa kwe-insulin, uma ngabe "i-honeymoon" isifikile. |
| 0,3-0,5 | Ekuqaleni kokwelashwa kwe-insulin kwesifo sikashukela sohlobo 2. |
| 0,5-0,6 | Esikhathini sokuqala kwesifo sohlobo 1. |
| 0,7-1 | Ngokugula isikhathi eside nokungabikho ngokuphelele kwama-hormone ayo. |
| 0,5-2 | Ebusheni. |
| 2-2,5 | Okwesikhashana isikhathi sesidingo esengeziwe se-hormone (ketoacidosis, ukumelana ngokuqinile kwe-insulin, ukuhlukumezeka kanye nokutheleleka). |
Uma isidingo se-insulin sibonisa ngokweqile isilinganiso sezinga, lokhu kubonisa ukumelana ne-insulin. Inganqotshwa ngosizo lwezidakamizwa olunqunywe yi-endocrinologist.
Ingxenye ye-insulin emfushane enanini eliphelele lomuthi ngu-8-50%, kuya ngohlobo olukhethiwe lwendlela yokwelashwa. Nge-insulin yokwelapha esekwe kumpompo, kusetshenziswa kuphela i-insulin emfushane ne-Ultra-iDemo.
Ungayisebenzisa kanjani i-insulin efushane
Mayelana nokuthi ungawujova kanjani i-insulin - //diabetiya.ru/lechimsya/insulin/kak-kolot-insulin-pri-diabete.html
Ungawenza kanjani umjovo (imiyalo):
- Khetha isayithi lomjovo. Isisu esivame ukusetshenziswa kakhulu, hhayi eduze kuka-3 cm ukusuka ku-navel.
- Khipha isirinji e-vial futhi elahlekayo kusuka kwephakeji.
- Pierce isicubu senjoloba bese udweba umthamo obalwe wangaphambi kwawo umuthi ku-syringe.
- Ukucindezela isiqu khipha wonke umoya kwisirinji.
- Qoqa isikhumba ku-crease ngendlela yokuthi kuphela isikhumba namafutha angaphansi. Imisipha akufanele ithinteke.
- Faka inalithi ku-crease bese ufaka yonke insulin.
- Ngaphandle kokuthatha izinaliti noma ususe i-crease, linda imizuzwana embalwa.
- Susa inaliti kancane, bese udedela isikhumba.
Ibanga ukusuka endaweni yomjovo wangaphambilini akufanele libe ngaphansi kwamasentimitha ayi-2. Akukhathalekile ukuthi isikhumba noma inalithi ziphathwe ngotshwala, ngoba kungawenza buthaka kakhulu umphumela we-insulin.
