I-insulin esebenza isikhathi eside - izidakamizwa, ukuthi ungabale kanjani umthamo

Ukuze ugcine ushukela uselangeni eliqondiwe ngesikhathi sesifo sikashukela ubusuku bonke futhi uqinisekise ukugcwala kwayo okujwayelekile esiswini esingenalutho ntambama, kusetshenziswa i-insulin ebambekayo. Inhloso yawo ukuletha i-hormone egazini eduze kokucashelwa kwayo okungokwemvelo okuyisisekelo. I-insulin ende ivame ukuhlanganiswa nesifushane, esifakwa ngaphambi kokudla ngakunye.

Imithamo umuntu ngamunye, ungabathola kuphela ngezindlela zokuhlola. Ukuvimbela i-hypoglycemia, inani lokuqala le-hormone lenziwa ngamabomu kakhulu kakhulu, bese liyancipha kancane kancane kuze kube yilapho i-glucose yejwayelekile.

Ukukhetha kwe-Insulin Ekunwetshiwe

Ukukhishwa komzimba kwe-insulin egazini akuyeki ukujikeleza isikhathi, kungakhathalekile ukuthi kukhona noma kungatholakali ukudla. Ebusuku naphakathi nosuku, lapho enye yokudla isivele igcotshwe kanti enye ingakafiki, ukugcotshwa kwengemuva kwe-hormone kuyalondolozwa. Kuyadingeka ekuqhekekeni ushukela, ongena egazini kusuka ezitolo ze-glycogen. Ukuqinisekisa isizinda esilinganayo, esizinzile, ukwethulwa kwe-insulin ende kuyadingeka. Ngokwalokho osekubonile, kusobala ukuthi isidakamizwa esihle kufanele ube nomphumela omude, ofanayo, awunazo iziqongo neziziba.

Kusetshenziselwa lezi zinhloso:

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%

Ukuzikhethela kwe-insulin eyengeziwe kungumsebenzi kadokotela ohambelayo. Kucabanga ngesiyalo sesiguli, ukuba khona kokukhululwa okusele kwehomoni yakhe, umkhuba we-hypoglycemia, ubukhulu bezinkinga, imvamisa yokuzila ukudla kwe-hyperglycemia.

Ungayikhetha kanjani i-insulin esebenza isikhathi eside:

1. Ezimweni eziningi, okuthandwa kunikezwa kuma-insulin analogue, njengokuphumelela kakhulu nokufundwayo.
2. Ama-Protamine agents ajwayele ukusetshenziswa uma okunye okutholakalayo kungatholakali. Ama-insulin ama-NPH anganikeza isinxephezelo esanele sesifo sikashukela sohlobo 2 ekuqaleni kokulashwa kwe-insulin, lapho isidingo se-hormone sisephansi.
3. I-Tresiba ingasetjenziswa ngempumelelo nguhlobo 1 lwesifo sikashukela, esingathambekele ekwehlisweni okubukhali kushukela wegazi futhi siqale ukuzizwa izimpawu ze-hypoglycemia ekuqaleni. Ngohlobo 2 lwesifo sikashukela, uTresib ungumholi ongaphikisiwe emakethe ye-insulin, njengoba ihlangana kahle nama-ejenti omlomo we-hypoglycemic, unomthelela ongaguquki, futhi wehlisela imvamisa ye-hypoglycemia yangemuva ngo-36%.

Umthamo wansuku zonke we-insulin ende uhlukaniswe ekuphathweni kokusa nokuhlwa, umthamo wabo uvame ukuhluka. Isidingo somuthi sincike ekuweni kwesifo sikashukela. Izindlela eziningana zenzelwe ukubalwa kwayo. Zonke zidinga izilinganiso eziningi kashukela wegazi. Ukukhethwa komthamo kuthatha isikhathi, ngoba inani ebalwa ekuqaleni le-insulin ende liyalungiswa kucatshangelwa izici zokufakwa kanye nokwephuka kwe-hormone emzimbeni wesiguli esithile. Ukuqokwa komthamo wokuqalisa "ngeso" kuzoholela ekunciphiseni okubangelwa isikhathi eside futhi esibi soshukela i-mellitus, kwandisa izinkinga zesifo.

Isilinganiselo sedosi elikhethwe kahle i-glycemia esheshayo, ukuncipha kwamaphaphu nokungabikho kwe-hypoglycemia enzima. Emini, ukuguquguquka kweshukela ngaphambi kokudla kufanele kube ngaphansi kuka-1.5 mmol / L - indlela yokubala kahle umthamo we-insulin.

Ukubalwa komthamo wakusihlwa

Owokuqala ukukhetha umthamo we-insulin enwetshiwe, kufanele unikeze isilinganiso se-glucose ebhekiswe ebusuku nasekuseni ngemuva kokuvuka. Ku-mellitus yesifo sikashukela, "into yokusa yokusa" ivame ukubonwa. Lokhu kukhuphuka kwe-glycemia ngezikhathi zasekuseni, okubangelwa ukwanda kokukhushulwa kwamahomoni okwenza buthaka umphumela we-insulin. Ebantwini abaphilile, ukukhishwa kwe-insulin kuyanda ngalesi sikhathi, ngakho-ke i-glucose ihlala izinzile.

Ku-mellitus yesifo sikashukela, lokhu kuguquguquka kungaqedwa kuphela ngamalungiselelo e-insulin. Ngaphezu kwalokho, ukwanda okujwayelekile komthamo kunganciphisa ushukela wegazi ekuseni kuye kwesejwayelekile, kepha kuholele eglycemia ephansi kakhulu ekuqaleni naphakathi kobusuku. Ngenxa yalokho, onesifo sikashukela uhlushwa amaphupho amabi, ukushaya kwenhliziyo nokujuluka kwakhe kuyaqina, futhi nesistimu yakhe yezinzwa iyahlupheka.

Ukuxazulula inkinga ye-hyperglycemia ekuseni, ngaphandle kokukhulisa umthamo wezidakamizwa, ungasebenzisa isidlo sakusihlwa sangaphambili, ngokunengqondo - amahora ama-5 ngaphambi kokwethulwa kwe-insulin ende. Ngalesi sikhathi, wonke ushukela ovela ekudleni uzoba nesikhathi sokudlulela egazini, isenzo se-hormone esifushane sizophela, futhi i-insulin ehlala isikhathi eside kuzodingeka ukuthi ihlukanise i-glycogen kuphela esibindini.

Ukubalwa kwe-algorithm:

1. Ukunquma kahle inani lesidakamizwa somjovo wakusihlwa, kuyadingeka izinombolo ze-glycemic yezinsuku eziningana. Udinga ukudla kwakusihlwa ngaphambi kwesikhathi, ukukala ushukela ngaphambi kokulala, bese ekuseni ngokushesha ngemuva kokuvuka. Uma i-glycemia yasekuseni ibiphezulu, ukukalwa kuyaqhubeka ngezinye izinsuku ezingama-4. Izinsuku lapho isidlo sakusihlwa okufike sekwedlule isikhathi asifakwa kuhlu.
2. Ukunciphisa ubungozi be-hypoglycemia, umehluko omncane kakhulu phakathi kwalezi zilinganiso ezimbili ukhethwa kuzo zonke izinsuku.
3. Isici sokuzwela i-insulin siyabalwa. Lokhu kungubukhulu bokwehliswa kwe-glycemia ngemuva kokwethulwa kweyunithi elilodwa le-hormone. Kumuntu onesisindo esingu-63 kg, iyunithi eli-1 le-insulin enwetshiwe lizokwehlisa ushukela ngo-4,4 mmol / L ngokwesilinganiso. Isidingo somuthi sikhula ngokulingene ngokuqondile kwesisindo. I-PSI = 63 * 4,4 / isisindo sangempela. Isibonelo, ngesisindo sama-85 kg, i-PSI = 63 * 4.4 / 85 = 3.3.
4. Umthamo wokuqala ubalwa, ulingana nomehluko omncane kakhulu phakathi kwezilinganiso ngaphambi kokulala nesekuseni, uhlukaniswe yi-PSI. Uma umehluko ungu-5, faka ngaphambi kokulala udinga amayunithi ayi-5 / 3.3 = 1.5.
5. Izinsuku eziningana, ushukela ulinganiswa ngemuva kokuvuka futhi, ngokususelwa kule mininingwane, inani lokuqalisa le-insulin liyalungiswa. Kungcono ukushintsha umthamo njalo ezinsukwini ezi-3, ukulungiswa ngakunye akufanele kube ngaphezu kweyunithi elilodwa.

Ngohlobo 2 sikashukela, ushukela ekuseni ungaphansi kunokuba ulala. Kulokhu, i-insulin ehlala isikhathi eside ayilimwanga kusihlwa. Uma i-glycemia ngemuva kokuphaka isidlo sakusihlwa iphakeme, kwenziwa i-jab yokulungisa ye-hormone esheshayo. I-insulin ende ngalezi zinhloso ayikwazi ukusetshenziswa, ilawulwa ngomuthi ofanayo.

Uma ukulungiswa kwamthamo kwehluleka

I-Hypoglycemia ebusuku ingafihlwa, okungukuthi, isiguli ephusheni asizwa lutho futhi asazi ngobukhona baso. Ukuthola ukwehla okufihliwe kushukela wegazi, ukukalwa kwenziwa kaningana ngobusuku: ngamahora ayi-12, 3 no-6. Uma nge-3 entathakusa i-glycemia isondele kumkhawulo ophansi wesimo esijwayelekile, ngosuku olulandelayo lukalwa ngo-1-00, 2-00, 3-00. Uma okungenani inkomba eyodwa inganakwa, kukhombisa ukweqisa

Abanye abanesifo sikashukela abadinga i-insulin encane babhekene neqiniso lokuthi isenzo se-hormone siba buthaka ekuseni, futhi akwanele ukuqeda into yokusa yokusa. Ukhuphuka komthamo kuleli cala kuholela ku-hypoglycemia yasesikhathini. Lo mphumela ungabonakala uma ungasebenzisi i-NPH-insulin engasebenzi kuphela, kodwa futhi noLantus, Tujeo noLevemira.

Uma kunethuba lezezimali, kungenzeka ukuthi uxoxe nodokotela oholayo ngesidingo sokusebenzisa i-insulin engaphezulu. Izenzo zikaTreshiba zanele ubusuku bonke, ngakho ushukela wegazi ekuseni uzoba uvamile ngaphandle kwemijovo eyengeziwe. Ngesikhathi sokuguquka, ukulawula okuvame kakhulu kwe-glycemia kuyadingeka ukuvimbela ukuncipha kwayo ntambama.

Iningi lama-endocrinologists lincoma ukushintshela eTreshiba kuphela izinkomba. Ochwepheshe besifo sikashukela, okuyilapho ama-ejenti abo efakazelwe ehlinzeka ngesinxephezelo esivamile ngalesi sifo, bayalulekwa ukuba bayeke i-insulin entsha kuze kube lapho umenzi sekwenziwe inani elanele lezifundo futhi nesipiliyoni sitholile ngalo muthi.

Ukukhetha imithamo yasekuseni

I-insulin ende yemini iyadingeka ukwehlisa ushukela lapho ukudla sekugaywe kakade. Ama-carbohydrate avela ekudleni anxephezelwa yi-hormone emfishane. Ukuze umphumela wayo ungaphazamisi ekukhetheni inani elifanelekile le-insulin, kuzofanela ulambe ingxenye yosuku.

I-algorithm yokubala umthamo yansuku zonke:

1. Khetha usuku lwamahhala. Iba nokudla kwakusihlwa ekuseni. Kala ushukela wegazi ngemuva kokuvuka, ngemuva kwehora, bese uliphinda kathathu njalo amahora ama-4. Sonke lesi sikhathi awukwazi ukudla, kuvunyelwe kuphela amanzi. Ngemuva kwesilinganiso sokugcina ungadla.
2. Khetha ushukela omncane kakhulu wosuku.
3. Bala umehluko phakathi kwaleli zinga nekhwalithi, kuthathwa kuyo i-5 mmol / l.
4. Bala insulin nsuku zonke: hlukanisa umehluko yi-PSI.
5. Ngemuva kwesonto, phinda ukulinganisa esiswini esingenalutho, uma kunesidingo, lungisa umthamo osuselwa kwidatha

Uma ukuzila isikhathi eside kuvinjelwe abanesifo sikashukela, ukukalwa kungenziwa ngezigaba eziningana: okokuqala weqa ibhulakufesi, ngosuku olulandelayo - isidlo sasemini, ngosuku olulandelayo - isidlo sakusihlwa. Ukusuka ekudleni kuya ekulinganiseni ushukela kufanele kuthathe amahora angama-5 uma isiguli silimaza ama-analogues amafushane we-insulin ngaphambi kokudla, futhi cishe amahora angama-7 uma kusetshenziswa i-insulin yabantu.

Isibonelo Sokubalwa

Isiguli esinesifo sikashukela sohlobo 2 esinesisindo esingama-96 kg asikho izidakamizwa ezwehlisa ushukela, ngakho-ke sinqunyelwe ukwelashwa kwe-insulin. Ukubala umthamo wansuku zonke we-insulin ende, sikala:

Inani elincane ngu-7.2. Umehluko ngezinga lokuqondiwe: 7.2-5 = 2.2. PSI = 63 * 4.4 / 96 = 2.9. Umthamo odingekayo nsuku zonke = 2.2 / 2.9 = amayunithi angu-0.8, noma iyunithi eli-1. ngaphansi kokuzungeza.

Ukuqhathanisa imithetho yokubala imithamo yasekuseni nakusihlwa

Ngokwesifo sikashukela sohlobo 2, akudingekile ukuba ne-insulin emifushane nehlala isikhathi eside ekwelashweni. Kungavela ukuthi i-pancreas uqobo ibhekana nokunikeza isizinda esejwayelekile se-basal, futhi i-hormone eyengeziwe ayidingeki. Uma isiguli sinamathela ekudleni okuqinile kwe-carb, akunakuba nesidingo se-insulin esifushane ngaphambi kokudla. Uma isifo sikashukela sidinga i-insulin ende ubusuku nemini, umthamo wansuku zonke uvame ukuba phansi.

Esikhungweni sesifo sikashukela sohlobo 1, uhlobo nesamba somuthi esidingekayo zivame ukukhethwa esibhedlela. Imithetho yokubala engenhla ingasetjenziselwa ukulungisa umthamo uma owokuqala eyekile ukunika isinxephezelo esihle.

Okubi kwe-NPH-Insulin

Uma kuqhathaniswa noLevemir noLantus, ama-NPH-insulin anokuphazamiseka okuningana okubalulekile:

• bonisa inani eliphakeme lesenzo ngemuva kwamahora ayi-6, ngakho-ke, ukufihlwa kwesizinda okwenziwe kabi, okuhlala njalo;
• kubhujiswe ngokungalingani, ngakho-ke umphumela ungahluka ngezinsuku ezihlukile;
• maningi amathuba okubangela ukungezwani komzimba kwisifo sikashukela. Ingozi yokusabela kwe-anaphylactic yanda ngama-antibhakthiki, ama-radiopaque zinthu, ama-NSAIDs;
• Bayi-ukumiswa, hhayi isixazululo, ngakho-ke umphumela wabo uncike ekuxubeni kahle kwe-insulin nokuhambisana nemithetho yokuphatha kwayo.

Ama-insulin amade amanje anazo lezi zinto ezisilela, ngakho-ke ukusetshenziswa kwawo ekwelashweni kwesifo sikashukela kuyathandwa.