Ungayibala kanjani kahle i-insulin yesiguli enesifo sikashukela (i-Algorithm)

Ukwelashwa nge-insulin njengamanje ukuphela kwendlela yokwelula impilo yabantu abanesifo sikashukela sohlobo 1 nohlobo olubi lwesifo sikashukela. Ukubalwa okulungile komthamo odingekayo we-insulin kukuvumela ukulingisa kakhulu ukukhiqizwa okungokwemvelo kwaleli hormone kubantu abanempilo.

I-algorithm yokukhethwa komthamo incike kuhlobo lwesidakamizwa esisetshenzisiwe, uhlobo olukhethiwe lwe-insulin therapy, umsoco kanye nokuzivocavoca kwesiguli onesifo sikashukela. Ukuze ukwazi ukubala umthamo wokuqala, lungisa inani lomuthi ngokuya ngama-carbohydrate esidlweni, uqede i-episodic hyperglycemia iyadingeka kuzo zonke iziguli ezinesifo sikashukela. Ekugcineni, lolu lwazi luzosiza ukugwema izinkinga eziningi futhi unikeze amashumi eminyaka wempilo enempilo.

Izinhlobo ze-insulin ngesikhathi sesenzo

Iningi le-insulin emhlabeni likhiqizwa ezitshalweni zezemithi lisebenzisa ubuchwepheshe bokwenza izakhi zofuzo. Uma kuqhathaniswa namalungiselelo aphelelwe yisikhathi wemvelaphi yezilwane, imikhiqizo yanamuhla ibonakala ngokuhlanzwa okuphezulu, ubuncane bemiphumela emibi, kanye nomphumela ozinzile, ongabikezelwa. Manje, ekwelashweni kwesifo sikashukela, kusetshenziswa izinhlobo ezi-2 ze-hormone: ama-analogia womuntu ne-insulin.

I-molecule ye-insulin yabantu iyiphinda ngokuphelele i-molecule ye-hormone ekhiqizwa emzimbeni. Lezi izidakamizwa ezisebenza isikhashana; ubude bazo abudluli amahora angama-6. Isikhathi esiphakathi se-NPH insulin nazo zingokweli qembu. Banesikhathi eside sokusebenza, cishe amahora ayi-12, ngenxa yokungezwa kweprotheni yeprotheni kulo muthi.

Isakhiwo se-insulin sehlukile ngesakhiwo kusuka ku-insulin yomuntu. Ngenxa yezimpawu ze-molecule, le mithi ingasinxephezela kangcono isifo sikashukela. Lokhu kufaka phakathi ama-ultrashort agents aqala ukunciphisa ushukela imizuzu eyi-10 ngemuva komjovo, osebenza isikhathi eside no-Ultra, esebenza usuku nosuku kuya emahoreni angama-42.

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%

Ukubalwa kwenani elidingekayo le-insulin esebenza isikhathi eside

Imvamisa, ama-pancreas afihla i-insulin ubusuku nemini, cishe iyunithi elilodwa ngehora. Lokhu kubizwa ngokuthi yi-basal insulin. Ngosizo lwayo, ushukela wegazi ugcinwa ebusuku nasesiswini esingenalutho. Ukulingisa ukukhiqizwa kwangemuva kwe-insulin, kusetshenziswa ama-hormone asebangeni eliphakathi nalawo asasebenza isikhathi eside.

• >> Uhlu lwe-insulin olusebenza isikhathi eside

Iziguli ezinesifo sikashukela sohlobo 1 azinayo le-insulin, zidinga imijovo yezidakamizwa ezisebenza ngokushesha okungenani kathathu ngosuku, ngaphambi kokudla. Kepha ngesifo sohlobo 2, imjovo eyodwa noma emibili ye-insulin ende imvamisa yanele, ngoba inani elithile le-hormone litholwa ngamanyikwe ngaphezu kwalokho.

Ukubalwa komthamo we-insulin osebenza isikhathi eside kwenziwa kuqala, ngoba ngaphandle kokugcwalisa ngokugcwele izidingo eziyisisekelo zomzimba, akunakwenzeka ukukhetha umthamo ofanele wokulungiselela okufushane, futhi ngemuva kokudlulela ngezikhathi ezithile kushukela kuzokwenzeka.

I-algorithm yokuthola isilinganiso se-insulin ngosuku:

1. Sinquma isisindo sesiguli.
2. Siphinda isisindo ngento kusuka ku-0,3 kuya ku-0,5 isifo sikashukela sohlobo 2, uma amanyikwe esakwazi ukufaka insulin.
3. Sisebenzisa i-coefflication engu-0,5 yohlobo lwe-1 yesifo sikashukela ekuqaleni kwesifo, kanye no-0,7 - ngemuva kweminyaka eyi-10-15 kusukela ekuqaleni kwalesi sifo.
4. Sithatha u-30% womthamo owutholile (imvamisa ukuya kuma-yunithi ayi-14) bese siwasabalalisa kwezokuphatha ezi-2 - ekuseni nakusihlwa.
5. Sihlola umthamo wezinsuku ezi-3: okokuqala weqa ibhulakufesi, ekudleni kwasemini kwesibili, ngolwesithathu - isidlo sakusihlwa. Ngesikhathi sokulamba, izinga likashukela kufanele lihlale liseduze nokujwayelekile.
6. Uma sisebenzisa i-NPH-insulin, sibheka i-glycemia ngaphambi kokudla kwakusihlwa: ngalesi sikhathi, ushukela ungancishiswa ngenxa yokuqala komphumela womuthi.
7. Ngokusekelwe kudatha etholakele, silungisa ukubalwa komthamo wokuqala: sinciphise noma sikhuphuke ngamayunithi ama-2, kuze kube yilapho i-glycemia ijwayelekile.

Umthamo ofanele we-hormone uhlaziywa ngokuya ngezindlela ezilandelayo:

• ukusekela i-glycemia ejwayelekile ngosuku, akudingeki imijovo engaphezu kuka-2;
• akukho-hypoglycemia yasebusuku (ukukalwa kwenziwa ebusuku e-3 o’clock);
• ngaphambi kokudla, izinga loshukela lisondele kwithagethi;
• umthamo we-insulin ende awudluli isigamu senani eliphelele lomuthi, imvamisa usuka ku-30%.

Isidingo se-insulin efushane

Ukubala i-insulin emfushane, kusetshenziswa umqondo okhethekile - iyunithi lesinkwa. Ilingana nama-gramu ayi-12 ama-carbohydrate. I-XE eyodwa imayelana nocezu lwesinkwa, uhhafu we-bun, uhhafu wengxenye yepasta. Ungathola ukuthi mangaki amayunithi esinkwa epuletini esebenzisa izikali namatafula akhethekile abanesifo sikashukela, esibonisa inani le-XE kuma-100 g wemikhiqizo ehlukile.

• >> Kusetshenziswa ama-insulin amafushane

Ngokuhamba kwesikhathi, iziguli ezinesifo sikashukela ziyeka ukudinga isisindo sokudla, futhi zifunde ukuthola okuqukethwe ama-carbohydrate akulo. Njengomthetho, leli nani elilinganiselwe lanele ukubala umthamo we-insulin futhi uzuze i-Normoglycemia.

I-algorithm yesilinganiso se-insulin esifushane sokubala:

1. Sihlehlisela ingxenye yokudla, siyilinganise, sinqume inani le-XE kuyo.
2. Sibala umthamo odingekayo we-insulin: siphindaphindeka i-XE ngokwesilinganiso se-insulin ekhiqizwa ngumuntu ophilile ngesikhathi esithile sosuku (bheka ithebula elingezansi).
3. Sethula isidakamizwa. Isenzo esifushane - isigamu sehora ngaphambi kokudla, i-ultrashort - ngaphambi nje noma ngokushesha ngemuva kokudla.
4. Ngemuva kwamahora ama-2, sikala ushukela wegazi, ngalesi sikhathi kufanele kube ngokujwayelekile.
5. Uma kunesidingo, lungisa umthamo: ukunciphisa ushukela nge-2 mmol / l, kuyadingeka iyunithi eyodwa ye-insulin.

Ukwenza lula ukubalwa kwe-insulin, idayari yokondleka izosiza, ekhombisa i-glycemia ngaphambi nangemva kokudla, inani le-XE elichithwayo, umthamo nohlobo lomuthi olungiselelwe. Kuzoba lula ukukhetha umthamo uma udla uhlobo olufanayo okokuqala, kudla cishe izingxenye ezifanayo zama-carbohydrate namaprotheni ngasikhathi. Ungafunda i-XE bese ugcine idayari online noma ezinhlelweni ezikhethekile zezingcingo.

Ama-insulin therapy regimens

Kunezindlela ezimbili zokwelashwa kwe-insulin: zendabuko nenamandla. Owokuqala uhlanganisa imithamo ye-insulin engapheli, ebalwa ngudokotela. Elesibili lifaka imijovo eyi-1-2 yenani elakhethiwe le-hormone ende nelembalwa - elifushane, elibalwa ngaso sonke isikhathi ngaphambi kokudla. Ukukhetha kwama-regimen kuncike ebukhali balesi sifo kanye nokuzimisela kwesiguli ukulawula ushukela wegazi ngokuzimele.

Imodi yendabuko

Izinzuzo zombuso wendabuko ukungabikho kwesidingo sokusebenzisa ama-algorithms wokubala nsuku zonke, isilinganiso se-glucose engavamile, njalo ezinsukwini ezingama-1-2. Ingasetshenziswa kwiziguli ezingakwazi noma ezingathandi ukulawula ushukela wazo njalo.

Okudonsela emuva kohlobo lwendabuko ukuthi umthamo nesikhathi sokuphuza i-insulin akujimi akuhambelani nhlobo nokwakheka kwe-insulin kumuntu ophilile. Uma i-hormone yemvelo igcotshwa ukuze kudle ushukela, khona-ke yonke into iyenzeka ngenye indlela: ukufinyelela i-glycemia ejwayelekile, kufanele uguqule indlela odla ngayo nenani le-insulin elifakiwe. Ngenxa yalokhu, iziguli zibhekene nokudla okuqinile, ukuphambuka ngakunye lapho kungahle kube nomphumela we-hypoglycemic noma hyperglycemic coma.

Imodi ebukhali

Ukwelashwa kwe-insulin okujulile kwaziwa njengendawo yohlobo lwe-insulin ehamba phambili kakhulu. Ibizwa nangokuthi yi-basal bolus, njengoba ingalingisa bobabili njalo, i-basal, secretion yama-hormone, kanye ne-bolus insulin, ekhishwe ngokuphendula ukukhula kweglucose yegazi.

Inzuzo engenakuphikwa yalombuso ukungabikhona kokudla. Uma isiguli esinesifo sikashukela sesikwazi imigomo yokubala okufanele umthamo nokulungiswa kwe-glycemia, singadla njenganoma yimuphi umuntu ophilile.

Isikimu sokusebenzisa kakhulu i-insulin:

Alukho uhlobo oluthile lwe-insulin oluthe xaxa kuleli cala, lushintsha nsuku zonke ngokuya ngezici zokudla, izinga lomsebenzi owenziwe ngokomzimba, noma ukwanda kwezifo ezihambisanayo. Akukho mkhawulo ophezulu enanini le-insulin, umbandela oyinhloko wokusebenzisa umuthi kahle yizibalo ze-glycemia. Iziguli ezinesifo sikashukela ezigula kakhulu kufanele zisebenzise imitha izikhathi eziningi phakathi nosuku (cishe ngo-7) futhi, ngokususelwa kwidatha yokulinganisa, zishintshe umthamo olandelayo we-insulin.

Ukulungiswa kwe-Hyperglycemia

Ngemuva kokuqala kokusetshenziswa kwe-insulin, kuyadingeka ukulungisa inani lomuthi nge-1 XE kuye ngezimpawu zomuntu ngamunye. Ukuze wenze lokhu, thatha isilinganiso esilinganiselwe se-carbohydrate esidlweni esinikeziwe, i-insulin iyabhalwa, ngemuva kokulinganiswa kwama-2 glucose. I-Hyperglycemia ikhombisa ukuntuleka kwe-hormone, i-coefficient idinga ukukhushulwa kancane. Ushukela ophansi, i-coefftire iyancishiswa. Ngedayari engaguquki, ngemuva kwamasonto ambalwa, uzoba nedatha yesidingo somuntu siqu se-insulin ngezikhathi ezihlukile zosuku.

Noma sinezilinganiso ezikhethwe kahle i-carbohydrate isilinganiso ezigulini ezinesifo sikashukela, i-hyperglycemia kwesinye isikhathi ingavela. Kungabangelwa ukutheleleka, izimo ezicindezelayo, umsebenzi omncane womzimba ngokungajwayelekile, ushintsho lwamahomoni. Lapho kutholwa i-hyperglycemia, kuthathwa umthamo wokulungisa, obizwa ngokuthi i-poplite, kufakwa kwi-bolus insulin.

Ukubala ngokunembile umthamo we-poplite, ungasebenzisa into yokulungisa. Nge-insulin emfushane, iyi-insulin engu-83 / nsuku zonke, ye-ultrashort - i-100 / insulin nsuku zonke. Isibonelo, ukunciphisa ushukela ngo-4 mmol / l, isiguli esinomthamo wansuku zonke wamayunithi angama-40, sisebenzisa uHumalog njengokulungiselela kwe-bolus, kufanele senze lesi sibalo: 4 / (100/40) = amayunithi ayi-1,6. Sizungeza leli nani lifinyelela ku-1.5, engeza kuthamo elilandelayo le-insulin futhi uliphathe ngaphambi kokudla, njengenjwayelo.

Imbangela ye-hyperglycemia nayo ingaba yindlela engalungile yokusebenzisa i-hormone:

• I-insulin emfushane ifakwe kangcono esiswini, yinde - ethangeni noma ebhulukhweni.
• Ukuphumula okuqondile kusuka ekujuleni kuya ekudleni kukhonjisiwe kwimiyalo yomuthi.
• Isirinji asikhiphi imizuzwana eyi-10 ngemuva komjovo, sonke lesi sikhathi sibambe isibaya sesikhumba.

Uma umjovo wenziwa kahle, azikho izimbangela ezibonakalayo ze-hyperglycemia, futhi ushukela uyaqhubeka ukukhuphuka njalo, udinga ukuvakashela udokotela wakho ukwandisa umthamo we-insulin oyisisekelo.

Okuningi ngesihloko: indlela yokujova i-insulin kahle futhi ngaphandle kobuhlungu