Izinhlobo kanye nama-regimens of insulin therapy

I-insulin ukuphela kwe-hormone esehlisa ushukela wegazi, ivuselele ukumuncwa kanye nokuqedwa kwe-glucose kwezicubu, futhi kuvimbe ukwakheka kwezidumbu ze-ketone. Lokhu okubangelwa i-ketoacidosis eyingozi ngokweqile, okuyinkinga enkulu yesifo sikashukela.

Ukwelashwa kwe-insulin kuyindlela eqhubekayo futhi esebenza kakhulu yokwelapha, okuhloswe ngayo ukunxephezela ukwehluleka kwe-carbohydrate metabolism ngokufakwa kwezidakamizwa ze-insulin.

Isetshenziselwa ukwelapha isifo sikashukela esincike ku-insulin, ekwelashweni kwesikhashana sesifo sikashukela sohlobo 2, ngaphambi kokuhlinzwa, ukuthola izifo ezithinta izifo zokuphefumula kanye nezinye izifo ezisetshenziselwa ukwelashwa kwesifo sikashukela sohlobo 2, uma imithi enciphisa ushukela ingasebenzi. Cabanga ngezinhlobo nemigomo yokwelashwa kwe-insulin.

Isikimu

Ukwelashwa kwe-insulin kwenziwa ngokwesikimu esikhethekile esakhiwa i-endocrinologist. Udokotela ukhetha izinhlobo ze-insulin (isenzo esisheshayo noma isikhathi eside), isikhathi sokuphatha, umthamo.

Uma udokotela we-endocrinologist enquma ukwelashwa ngaphandle kokubheka imiphumela yokuzihlola ngokwakho ushukela, kungcono ukuthola omunye udokotela, uma kungenjalo ungaya kudokotela we-nephrologist ngezifo ezahlukahlukene zezinso noma odokotela abahlinzayo abakhipha imikhawulo engezansi.

Udokotela kumele anqume ukuthi hlobo luni lwe-insulin oludingekayo ukuze kugcinwe ukudla okujwayelekile kwe-glycemia, noma ngabe imijovo yama-hormone esebenza ngokushesha iyadingeka yini, noma uma onesifo sikashukela edinga i-insulin yesikhathi esifushane nehlala isikhathi eside.

Udokotela we-endocrinologist udinga izilinganiso ze-glycemia yesiguli ngeviki eledlule nencazelo yezimo ezibazungezile:

1. Isikhathi Sesidlo;
2. Inani nezimpawu zokudla okudliwayo;
3. Ukuba khona komzimba, lungisa isikhathi saso;
4. Isikhathi nomthamo wemithi yesifo sikashukela somlomo;
5. Ukuba khona kwezifo ezithathelwanayo nezinye;
6. Ukwanda noma ukuncipha koshukela ebusuku (kunqunywa ukuthi ngabe umthamo we-hormone owengeziwe uyadingeka yini ngesikhathi sokulala).

Ukuqhuba

Kungani ukujova hhayi amaphilisi? Ngemuva kokuphathwa ngomlomo, into ibhujiswa ngokushesha okukhulu emgodini wokugaya ukudla. Ukulungiswa kwe-insulin yabantu, manje esetshenziswa ekwelapheni, kutholakala ngezindlela eziningana: indlela eyenziwe nge-semi-synthetic noma i-biosynthetic.

Phambilini kwakusetshenziswa i-insulin ye-bovine ne-ingulube, kepha ngemuva kocwaningo olude kwafakazelwa ukuthi izimfanelo zale mithombo emibili zithinta kabi impilo yabantu futhi zibangela ukungahambelani kahle.

I-hormone ehlanziwe kakhulu manje. Into ephumela ngendlela ye-biosynt zokwenziwa ayiqukethe ukungcola okulimazayo.

Izakhi ezilandelayo zengezwe ku-insulin esebenza ngabantu:

• Ngomthelela wokwandisa;
• Izidambisi;
• Ukumemeza.

Ngaphambi kokuqala ukwelashwa, kufanele uzijwayeze imigomo nemithetho yokwelashwa kwe-insulin:

1. Ngaphambi komjovo, isayithi okuhlosiwe ukuliveza ligaxwe kahle;
2. Sebenzisa isirinji ekhethekile ye-insulin ngenaliti emincane noma ipeni lesirinji.

Izinzuzo zokugcina:

• Inaliti eklanywe ngokukhethekile iyakwazi ukunciphisa izinhlungu zomjovo;
• Ukusetshenziswa kalula, imijovo ingenziwa nganoma yisiphi isikhathi.

Uhlobo lokwelashwa kufanele lubandakanye:

1. Ukuzila - umjovo wesikhathi esifushane nesikhathi eside;
2. Umjovo wesikhashana esifushane ngaphambi kwasemini;
3. "Ngokushesha" ama-hormone ngaphambi kokudla;
4. Umjovo osebenza isikhathi eside ngaphambi kokulala.

Izici zithinta isilinganiso sokufakwa kwe-insulin:

• Izinga lokushisa, i-solubility;
• Ngabe bandisa umthamo wokuphatha;
• Umsebenzi womzimba;
• Ngabe isiguli sithola ukucindezelwa?

Izinkomba zokwelashwa kwe-insulin:

1. Thayipha isifo sikashukela sokuqala
2. I-ketoacidosis;
3. Coma;
4. Izinqubo ezithathelwanayo nezihlanzekile kuma-diabetesics;
5. Ama-pathologies ama-acute acute kuma-diabetes;
6. Ukungasebenzi kahle kwama-ejenti omlomo anciphisa ushukela ngohlobo 2 sikashukela;
7. Isiguli sehlise ngokushesha isisindo esiningi ngesikhathi esifushane.

Izinhlobo zokwelapha

Cabanga ngezinhlobo zesimanje zokwelapha i-insulin.

Kuqinisiwe

Le ndlela isetshenziswa lapho isiguli singenaso isisindo ngokweqile, ukucindezelwa okungapheli. Umuthi unqunyelwa iyunithi ngalinye ngekhilogremu ngalinye lesisindo kanye ngosuku. Ubukhulu belingisa ukuvikela kwemvelo kwe-hormone emzimbeni.

Imibandela:

• Ihormone kufanele ihlinzekwe ngenani ukuze kukhishwe ushukela;
• Umuthi owethulwe kufanele ulingise ngokuphelele imfihlo yesibeletho, egcotshwa ngamanyikwe abantu.

Le ndlela ilungele ukwelashwa kwe-insulin yohlobo lwe-1 yesifo sikashukela.

Izidingo ezingenhla zakha uhlelo lohlobo olubhekwayo lokwelapha, lapho umthamo wansuku zonke we-insulin uhlukaniswa waba yi-hormone enomphumela omfushane noma wesikhathi eside. Uhlobo lokugcina lwethulwa ekuseni nasekuseni.

Thatha i-insulin esebenza ngemuva nje kokudla okune-carb ephezulu. Ukudla kufanele kube nama-carbohydrate. Udokotela ubeka umgomo ngamunye.

Isiguli sohlobo lwe-1 sikashukela kufanele sikalwe njalo i-glycemia ngaphambi kokudla.

Ngokwesiko

Le ndlela ehlangene ehlanganisa ama-insulins ezinkathi ezihlukene zesenzo kumjovo owodwa. Inzuzo enkulu ukuthi isibalo semijovo sincishiswa saba kathathu ngosuku. Leli inani elincane.

Ukhiye obalulekile ukuthi awulingisi ukucashelwa ngokomzimba kwamanyikwe ngokugcwele, ngakho-ke, isinxephezelo ngokuphelele sokwehluleka komzimba we-carbohydrate metabolism asenzeki.

Isiguli senza imijovo emibili ngosuku, sethula izinto zesenzo esifushane nesihlala isikhathi eside. Ama-hormone anesikhathi esimaphakathi kwezingxenye ezimbili kwezintathu zemithamo yezidakamizwa. Okunye okwesithathu kugcinelwe imali yesikhashana.

Isiguli esinesifo sikashukela sohlobo 1 kungenzeka singathathi isilinganiso soshukela ngaphambi kokudla.

Ukwelashwa kwe-insulin pump

Lolu wuhlobo lwedivaysi ye-elekthronikhi eyenza umjovo we-insulin oyindilinga kanye nezikhathi zesikhashana zesikhashana nangesikhashana se-dure.

Idivayisi isebenza ngezindlela ezahlukahlukene zokulawulwa kwezidakamizwa:

1. Ukulethwa okuqhubekayo kwe-insulin kumthamo omncane (isilinganiso se-basal). Lesi sikimu silingisa ukukhishwa kwangemuva kwehomoni. Lokhu kukuvumela ukuthi ungene esikhundleni sokusebenzisa ama-insulin asebenza isikhathi eside.
2. Ijubane leBolus - imvamisa yokuphathwa komuthi, onesifo sikashukela ulawula umthamo wakhe ngokuzimela. Isetshenziswa ngaphambi kokudla noma ngenkomba ye-glycemic ekhulayo.

Lapho usebenzisa isilinganiso se-bolus, ukwelashwa kwe-insulin okunjalo kubeka esikhundleni se-hormone ngesenzo se-Ultra-esifushane noma esifushane. Ubunzima bezindlela bunikeza ukulingisa okusondele kakhulu kwe-secretion yama-hormone. I-catheter ithathelwa indawo zonke izinsuku ezintathu.

I-hormonal ingena ngama-catheters acinene wephampu. I-cannula ekhethekile ibekwa ngaphansi kwesikhumba lapho inaliti yesirinji ifakwe khona namanye amasu. Inikezwa ngemithamo emincane ngejubane ehlelwe yisiguli, futhi into imuncwa khona manjalo. Amashejuli angaguquka njalo ngemizuzu engama-30.

Ezinye izinzuzo zokusebenzisa ucingo:

• Ukunemba kwemithamo ephezulu, ubuncane bokukhuphuka komthamo we-bolus;
• Isibalo sokufika kwesikhashana sinciphile;
• Kuyasiza ukubala umthamo we-bolus insulin (isiguli singena imininingwane ngezilinganiso zakhe ze-glycemic nezinye izinkomba ohlelweni);
• Idivaysi ingalungiswa ukuze ingahambi ngethamo le-bolus ngasikhathi sinye, kepha yandisa inqubo (ephumelelayo uma isiguli sikashukela sisebenzisa ama-carbohydrate aphambili noma uma kunomkhosi omude);
• Impompo ngokuqhubekayo ilinganisa i-glycemia, ixwayisa ngoshukela omningi;
• Ukwethulwa kwento yokwenza noshukela ngokwejwayelekile kungashintsha ijubane (ngokwesibonelo, ukuhanjiswa kwe-hormone kucishiwe nge-hypoglycemia);
• Amaphampu anamuhla ayakwazi ukugcina irekhodi ledatha izinyanga eziningana, adlulise imininingwane kwikhompyutha, umsebenzi ulungele isiguli nodokotela kakhulu.

Ukwelapha izinhlobo ezahlukahlukene zesifo sikashukela

Uhlobo lokwelapha isifo sikashukela sohlobo 1 lubonakala ngokuphathwa kwe-insulin kabili ngosuku. Ukwethulwa kwe-bolus - ngaphambi kokufaka ukudla.

Inhlanganisela yemibuso ibizwa ngokuthi i-basic bolus therapy, kanye nerejimenti yokujova okuningi. Enye yezinhlobo ezenzelwe ukuqinisa insulin.

I-endocrinologist ikhetha umthamo, icabanga ngezinto eziningi. I-basal insulin ingathatha cishe ama-50% womthamo wansuku zonke. Umthamo we-bolus hormone ubalwa ngawodwana.

Ukwelashwa kwe-insulin ngohlobo 2 sikashukela kuqala ngokufakwa kancane kancane kwemithamo emincane ye-protein yamaprotheni ezidakamizweni ezinciphisa amazinga kashukela. Uma isiguli sinqunywe okokuqala ama-basal ama-basal amade, kukhethwa i-10 IU yansuku zonke. Udinga ukuphatha umuthi ngasikhathi sinye.

Ukwelashwa kusenesikhathi

Njengengxenye yezindlela zokwelapha ezinganeni, ama-hormone athi “amafushane” kanye “aphakathi” ayahlanganiswa. Kwindlela elula, isinxephezelo esihle kufanele sigcinwe. Uma ingane ineminyaka engaphezu kwengu-12 ubudala, kuyenziwa ukwelashwa okukhulu.

Umthamo ulungiswa ngezigaba. Imiphumela inqunywa ngaphezulu kwezinsuku ezimbalwa. Ukulungiswa kwamthamo okuhlanganayo ekuseni nakusihlwa akufanele kuvunyelwe. Lapho ekhetha indlela yokwelashwa, udokotela ubheka inani elikhulu lezinto nezimpawu zomzimba wesiguli esincane.

Izinga eliphakeme lezidakamizwa liqeda ubungozi bokubangelwa yimiphumela emibi kakhulu kanye nokuthuthukiswa kwe-lipodystrophy ezindaweni zomjovo. Nge-lipodystrophy, akukho ungqimba lwamafutha. Lokhu kunzima kakhulu. Lesi sifo selashwa isikhathi eside kakhulu, futhi ngeke uyeke ukujova i-insulin.

Ama-diabetesics asemncane anokuzwela okuphezulu afakwa ngama-analogues ayihlanjululwe. Ngale ndlela, ingozi yokuncipha okubukhali kwe-glucose incane ngenxa yethomu elifanele elibekiwe.

Ukuqapha isimo sezingane eminyakeni yokuqala yokuphila kufanele kube ngokucophelela ikakhulukazi, ngoba ukusabela ekusetshenzisweni kwezidakamizwa ezifakazelwe nezithembekile akulindelekile.

Ukwelashwa kwabesifazane abakhulelwe

Ukwelashwa kwe-insulin okhulelwe kugcina i-glucose eyanele yokudla futhi ngemuva kokudla. I-metabolism yowesifazane osesimweni esingazinzile, ukulungiswa njalo kwezokwelapha kuyadingeka. Isidingo se-insulin ngalesi sikhathi siyakhuphuka.

Ukuvimbela i-hyperglycemia, imijovo emi-2 ngosuku imvamisa inikezwa ekuseni nasemveni kokudla. Kusetshenziswa amalungiselelo amafushane, aphakathi nendawo, ngaphambi kokudla kokuqala nokugcina.

Vimbela i-hyperglycemia yasebusuku ngomjovo owenziwe ngaphambi kokulala. Hypoglycemia emnene kungenzeka. Kwabesifazane abasezikhundleni, le nto ayinabungozi. Uma kunokusongela kokuzalwa ngaphambi kwesikhathi, kunqunywa ikhambi le-intravenous le-magnesium sulfate. Ezinye izidakamizwa ezinciphisa ushukela kowesifazane okhulelwe ziyagqitshwa.

Ngesikhathi sokubeletha, i-glycemia ibhekwa ngokucophelela nangehora. Ingagxuma ngenxa yokuxineka noma ukuwa kakhulu.

Okokugula kwengqondo

Ukwelashwa kuvame ukubhekisa kwiziguli ezine-schizophrenia. Kuhlolwa kuqala ngesimo sezinye iziguli. Ngokuthola i-insulin ekwelashweni kwengqondo, umjovo wokuqala wenziwa esiswini esingenalutho, ngempelasonto - ikhefu.

I-Hypoglycemia iyakhula. Iziguli zingakhononda ngobuthakathaka, indlala, ukoma, i-integument redden, ukujuluka kungenzeka. Ukushayela kuyashesha. Iziguli zivila kancane ngokwenzeka kulokho okwenzekayo, ziwele phansi.

Kulesi simo, bame amahora amathathu. Banikeza ingilazi yetiye elimnandi elifudumele, isidlo sasekuseni esinama-carb aphezulu. Izinga le-glycemia liyabuyiselwa, iziguli zibuyele esimweni sazo sokuqala.

Esigabeni esilandelayo sokwelashwa, umthamo wezidakamizwa uyanda, ukwazi ukungasebenzi kahle kugobhoza ku-stupor. Isimo senziwa ngokwejwayelekile ngemuva kwemizuzu engama-20, kubekwa i-dropper. Kuthululwa isisombululo se-glucose, bese sondliwa ngokudla okune-carb ephezulu.

Esigabeni sokugcina, ukwelashwa kungenisa isiguli esimweni semingcele esifana ne-coma. Ngemuva kwengxenye yehora, isiguli siqala "ukubuya" ngokuphuthumayo.

Chitha cishe izikhathi ezimbili. Ngemuva kokuthi umthamo we-hormone uphungulwa kancane kancane kuze kube yilapho ukhanseliwe ngokuphelele.

Ngokulashwa okunjalo kwe-insulin kokuphazamiseka kwengqondo, kungavela lezi zinkinga ezilandelayo:

1. I-coma evikelwe. Isiguli asikwazi ukubuyiselwa esimweni saso sangaphambilini. Ngemuva kwalokho isixazululo se-caffeine, ushukela ufakwa emthanjeni. Uma kungekho mphumela, isisombululo se-adrenaline siyasetshenziswa. Awukwazi ukujova ushukela okwesibili ulandelana. I-coma evela ku-hypoglycemic ingaba yi-hyperglycemic.
2. Iphindaphindwe ikhefana. Kungenzeka isikhathi esithile ngemuva kokumisa ukoma wokuqala. Isimo siyema ngendlela efanayo nangokomqondo ojwayelekile.

Imiphumela yokuphathwa ngokungafanele

Izinkinga ezingaba khona zokwelashwa kwe-insulin:

• Ukungezwani komzimba kumasayithi wokujova. Izindawo ezibomvu futhi ukulunywa kuvela ngemuva kobuchwepheshe bokulimala obungafanele, ukusetshenziswa kwezinaliti ezingcolile kakhulu, i-insulin ebandayo, ukukhethwa kwesiza okungafanele.
• I-Lipodystrophy, lapho ungqimba lwamafutha angaphansi lushabalale endaweni yomjovo we-insulin. Amafomu amancane wefossa.
• I-Lipohypertrophy. Amathumbu omzimba avela kumasayithi womjovo.

Enye inkinga ukuthi izinga likashukela liyancipha, i-hypoclycemia iyakhula. Iziguli zizizwa zilambile kakhulu, ziyajuluka, izithukuthuku ziyavela, ukushaya kwenhliziyo kuyashesha. Kwenzeka ngenxa yokwethulwa komthamo omkhulu noma inani elincane lokudla. Ama-shock, ukusebenza ngokweqile komzimba kungathinta ukuthuthukiswa kwesimo.

Kukhanya futhi kusinda. Bazikhipha ngokwabo i-hypoglycemia emnene, bathathe ama-carbohydrate. Kudlula ngokushesha ngaphandle komkhondo. Ifomu elinzima lingahambisana ne-hypoglycemic coma. Isiguli sidinga ukunakekelwa okuphuthumayo kwezokwelashwa.

Ukunquma imithamo ebalwe ngokungafanele kubangela isimo sesiguli. Ukwehluleka kwamakhala kungakhula, ukunikezwa kwegazi ezingalweni kungathinteka. Lapho-ke izinqubo zobudlova zingenzeka kwezicubu.

Umgomo oyinhloko wokwelapha i-insulin yesimanje ukugcina izinga le-carbohydrate metabolism eliseduze nalelo elibonwa kumuntu ophilile. Ushukela ophakanyiswe njalo uholela ezinkingeni ezinkulu: isifo sikashukela, i-ketonuria, i-ketoacidosis, ukukhubazeka, ukunqunywa kwemilenze, nokufa ngaphambi kwesikhathi kweziguli.