I-insulin esebenza nge-soluble enziwe izakhi zofuzo nakho konke ngayo

Indima ye-insulin emzimbeni ayinangqondo ku-overestimate. Noma yiliphi izinga lokushoda kwe-insulin ligcwele isifo esibucayi se-endocrine - isifo sikashukela. Eminyakeni engama-40 eyedlule, abanesifo sikashukela baphila iminyaka engaphansi kwengu-10-15.

Umuthi wanamuhla usebenzisa i-insulin esebenza kahle kakhulu eyenziwe yofuzo eyenziwe yofuzo ukuze ijwayele amazinga kashukela egazi. Ngenxa yalesi sidakamizwa, isifo sikashukela sesiyekile ukuba yisigwebo, sinikeze iziguli ithuba lempilo ephelele ne ende.

Kungani i-insulin ibizwa ngokuthi "yenzelwe izakhi zofuzo"

Ezinye iziguli zesaba igama elithi “enzelwe izakhi zofuzo,” lizikhumbuza “ngama-GMO amabi.”

Eqinisweni, kwakuwukusungulwa kwalesi sidakamizwa okusindisa izigidi zabantu izimpilo ezinesifo sikashukela.

Ekuqaleni, odokotela basebenzise i-insulin ehlukile ezilwaneni (ikakhulukazi izingulube nezinkomo). Kodwa-ke, le-hormone yayingagcini nje kubantu, kodwa futhi yangena manzi egazini, yagxumagxuma i-glucose futhi yabangela ubunzima obuningi.

I-soluble insulin yathuthukiswa icubungula zonke izidingo zesiguli esinesifo sikashukela, yenza abantu bangaphenduki ngendlela ehlukahlukene. Ngemuva kokuphela kokusebenza kwayo, ivele ibe ngama-amino acid ajwayelekile bese ikhishwa emzimbeni.

Izici eziphambili ze-pharmacological

I-soluble human insulin isho izidakamizwa ezithatha indawo ezingena esikhundleni se-insulin.

Ngokubambisana ne-cell wall receptor, lesi sidakamizwa sakha i-insulin receptor complex ekhuthaza izinqubo ezingaphakathi:

1. Ukuhlukaniswa kwama-enzymes wokusebenza okugcwele nokwenziwa ushukela ngama-tishu;
2. Ukwanda kokuthathwa kwe-intracellular kanye nokuthathwa kwe-glucose;
3. Izinga elehlisiwe lokwakheka kwe-glycogen esibindini;
4. Ukugqugquzela ukukhiqizwa kwamaprotheni namafutha.

Ngokuphathwa kwe-subcutaneous, isidakamizwa siqala ukusebenza ngemuva kwemizuzu engama-20-30, sifinyelele esiphezulu saso ngaphakathi kwamahora ama-1-3, sithatha cishe amahora angama-5-8.

Lesi sidakamizwa sisatshalaliswa ngendlela ehlukile kwezicubu: ngokwesibonelo, asingene emgqonyeni we-placental futhi asidluleli ebisini lobisi. Ngemuva kokuphela kokusebenza kwayo, i-insulin yomuntu ikhishwa ezinso (cishe ama-80%) ngemuva kokubhujiswa yi-insulinase.

Izinkomba zokusetshenziswa

Imvamisa, odokotela banquma i-insulin enganyibiliki ezimeni ze:

• Ukuzilapha noma ukwelashwa okuxubile kohlobo 1 nohlobo 2 sikashukela mellitus;
• Ukumelana okugcwele noma okuyingxenye (ukumelana) komzimba kwimithi yomlomo (ethathwe ngomlomo) yezidakamizwa zesifo sikashukela;
• Isifo sikashukela i-mellitus ngesikhathi sokukhulelwa (uma ukudla kungasebenzi);
• Izinkinga zesifo sikashukela i-mellitus (ketoacidosis, hypersmolar noma ketoacidotic coma);
• Inkambo yokwelashwa kwesifo sikashukela ngokumelene nemvelaphi yezifo ezahlukahlukene;
• Izimo ezisongela phansi ezinesifo sikashukela abasezindabeni zokulawulwa ngomlomo kwezidakamizwa ezinciphisa ushukela (isikhathi sokusebenza, izifo ezinzima, ukulimala noma i-frostbite, ngaphambi kokubeletha, njll.);
• I-Diabetes nephropathy noma ukulimala kwe-hepatic;
• Izilonda zesikhumba se-Dystrophic (furunculosis, carbuncle, ulcers);
• Ukushintshela ku-insulin ngenomphumela omude (isikhathi eside).

Contraindication

Ilungiselelwe ukusetshenziswa kwe-insulin ku:

• Yehlisa ushukela wegazi (hypoglycemia);
• Ukhulisa ukuzwela komzimba ku-insulin.

Ukuphendula okungafani

Naphezu kokubekezelela kwayo okuhle, i-insulin ingaba nemiphumela emibi uma isetshenziswa njenge:

1. Ukuthuthukiswa kwe-hypoglycemia ngenxa yokwaliwa kwesidakamizwa umzimba noma ukusabela kwe-immunological nge-insulin yayo uqobo;
2. Ukungezwani komzimba (i-urticaria, ukulunywa noma i-edema ye-Quincke engathi sína ngokuvuvukala okubukhali kobuso kanye nama-mucous membranes, i-pallor kanye nokushoda komoya);
3. I-Hypoglycemic coma;
4. Ukulimazeka kokuqwashisa (ngezikhathi ezithile kufinyelela ukukhohlisa);
5. I-Hyperglycemia noma i-diabetesic acidosis (ngokumelene nesizinda somkhuhlane noma izifo, ukudla okungenampilo, ngemuva komjovo ophuthelwe noma umthamo ongafanele);
6. Ukwehla kokuphila kahle ngesimo somile, ukozela, ukuncipha kokudla, ubomvu bobuso;
7. Ukuphendula kwendawo lapho kungeniswa ndawonye (ukuvutha, ukulunywa, ubomvu, ukugcwala noma i-atrophy of adipose izicubu).

Ukuhlanganiswa nezinye izidakamizwa

Uma usebenzisa i-insulin yabantu ngezidakamizwa ezithile, umphumela wayo we-hypoglycemic uyaqina noma buthaka.

Umphumela wehlisela ushukela ungakhuphuka lapho uthatha i-insulin nge:

1. Ama-Sulfonamides (ama-sulfonamide noma ama-hypoglycemic agents);
2. Ama-inhibitors we-MAO (furazolidone, njll.);
3. Ama-inhibitors we-ACE (Captopril, enalapril, njll);
4. Ama-NSAIDs inhibitors (i-aspirin, i-diclofenac, njll);
5. Ama-Androgens nama-anabolic steroid (Anavar, Androxon, njll);
6. Izidakamizwa ze-Antimalarial (quinoline, quinidine, njll);
7. Ama-Tetracyclines (tetracycline, doxycycline);
8. Ezinye izidakamizwa (theophylline, pyridoxine, morphine, njll)

Ukunciphisa umphumela we-hypoglycemic wesidakamizwa, ukusebenzisana kwaso:

• Glucocorticoids;
• Amphetamines;
• Ama-Estrogens (kufaka phakathi uhlobo lokuvimbela inzalo ngomlomo);
• I-Diuretics;
• I-Sympathomimetics;
• Ama-hormone egilo;
• Izidakamizwa ezihlukile (i-triamterone, i-phenytoin, i-glucagon).

Futhi, ngokuhlanganiswa ne-insulin, izidakamizwa zinganciphisa noma zithuthukise umphumela we-hypoglycemic:

1. Beta-blockers;
2. I-Reserpine;
3. Morphine;
4. I-Octreotide.

Ukusetshenziswa kwesicelo kanye nomthamo

Umthamo nendlela yokuphatha i-insulin yomuntu ihlala inqunywa ngudokotela ongu-endocrinologist, kucatshangelwa izinkomba ezidingekayo zeglue kanye nomchamo wesiguli.

Lesi sidakamizwa sihanjiswa kushukela ngezindlela eziningi: ngokweqile (s / c), nge-intramuscularly (i / m) noma nge-intravenously (i / v). Kaningi, i-insulin ilawulwa ngokungaziphathi. Ukuze wenze lokhu, sebenzisa indawo:

• Isisu;
• Amahlombe;
• Isikhumba sigoqa phezu kwethaphu.

Umuthi uvame ukuphathwa ngokuhlinzwa ezimweni ezinzima zokucasulwa yisifo sikashukela: ketoacidosis, coma sikashukela.

Kuyalulekwa ukuphatha i-insulin imizuzu engu-15-30 ngaphambi kokudla, izikhathi ezi-3 ngosuku. Kwesinye isikhathi ukuphathwa kwezidakamizwa okuyi-5-6 kuvunyelwe.

Umthamo we-insulin uvame ukubalwa engxenyeni yamayunithi angama-0.5-1 nge-1 kg yesisindo. Uma i-insulin ikhishwa ngaphezu kwe-0,6 mg kilo nganye yesisindo somzimba, khona-ke umuthi kufanele uphathwe okungenani izikhathi ezi-2 ngosuku. Ngokwesilinganiso, umthamo wansuku zonke cishe amayunithi angama-30- 40 (ezinganeni, amayunithi ayi-8).

Abesifazane abakhulelwe bavame ukunikezwa umthamo wamayunithi angama-0.6 ngekhilogremu ngayinye yesisindo. Imijovo ivame ukukhiqiza izikhathi ezingama-3-5 ngosuku, ngokuya ngenani lokudla.

Imvamisa, insulin esebenza ngokushesha ehlanganiswa ne-insulin esebenza isikhathi eside.

Imithetho yokuphatha i-insulin

Ngisho nabanesifo sikashukela abanolwazi benza amaphutha lapho bephatha i-insulin.

Imithetho ebaluleke kakhulu yokwelashwa kwe-insulin yile:

1. Ihlola impilo yeshalofu nezimo zesitoreji somuthi: akufanele ivezwe ekushiseni ngokweqile noma ku-hypothermia.
2. Iziqandisi zokuvikela insulin. Kwanele ukugcina ibhodlela eliqalisiwe endaweni emnyama endaweni yokushisa yasekamelweni.
3. Ukubuyisana ngomthamo womuthi ngemiyalo nangokunconywa kukadokotela.
4. Khipha umoya kwisirinji ngaphambi kokujova. Akudingekile ukusula isikhumba ngotshwala. Ukutheleleka ngokwelashwa kwe-insulin akuvamile kakhulu, futhi notshwala buyanciphisa umphumela wesidakamizwa.
5. Ukukhetha indawo efanelekile ongayethula. Ngokuthola i-insulin esebenza kancane, lesi yisisu. Lapho ufakwa ehlombe noma emgodini wokugcotshwa, umuthi usebenza kancane.
6. Ukuvimbela izinkinga ezinkingeni endaweni yomjovo ngendlela yokusebenzisa yonke indawo engaphezulu. Ukuze kwethulwe i-insulin esebenza ngokufushane, isisu sonke siyasetshenziswa: ukusuka phezulu kwemiphetho ebizayo kuya kufolda yesiqalo, enezimbobo ezingemuva ze-trunk. Kubalulekile ukubuyisa cishe amasentimitha amabili ukusuka kumasayithi omjovo wakudala, wethula isirinji engela lama-degree angama-45-60, ukuze umuthi ungavuthi.
7. Ngaphambi kokuwusebenzisa umuthi, kungcono ukuthatha isikhumba ku-crease ngesithupha nangeso sangaphambili. Uma ungena emsipha, umuthi uzonciphisa umsebenzi wawo. Ngemuva kokufaka inaliti, bamba isirinji ngemizuzwana eyi-5 ukuya kwezi-10.
8. Esiswini, i-insulin esebenza ngokufushane ibanjiswa kangcono imizuzu engama-20 ngaphambi kokudla. Kwezinye izindawo, umuthi uphathwa uhhafu wehora ngaphambi kokudla.

Igama lokuhweba lomuthi

I-insulin yenziwa ngendlela yesisombululo somjovo futhi iyathengiswa emakhemisi.

I-insulin yomuntu eyakhiwe ngofuzo ingakhiqizwa ngaphansi kwamagama omkhiqizo:

• I-Biosulin;
• I-Actrapid;
• I-Actrapid NM;
• IGensulin;
• Sizoyihola;
• Inhlawulo.

Ngenxa yobuchwepheshe besimanje bezakhi zofuzo, i-insulin yabantu yokufakelwa (eyenziwe kabusha) yadalwa. Nguye onguye into esebenzayo yamalungiselelo: uHumodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Le mishanguzo ihlukile kwesokuqala kokulandelana okuphambene kwama-amino acid, engeza izakhiwo ezintsha kuzo (ngokwesibonelo, umphumela omude wesigaba ezimbili), obaluleke kakhulu ezigulini ezinesifo sikashukela.

Ukuphendula okungafani

Naphezu kokubekezelela kwayo okuhle, lo muthi ungaba nemiphumela emibi ngendlela:

• Ukushintshwa kokugonywa kokuhambisana ne-insulin uqobo lesiguli;
• Ukuphendula kwe-allergic (urticaria, ukulunywa) noma i-edema kaQuincke (ngokuvuvukala okubukhali kobuso nezimbobo zezitho zomzimba, i-pallor,
• Ubunzima bokuphefumula, isikhumba esiluhlaza okwesibhakabhaka, noma ukulahlekelwa ukwazi);
• I-Hypoglycemic coma;
• Ukuqwashisa okuphazamisekile (ngezikhathi ezithile kufinyelela ukugcwala);
• I-Hyperglycemia noma i-diabetesic acidosis (ngokumelene nesizinda somkhuhlane noma izifo, ukudla okungenampilo, ngemuva komjovo ophuthelwe noma umthamo ongafanele);
• Ukomela, ukozela, ukuncipha kokudla, ubomvu bobuso;
• Ukubonakaliswa kwe-Pathological kwesingeniso sindawonye (ukuvutha, ukulunywa, ukwanda noma i-atrophy yezicubu ze-adipose).

Kwesinye isikhathi ekuqaleni kokuthatha umuthi kuba nokubonakaliswa ngendlela yokonakala okuhlukahlukene okubukwayo (umbono ophindwe kabili, ukufiphala, njll.) Noma ukubukeka kwe-edema. Kepha ziyindlela yokusabela yomzimba eguqukayo futhi idlule emva kwamasonto ambalwa yokwelashwa.

Ukweqisa

Kwenzeka ukuthi ukuphathwa kwe-insulin kwezinye izimo kuholela ku-hyperglycemia.

Izimpawu eziphambili ze-hyperglycemia ziyizibonakaliso zendlela:

• Ubuthakathaka;
• Pallor;
• Umjuluko obandayo;
• I-Palpitations
• Ubuhlungu bekhanda;
• Imizwa yendlala;
• Tremors emzimbeni;
• Amandla olimi, izindebe, izitho.

Lapho kuqala izimpawu ezifanayo, isiguli kufanele masinyane sithathe ukudla okune-carbohydrate okulula ukugaya (ngokuvamile uswidi, ucezu kashukela noma itiye elimnandi).

Izinkinga

Ukwelashwa isikhathi eside nge-insulin kungaholela ezinkingeni ezahlukahlukene. Okusemqoka yile:

1. Ukuvela kwe-hypoglycemia. Lokhu kungasizwa ukuphazamiseka kokudla, ukweqisa izidakamizwa, ukuzivocavoca ngokweqile, izifo zezinso nezinso.
2. Ipostinjection lipodystrophy. Ukuvimbela i-pathology ukushintsha indawo yomjovo, engeza isixazululo se-novocaine (0.5-1,5 ml) ku-insulin, bese ufaka isirinji ku-Ѕ yobukhulu bezicubu ze-adipose.
3. Ukumelana nezidakamizwa. Ezinye izidakamizwa ezinciphisa ushukela ziyakhethwa.
4. Ukungezwani komzimba. Ukwelapha okuyinkimbinkimbi okusetshenzisiwe (ama-antihistamines, ama-glucocorticoids) nokubuyiselwa okwanele komuthi.

I-soluble insulin yomuntu iyona ephulukisa iziguli eziningi zikashukela. Kodwa-ke, kubalulekile ukusebenzisa lesi sidakamizwa ngobuhlakani, ubheka yonke imithetho yokuphatha kwawo. Kuyadingeka ukuthi udokotela anqume lesi sidakamizwa, abale isilinganiso saso futhi aqaphele isimo sesiguli phakathi nalo lonke ukwelashwa.