Ngabe isebenza kanjani iphampu ye-insulin?

Enye indlela enhle yokujova okuphindaphindwe nge-insulin, ejova ngamapeni wesirinji okhethekile, yipompo. Ezimweni eziningi, kusetshenziswa ekwelapheni uhlobo lwesifo sikashukela sohlobo 1.

Iphampu iyithuluzi elikhethekile lapho inani elifanele le-hormone lingena emzimbeni wesiguli. Idivayisi ivumela ukwelashwa kwe-insulin ejwayelekile ngaphansi kokulawulwa kwe-glycemia, kanye nokubalwa okuphoqelekile kwama-carbohydrate asetshenziswa ngabantu.

Isimiso sokusebenza

Idivayisi ihlinzeka ngokuphathwa okuqhubekayo kwehomoni ngaphansi kwesikhumba somuntu ogulayo.

Ikhithi yensimbi ifaka:

1. I-Pomp - iphampu eyenzelwe ukuletha umuthi.
2. Ikhompyutha enohlelo oluhlanganisiwe lokulawula.
3. I-Cartridge equkethe i-insulin (iyashintshana).
4. Ukumiliselwa kusethiwe. Kuqukethe i-catheter yomjovo we-insulin nohlelo lwama-tubes axhumanisa iphampu ne-cannula.
5. Amabhethri

Idivayisi ikhokhiswa i-insulin, enomphumela omfushane. Kunconywa ukusebenzisa izidakamizwa ezinjengeHumalog, NovoRapid noma i-Apidra, ezimweni ezingavamile, i-insulin yabantu ingasetshenziswa. Isistimu eyodwa yokumnika, njengomthetho, yanele izinsuku eziningana, khona-ke ukufaka esikhundleni kwayo kuyadingeka.

Amadivayisi wanamuhla ayaphawuleka ngesisindo sawo esilula nosayizi, okubuye kukhunjulwe ngama-pager. Umuthi ulethwa ngokusebenzisa ama-catheters nge-cannula ekugcineni. Ngenxa yalawa mashubhu, ikhareji eliqukethe i-insulin lixhuma izicubu ezinamafutha.

Isikhathi sokushintsha ukongiwa nge-insulin kuya ngomthamo kanye nesidingo sokuwusebenzisa. I-cannula ibekwa ngaphansi kwesikhumba ezindaweni esiswini, yenzelwe ukujova ngosizo lwamapeni wesirinji.

Umgomo wokusebenza kwephampu uyafana nemisebenzi eyenziwa ama-pancreas, ngenxa yalokho, umuthi ulawulwa ngemodi ye-basal ne-bolus. Izinga lomthamo we-basal lihlelwe yidivayisi futhi lingashintsha ngemuva kwengxenye yehora. Isibonelo, njalo ngemizuzu emi-5, amayunithi we-0.05 we-hormone alethwa (ngejubane lama-unit angu-0,60 / ihora).

Ukuhlinzekwa ngomuthi kuncike kwimodeli yedivayisi futhi kwenziwa ngenani elincane (imithamo ngezikhathi zobubanzi ukusuka kumayunithi angama-0,025 kuya kwayi-0.1). Umthamo we-bolus kufanele uphathwe iziguli ngesandla ngaphambi kokudla okuvamile. Ngaphezu kwalokho, amadivaysi amaningi enza kube nokwenzeka ukusungula uhlelo olukhethekile olunikeza ukunakekelwa kwesikhathi esithile kwenani elithile le-hormone uma inani likashukela ngalesi sikhathi lidlula okujwayelekile.

Izinzuzo zesiguli

Abakhiqizi benza umzamo omkhulu wamaphampu we-insulin ababedingeka emakethe eRussia.

Izinzuzo ezimbili eziyinhloko zamadivayisi:

• ukulungiselela ukuphathwa okuphindaphindiwe kwehomoni usuku lonke;
• neqhaza ekuqothulweni kwe-insulin isikhathi eside.

Izinzuzo ezingeziwe:

1. Ukunemba okuphezulu kwemithamo esethiwe. Uma kuqhathaniswa namazibuko wesirinji ojwayelekile ngesinyathelo esingu-0.5-1 ED, iphampu ingahambisa umuthi esikalini samayunithi angama-0,1.
2. Inani le-punctures liyancishiswa. Ukuguqulwa kohlelo lokufakwa kusenziwa njalo ngemuva kwezinsuku ezintathu.
3. Idivayisi ikuvumela ukubala i-bolus insulin yesiguli ngazinye (kucatshangelwa ukuzwela kwe-hormone, i-glycemia, i-carbohydrate coeffnty). Idatha ifakwa ohlelweni ngaphambi kwesikhathi ukuze umthamo ofanele wemithi ufike ngaphambi kokudla okuhleliwe.
4. Idivaysi ingalungiswa ukuphatha kancane kancane umthamo we-hormone ohlelweni lwe-bolus. Lo msebenzi wenza sikwazi ukusebenzisa i-carbohydrate ecijiswa kancane kancane ngumzimba ngaphandle kwengozi ye-hypoglycemia ngesikhathi sedili elingapheli. Le nzuzo ibalulekile ezinganeni ezinesifo sikashukela, lapho noma iphutha elincane kumthamo lingathinta kabi isimo esijwayelekile.
5. Ushukela ubhekwa njalo. Idivayisi isayina okweqile kwemikhawulo evunyelwe. Amamodeli amasha afakwe umsebenzi wokuhlukahluka okuzimele kwesilinganiso sokuphathwa kwama-hormone ukuze kwenziwe i-glycemia isebenze ngokwejwayelekile. Ngenxa yalokhu, umuthi umiswa ngesikhathi sokuwohloka okubucayi kweglucose.
6. Kungenzeka ukugcina irekhodi ledatha, ukuligcina, futhi ukuledlulise kwikhompyutha ngenhloso yokuhlaziywa. Yonke imininingwane igcinwa kudivayisi kuze kuphele izinyanga eziyisithupha.

Ukwelashwa kwesifo sikashukela ngamadivaysi anjalo ukusebenzisa ama-analogues e-ultrashort e-hormone. Isixazululo esivela ku-cartridge siza ngemithamo emincane, kepha kaningi, ngakho-ke umuthi udonswa ngaso leso sikhathi. Ngaphezu kwalokho, izinga le-glycemia lingahluka ngokuya ngesilinganiso sokutholwa kwe-insulin enwetshiwe ngumzimba. Amadivaysi anjalo aqeda le nkinga ngenxa yokuthi ama-hormone amafushane efakwe ethangini lawo ahlala esebenza ngokuqinile.

Ukuqeqeshwa ngesineke epompini le-insulin

Ukusebenziseka kalula kwensiza kuncike ngqo ekuqwashiseni okujwayelekile kwesiguli mayelana nezici zokwelashwa kwe-insulin. Ukuqeqeshwa okungekuhle nokuntula ukuqonda kokuncika kwama-dosages ama-hormone ku-XE edliwayo (amayunithi esinkwa) kunciphisa amathuba okushintsha ngokushesha i-glycemia.

Umuntu kufanele aqale afunde imiyalo yedivayisi ukuze aqhubekise phambili ukulethwa komuthi futhi enze ushintsho ekujuleni kokuphathwa kwawo ngemodi ye-basal.

Imithetho yokufaka insimbi:

1. Vula ithangi.
2. Khipha isibhamu.
3. Faka inaliti ekhethekile ebhokisini lomuthi.
4. Khipha umoya esitsheni ukuvikela ukuvela kwe-vacuum ngesikhathi sokudla kwe-hormone.
5. Faka i-insulin esikhwameni usebenzisa ipiston, bese ukhipha inaliti.
6. Susa amabhamuza womoya aseqongelelwe esikebheni kanye nepiston.
7. Xhuma isigcini ku-infusion set tube.
8. Faka iyunithi elihlanganisiwe kusixhumi sePompo bese ugcwalisa ishubhu ngokukhulula i-insulin encane kanye nama-bubble air. Okwamanje, iphampu kufanele inqanyulwe esigulini ukuvikela ukuthi i-hormone ingalimali ngengozi.
9. Xhuma izingxenye zedivayisi endaweni yokulethwa izidakamizwa.

Izenzo ezengeziwe zokusebenzisa idivaysi kufanele zenziwe ngokuya ngezincomo zikadokotela nemiyalo enamathiselwe kuyo. Iziguli kufanele zikwazi ukukhetha imithamo yazo ngokuya ngenani le-XE nangaphansi kokulawulwa kwe-glycemia, ukuze bazi ukuthi ngabe inqubo yokwelashwa iyasebenza yini noma cha.

Ividiyo yokufakwa kwepampu ye-Omnipod:

Izinkomba zokwelapha i-pump insulin

Amacala okufaka isicelo:

• isiguli uqobo siveza isifiso;
• isifo sikashukela esingaxinzekanga kahle;
• ukuguquguquka njalo futhi okubalulekile koshukela kuyabonakala;
• ukuhlaselwa njalo kwe-hypoglycemia, ikakhulukazi ebusuku;
• kunezimo ezivezwa ngokwenzakala kokuthi "kusa kokusa";
• umuthi unomphumela ohlukile esigulini izinsuku eziningana;
• ukukhulelwa kuhlelwe noma sekuqalile;
• isikhathi sokuya esikhathini;
• ingane iyagula.

Idivaysi ivunyelwe ukusetshenziswa ngabantu abanesifo sikashukela esivele satholakala, kanye nezinhlobo zesifo se-monogenic.

Izinto zevidiyo ezivela kuDkt Malysheva mayelana nezinzuzo zamaphampu we-insulin:

Contraindication

Le divayisi akufanele isetshenziswe ngabantu abangenaso isifiso namandla okusebenzisa i-insulin Therapy.

Idivayisi iphikisiwe uma:

• akunamakhono okuzithiba we-glycemia;
• isiguli asazi ukubala i-XE;
• isiguli asihlelelanga umzimba ngaphambi kwesikhathi;
• isiguli asifuni noma asazi ukuthi singayikhetha kanjani isilinganiso somuthi;
• kukhona ukuhlukunyezwa kwengqondo;
• isiguli sinombono ophansi;
• akunakwenzeka ukuthi kubhekwe njalo yi-endocrinologist ngezigaba zokuqala zokusebenzisa ifoni.

Imiphumela yokusebenzisa kabi iphampu:

• amathuba okukhula njalo kwe-hyperglycemia anda noma, ngakolunye uhlangothi, ushukela ungancipha kakhulu;
• iketoacidosis kungenzeka.

Ukuvela kwalezi zinkinga kungenxa yokuthi iziguli azinikezi i-hormone enomphumela oweluliwe. Uma i-insulin emfushane iyeka ukugeleza (nganoma yisiphi isizathu), izinkinga zingavela ngemuva kwamahora ama-4.

Ungabala kanjani umthamo?

Ukwelashwa kwe-insulin kubandakanya ukusetshenziswa kwama-analogues we-hormone ngesenzo se-ultrashort.

Imithetho okufanele ibonwe lapho kubalwa imithamo:

1. Gxila kunani le-insulinisiguli esithole ngaphambi kokuqala ukusebenzisa iphampu. Umthamo wansuku zonke, osuselwa kwidatha yomthombo, kufanele wehliswe ngo-20-30%. Ukusetshenziswa kwensiza ohlelweni lohlobo lwe-basal regimen kuhlinzeka ukuthi kwethulwe cishe i-50% yenani eliphelele lemithi etholakele. Isibonelo, uma isiguli sivele sathola amayunithi angama-50 e-hormone, khona-ke ngepompo lizodinga ama-PIECES angama-40 ngosuku (50 * 0.8), kanti izinga le-basal lizoba ama-PIECES angama-20 ngesivinini esilingana no-0.8 PIECES / ihora.
2. Ekuqaleni kokusetshenziswa, idivaysi kufanele ilungiselelwe ukuze ihlinzeke ngomthamo owodwa we-hormone olethwe kumodi ye-basal ngosuku. Ijubane ngokuzayo kufanele lishintshe, kususelwa kuzinkomba ze-glycemia ngezikhathi zobusuku nosuku. Ukulungiswa kwesikhathi esisodwa akufanele kudlule i-10% yenani lokuqala.
3. Ijubane lomuthi ebusuku kufanele likhethwe uma kubhekwa isilinganiso se-glucose ngesikhathi sokulala, cishe amahora amabili nesisu esingenalutho, futhi phakathi nosuku - ngokwemiphumela ye-glycemia lapho kungekho izidlo.
4. Umthamo we-insulin odingekayo ukunxephezela ama-carbohydrate usethwa ngesandla ngaphambi kokudla okuvamile noma ekudleni. Ukubalwa kufanele kwenziwe ngokwemithetho yokwelashwa kwe-insulin usebenzisa amapeni wesirinji.

Izinto zevidiyo ekubaleni imithamo edingekayo ye-insulin:

Ubunzima besifo sikashukela besebenzisa idivaysi

Ukwelashwa kwesifo sikashukela okubandakanya ukupompa umuthi ngepompo kunezinkinga ezilandelayo:

1. Izindleko zokuqala eziphakeme. Akusizo zonke iziguli ezingakwazi ukuthenga imishini enjalo.
2. Intengo yezinsizakalo ingumyalo wesilinganiso esiphakeme kunezindleko zama-insulin syringes.
3. Umuthi ungayeka ngenxa yokungasebenzi kahle okuhlukahlukene okuvelile lapho kusetshenziswa ucingo. Zihambisana nokungafanele kwe-insulin, ukungasebenzi kahle kulolu hlelo, kanye nezinye izinkinga ezifanayo.
4. Ubungozi bezinkinga ezahlukahlukene, kufaka phakathi i-ketoacidosis yasebusuku, bukhuphuka ngesikhathi sokusetshenziswa kwensiza ehluleka ngokungazelele.
5. Ukubuyekezwa kwesifo sikashukela kusivumela ukuthi siphethe ngokuthi ukugqokwa njalo kwalesi sisetshenziswa kubangela ukungaphatheki kahle kanye nokuphazamiseka okuthile okuvela ku-cannula efakwe ngokufaka. Ezimweni eziningi, kuba nobunzima lapho kubhukuda, ephupheni noma ngesikhathi sokuzivocavoca umzimba.
6. Kukhona ubungozi bokutheleleka nge-cannula.
7. Kungavela ithumba elingasuswa kuphela ngokuhlinzwa.
8. Imvamisa yokuhlaselwa kwe-hypoglycemia iphezulu ngamaphampu kunama-syringes. Lokhu kungenxa yokwehluleka ohlelweni lwe-dosing.
9. Umthamo we-bolus uphathwa cishe njalo ngehora, ngakho-ke inani elincane le-insulin amayunithi ayi-2.4. Lokhu kukhulu kakhulu ezinganeni. Ngaphezu kwalokho, akwenzeki njalo ukunikeza inani elifanele le-hormone ngosuku. Imvamisa kufanele ufake okuncane noma okungaphezulu. Isibonelo, uma isidingo singama-unit ayi-6 ngosuku, khona-ke insiza ikuvumela ukuthi ufake amayunithi angama-4,8 noma u-7.2. Ngenxa yalokhu, iziguli azihlali zikwazi ukugcina amazinga kashukela ngaphakathi kwamanani amukelekayo.
10. Ezindaweni zokufakwa kwe-catheter, kwakhiwa ama-sutures (fibrosis), okungagcini ngokubi kakhulu ukubukeka, kodwa futhi kunciphisa ukumuncwa kwalesi sidakamizwa.

Ngakho-ke, izinkinga eziningi abahlangabezana nazo ekwelashweni kwesifo sikashukela azinakuxazululeka ngokusebenzisa amaphampu.

Yini okufanele ucabangele lapho ukhetha?

Izinhlobo ezinhlobonhlobo zamaphampu we-insulin ezethulwe abakhiqizi zenza kube nzima kakhulu ukukhetha kwabo. Noma kunjalo, kunamapharamitha ambalwa okufanele unake ngesikhathi sokuthenga kwamadivayisi anjalo.

Izici eziphambili:

1. IVolumu yensimbi. Kubalulekile ukuthi inani elinjalo le-insulin lingenelele kulo, okufanele lihlale izinsuku eziningana.
2. Ukugqama nokucaca kwezinhlamvu ezikhonjiswe esibukweni.
3. Imithamo yokulungiselela bolus. Imikhawulo ephezulu futhi ephansi lapho i-insulin ingalungiswa khona kufanele icatshangwe.
4. Okokubala okwakhelwe ngaphakathi. Kuyadingeka ukuthi kuvumela ukuthi kubhekwe isikhathi sokusebenza kwe-insulin, ukuzwela kweziguli, isilinganiso sikashukela kanye nokuqina kwe-carbohydrate.
5. Amandla wedivayisi okubonisa ukuqala kwezinkinga.
6. Ukumelana namanzi. Le nqubo ibalulekile uma isiguli sihlela ukugeza ngedivayisi noma singafuni ukusikhipha ngenkathi sibhukuda.
7. Ukuxhumana namadivayisi ahlukahlukene. Amaphampu amaningi angasebenza ngokuzimela ngenkathi esebenzisa i-glucometer nawo.
8. Ukusetshenziswa kalula kwensiza. Akufanele kulethe ukuphazamiseka empilweni yansuku zonke.

Intengo yamadivayisi incike kumenzi, izici nemisebenzi enikeziwe. Amamodeli athandwayo yi-Dana Diabecare, Medtronic ne-Omnipod. Izindleko zephampu zisukela kuma-ruble ayizinkulungwane ezingama-25 kuye kwangama-120.

Kubalulekile ukuqonda ukuthi ukuphumelela kokusetshenziswa kwephampu kuzotholakala kuphela uma ulandela ukudla, amandla okubala umthamo womuthi futhi ubeke nesidingo se-insulin ye-XE ngayinye. Kungakho, ngaphambi kokuthenga idivaysi, kufanele uqhathanise konke okuhle nokubi, bese unquma ngesidingo sokusetshenziswa kwayo.