Umarnin insulin don amfani dashi

A halin yanzu, matakin haɓaka magunguna yana ba da damar koda a cikin manyan matsalolin kiwon lafiya don kula da yanayin rayuwa na yau da kullun. Magunguna na zamani suna zuwa ceto. Metabolism din glucose mai narkewa yanzu shine bincike akai-akai, amma tare da ciwon sukari zaku iya rayuwa kuyi aiki kullum. Mutanen da ke fama da nau'in 1 da nau'in cuta na 2 ba za su iya yin ba in ba tare da analog na anaulin ba. Lokacin da aiki na jiki da abinci mai dacewa ba sa ƙididdige matakan sukari na jini, to, insulin ɗin insemir ya isa ceton. Amma kafin amfani da wannan magani, mai haƙuri yana buƙatar fahimtar tambayoyi masu mahimmanci: yadda za'a gudanar da maganin yadda yakamata a lokacin da ba zai yiwu a yi amfani da shi ba kuma menene alamun da ba a so?

Insulin "Detemir": bayanin maganin

Ana samun maganin ta hanyar samar da mafita mai cike da launi mara launi. A cikin 1 ml na shi ya ƙunshi babban abun ciki - insulin detemir 100 PIECES. Bugu da ƙari, akwai ƙarin abubuwan da aka haɗa: glycerol, phenol, metacresol, zinc acetate, sodium hydrogen phosphate dihydrate, sodium chloride, hydrochloric acid q.s. ko sodium hydroxide q.s., ruwa don yin allura har zuwa 1 ml.

Ana samun magungunan a cikin sirinji na syringe, wanda ya ƙunshi 3 ml na bayani, daidaituwa na 300 PIECES. 1 na insulin ya ƙunshi 0.142 mg na insulin-gishiri mara gishiri.

Yaya Detemir yake aiki?

Detemir insulin (sunan cinikayyar shine Levemir) ana samin shi ta amfani da kimiyyar halittar deoxyribonucleic acid (DNA) fasahar kere-kere ta amfani da wani nau'in da ake kira Saccharomyces cerevisiae. Insulin shine babban bangaren Levemir flekspen kuma kwatanci ne na kwayar halittar mutum wacce ke hade da masu karuwar kwayar halitta kuma yana aiki da dukkanin hanyoyin halittu. Yana da sakamako masu yawa akan jiki:

yana ƙarfafa amfani da glucose ta kasusuwa na waje da sel,
yana sarrafa metabolism,
yana hana gluconeogenesis,
yana haɓaka aikin furotin,
yana hana lipolysis da proteolysis a cikin ƙwayoyin mai.

Yana da godiya ga ikon sarrafa duk waɗannan hanyoyin wanda matakan sukari na jini ya ragu. Bayan gabatarwar miyagun ƙwayoyi, babban tasiri yana farawa bayan sa'o'i 6-8.

Idan kun shigar dashi sau biyu a rana, to, ana iya samun cikakken daidaituwa na matakin sukari bayan allura biyu zuwa uku. Magungunan suna da tasiri iri ɗaya ga mata da maza. Matsakaicin matsakaiciyar rarraba shi yana tsakanin 0.1 l / kg.

Rabin rayuwar insulin, wanda aka allura a karkashin fata, ya dogara da kashi kuma yakai kimanin awanni 5-7.

Siffofin aikin miyagun ƙwayoyi "Detemir"

Insemir insulin (Levemir) yana da tasiri sosai fiye da samfuran insulin kamar Glargin da Isofan. Tasirinsa na tsawon lokaci akan jikin mutum ya samo asali ne ta hanyar hadewar jikin kwayoyin halittu yayin da suke tare da sarkar acid mai guba tare da kwayoyin albumin. Idan aka kwatanta shi da sauran insulins, yana bazu a hankali cikin jiki, amma saboda wannan, inganta ƙwaƙwalwar shi yana haɓaka sosai. Hakanan, idan aka kwatanta da sauran analogs, Detemir insulin shine mafi tsinkaye, sabili da haka yafi sauƙin sarrafa tasirin sa. Kuma wannan saboda dalilai da yawa:

kayan yana wanzuwa cikin yanayin ruwa daga lokacin da yake cikin allurar-kamar sirinji har sai an gabatar dashi a jiki,
kwayoyin dake jikinta suna daure wa kwayoyin albumin a cikin jini ta hanyar hanyar saiti.

Magungunan yana shafar ƙimar ƙwayar ƙasa ƙasa, wanda ba za a iya faɗi ba game da sauran insulins. Ba shi da illa da ƙwayoyin cuta a jikin mutum.

Yaya ake amfani da "Detemir"?

An zaɓi kashi na miyagun ƙwayoyi daban-daban ga kowane haƙuri tare da ciwon sukari. Kuna iya shigar da shi sau ɗaya ko sau biyu a rana, wannan ya nuna ta hanyar umarnin. Shaida akan amfanin Detemir insulin amfani da da'awar cewa don haɓaka sarrafa glycemia, ya kamata a ba da allura sau biyu a rana: da safe da maraice, akalla awanni 12 ya kamata yawuce tsakanin amfani.

Ga tsofaffi masu fama da ciwon sukari da waɗanda ke fama da hanta da koda, an zaɓi kashi tare da taka tsantsan.

Insulin an allurar da shi ya shiga cikin kafada, cinya da tsinkayen yankin. Intensarfin aikin ya dogara da inda ake sarrafa maganin. Idan an yi allura a yanki daya, to za a iya canza fagen murfin, alal misali, idan an saka insulin a cikin fatar ciki, to wannan ya kamata a yi 5 cm daga cibiya kuma a kewaya.

Yana da mahimmanci don samun allura daidai. Don yin wannan, kuna buƙatar ɗaukar alkalami na syringe tare da ƙwayar zazzabi na daki, maganin rigakafi da ulu ulu.

Kuma aiwatar da tsari kamar haka:

kula da shafin fitsari tare da maganin ƙwari kuma ƙyale fata ta bushe,
fatar an kama ta da man shafawa
Dole a saka allura a wani kusurwa, bayan wannan an kunna piston a ɗan kaɗan, idan jini ya bayyana, jirgin ruwa ya lalace, dole ne a canza wurin allurar,
ya kamata a gudanar da maganin a hankali kuma a ko'ina, a cikin abin da piston ya motsa tare da wahala, kuma a farjin fatar an sanya fatar, ya kamata a saka allura mai zurfi,
bayan kula da magunguna, ya zama dole ya yi kwanciyar hankali na wani sakan 5, bayan haka an cire sirinji tare da motsi mai kaifi, kuma ana kula da wurin allurar tare da maganin taɗama.

Don yin allurar mara zafi, allura ya zama kamar bakin ciki kamar yadda zai yiwu, bai kamata a matsi fatar fatar ba, kuma ya kamata a yi allura da hannun amintacce ba tare da tsoro da shakka ba.

Idan mai haƙuri ya saka nau'ikan insulin, to da farko ana lasafta gajere, sannan ya daɗe.

Me ake nema kafin shiga Detemir?

Kafin yin allura, kana buƙatar:

sake bincika nau'in kudaden
kewaya da membrane tare da maganin kashe kwayoyin cuta,
a hankali bincika amincin katun, idan kwatsam ya lalace ko kuma akwai shakku game da cancantarsa, to ba kwa buƙatar amfani da shi, yakamata ku mayar dashi kantin magani.

Yana da kyau a tuna cewa an haramta shi sosai don amfani da insulin Detemir mai sanyi ko wanda aka ajiye ba daidai ba. A cikin famfo na insulin, ba a yi amfani da maganin ba, tare da gabatarwar yana da mahimmanci a kiyaye dokoki da yawa:

gudanar kawai a karkashin fata,
allura ya canza bayan kowace allura,
kabad ba ya cika.

Yin hulɗa tare da wasu hanyoyi

Actionarfafa matakan motsa jiki yana ba da gudummawa ga:

Magunguna waɗanda ke ɗauke da ethanol,
cututtukan cututtukan zuciya (na baka),
Li +,
MAO masu hanawa
fenfluramine,
ACE masu hanawa
karafarini,
carbonic anhydrase inhibitors,
akarijin
ba zaɓin beta-blockers ba,
pyridoxine
bromocriptine
mebendazole,
sulfonamides,
ketonazole
anabolic jamiái
Clofibrate
karafarini.

Hypoglycemic kwayoyi

Nicotine, rigakafin (na baka), corticosteroids, phenytoin, hormones thyroid, morphine, thiazide diuretics, diazoxide, heparin, allunan tashar alli (jinkirin), tricyclic antidepressants, clonidine, danazole da tausayi suna rage tasirin cutar.

Salicylates da reserpine suna iya haɓaka ko rage tasirin abin da detemir ke ɗaukar insulin. Lanreotide da octreotide suna haɓaka ko rage yawan insulin.

Kula! Beta-blockers, saboda abubuwan da suka mallaka na musamman, yawancin lokuta suna rufe alamun bayyanar cututtukan jini da jinkirta tsarin dawo da matakan glucose na yau da kullun.

Kwayoyin magungunan Ethanol suna haɓakawa da haɓaka tasirin insulin. Magungunan ba su dace da kwayoyi dangane da sulfite ko thiol (an lalata insulin detemir). Hakanan, samfurin ba zai iya hade da mafita na jiko ba.

Umarni na musamman

Ba za ku iya shiga cikin Detemir a cikin jijiya ba, kamar yadda tsananin rashin ƙarfi na iya haɓaka. Kulawa mai zurfi tare da maganin ba ya bayar da gudummawa ga tarin ƙarin fam.

Idan aka kwatanta da sauran insulins, insulin detemir yana rage haɗarin hauhawar jini da daddare kuma yana ba da gudummawa ga mafi girman zaɓi na sashi wanda aka ƙaddara don cimma daidaituwar taro na sukari a cikin jini.

Mahimmanci! Dakatar da magani ko kuma yawan maganin da ba daidai ba, musamman ga nau'in ciwon sukari na I, yana ba da gudummawar bayyanar cututtukan hyperglycemia ko ketoacidosis.

Alamar asali na hyperglycemia, yafi faruwa a matakai. Suna bayyana cikin fewan awanni ko kwanaki. Bayyanar cututtukan hyperglycemia sun hada da:

warin acetone bayan gajiya,
ƙishirwa
rashin ci
polyuria
bushe bakin
tashin zuciya
bushe fata
gagging
hyperemia,
m barci.

Kwatsam da motsa jiki, da kuma rashin daidaituwa yayin cin abinci na yau da kullun suna taimakawa wajen haifar da ƙin jini.

Koyaya, bayan sake dawowar metabolism metabolism, alamomin alamomin da ke nuna alamun hypoglycemia na iya canzawa, don haka likitan halartar ya kamata a sanar da shi. Alamar cututtuka na yau da kullun na iya rufe idan akwai masu cutar sukari na tsawan lokaci. Hakanan cututtukan da ke tare da su kuma suna kara bukatar insulin.

Canja wurin mara lafiya zuwa sabon nau'in ko insulin, wanda wani masana'anta ya kera shi, koyaushe ana aiwatar dashi karkashin kulawar likita. Game da canji a masana'anta, sashi, nau'in, nau'in ko hanyar samar da insulin, sau da yawa ana buƙatar daidaita sashi.

Marasa lafiya da aka canjawa wuri zuwa magani wanda ake amfani da detemir insulin sau da yawa suna buƙatar daidaita sashi idan aka kwatanta da adadin insulin da aka bayar a baya. Bukatar canza kashi ya bayyana bayan allurar farko ko cikin mako ko watan. Tsarin shan ƙwayoyi a cikin yanayin gudanarwar intramuscular yana da sauri idan aka kwatanta da sc gwamnati.

Detemir zai canza salon aikinta idan aka cakuda shi da sauran nau'ikan insulin. Haɗuwarsa tare da insulin aspart zai haifar da bayanin ayyukan aiki tare da ƙarancin, dakatar da iyakar tasiri idan aka kwatanta da madadin gudanarwa. Bai kamata a yi amfani da insulin na insulin a cikin famfunan insulin ba.

Zuwa yau, babu bayanai game da amfani da maganin a lokacin daukar ciki, lactation da yara a ƙarƙashin shekaru shida.

Ya kamata mai haƙuri ya yi gargaɗi game da yiwuwar hyperglycemia da hypoglycemia akan aiwatar da tuki mota da hanyoyin sarrafawa. Musamman, yana da mahimmanci ga mutanen da ke da alamu masu laushi ko waɗanda basu halarci ba waɗanda ke ɗauke da cutar hypoglycemia.

Alamu don amfani da sashi

Ciwon sukari (mellitus) shine babbar cuta wacce aka nuna alamar maganin.

Ana aiwatar da shigarwar a cikin kafada, rami na ciki ko cinya. Dole ne a sauya wuraren da ake allurar insulin allurar rigakafin a koyaushe. Sashi da kuma yawan allurar an kafa su daban-daban.

Lokacin da aka allura sau biyu don inganta yawan glucose, yana da kyau a gudanar da kashi na biyu bayan awa 12 bayan na farko, lokacin cin abincin yamma ko kafin zuwa gado.

Ana iya buƙatar daidaita sashi da lokacin gudanarwa idan mai haƙuri ya canza shi daga tsawan insulin da magani mai matsakaici zuwa insulin.

Side effects

Sakamakon sakamako masu illa na yau da kullun (1 cikin 100, wani lokacin 1 cikin 10) sun haɗa da hypoglycemia da duk alamun masu halarta: tashin zuciya, ƙyallen fata, karuwar ci, disorientation, yanayin juyayi, har ma da rikicewar kwakwalwa wanda zai iya haifar da mutuwa. Hakanan halayen gida (itching, kumburi, hyperemia a wurin allura) suma zasu yuwu, amma suna ɗan lokaci kuma sun ɓace yayin jiyya.

Rashin sakamako masu illa (1/1000, wani lokacin 1/100) sun haɗa da:

allurar lipodystrophy,
kumburi na wucin gadi wanda ke faruwa a farkon maganin insulin,
bayyanar rashin lafiyan (raguwar hauhawar jini, cututtukan mahaifa, bugun jini da gazawar numfashi, ƙaiƙayi, rashin aiki na narkewar abinci, hyperhidrosis, da sauransu),
a farkon matakin insulin far, wani wucin gadi na tunani zai faru,
maganin ciwon sukari.

Game da maganin retinopathy, kulawa mai tsawo na glycemic yana rage yiwuwar haɓaka ƙwaƙwalwar ƙwayar cuta, amma maganin insulin mai zurfi tare da kwatsam a cikin ƙwayar metabolism na iya haifar da rikicewar wucin gadi na yanayin cututtukan cututtukan zuciya.

Da wuya sosai (1/10000, wani lokacin 1/1000) sakamako masu illa sun haɗa da neuropathy na yanki ko kuma ciwo mai zafi, wanda yake juyawa ne koyaushe.

Yawan abin sama da ya kamata

Babban alamar cutar yawan ƙwayar cutar ƙwaƙwalwa shine hypoglycemia. Marasa lafiya na iya kawar da wani nau'in sikari na hypoglycemia a kashin kansu ta hanyar cin abinci na glucose ko abinci na carbohydrate.

A cikin yanayin s / c mai tsanani, ana / m ana gudanar da 0,5-1 mg na glucagon ko kuma maganin dextrose a / in. Idan bayan mintina 15 bayan shan glucagon mara lafiyar bai sake murmurewa ba, to ya kamata a gudanar da maganin dextrose. Lokacin da mutum ya sake tunani don dalilai na hanawa, ya kamata ya ci abincin da yake cike da carbohydrates.

A cikin wane yanayi ne maganin yake shan wahala?

Kafin amfani da Detemir, yana da matukar muhimmanci a gano lokacin da ake yin takaddama mai ƙarfi:

idan mai haƙuri yana da hankalin mutum ga abubuwan da ke tattare da ƙwayar, zai iya haɓaka ƙwayar cuta, wasu halayen na iya haifar da mutuwa,
ga yara 'yan kasa da shekaru 6, ba a ba da shawarar wannan maganin ba, ba shi yiwuwa a bincika tasirinsa ga jarirai, saboda haka ba shi yiwuwa a faɗi yadda zai cutar da su.

Bugu da ƙari, akwai irin waɗannan nau'ikan marasa lafiya waɗanda aka ba su izinin amfani da miyagun ƙwayoyi a cikin magani, amma tare da kulawa ta musamman kuma a ƙarƙashin kulawa koyaushe. An nuna wannan ta umarnin don amfani. Insulin "Detemir» A cikin waɗannan marasa lafiya tare da irin wannan cututtukan, ana buƙatar daidaita sashi:

Take hakkin a cikin hanta. Idan an bayyana waɗancan a cikin tarihin mai haƙuri, to, aikin babban ɓangaren na iya gurbata, don haka dole ne a daidaita sashi.
Rashin nasarar cikin kodan. Tare da irin waɗannan cututtukan, ana iya canza tushen aikin miyagun ƙwayoyi, amma za'a iya magance matsalar idan kun lura da mai haƙuri koyaushe.
Tsofaffi mutane. Bayan shekaru 65, yawancin canje-canje da yawa suna faruwa a cikin jikin mutum, wanda zai iya zama mai wahala sosai waƙa. A cikin tsufa, gabobin basa aiki kamar yadda suke a cikin yara, sabili da haka, yana da mahimmanci a gare su su zaɓi madaidaicin sashi domin ya taimaka wajen daidaita matakan glucose, kuma ba cutarwa ba.

Idan kayi la'akari da duk waɗannan shawarwarin, to, ana iya rage haɗarin mummunan sakamako.

"Detemir" yayin ciki da yayin shayarwa

Godiya ga karatu kan ko amfanin insulin "Detemira» mace mai ciki da tayi, an tabbatar da cewa kayan aikin ba su shafi ci gaban jariri. Amma a faɗi cewa yana da cikakken hadari, ba shi yiwuwa, saboda yayin canje-canjen hormonal na faruwa a jikin matar, da kuma yadda magungunan za su yi halinsa a wani yanayi ba za a iya yin hasashen su ba. Abin da ya sa likitoci, kafin rubuta shi yayin daukar ciki, tantance haɗarin.

Yayin aikin jiyya, kuna buƙatar saka idanu akan matakan glucose koyaushe. Manuniya na iya canzawa da sauri, don haka saka idanu akan lokaci da kuma daidaita matakan wajibi ne.

Ba shi yiwuwa a faɗi daidai ko maganin yana shiga cikin madarar nono, amma koda ya samu, an yi imanin cewa ba zai kawo lahani ba.

Yin hulɗa tare da wasu kwayoyi

Sakamakon "Detemir" na iya gurbata saboda rabawa tare da wasu kwayoyi. Mafi sau da yawa, likitoci suna ƙoƙarin guje wa irin waɗannan haɗuwa na kwayoyi, amma wani lokacin ma kawai ba za su iya yin ba tare da, lokacin da mai haƙuri yana da wasu cututtukan ƙwayar cuta. A irin waɗannan halayen, ana iya rage haɗarin ta hanyar canza sashi. Wajibi ne a kara yawan idan an wajabta irin wadannan magungunan ga masu ciwon sukari:

Suna rage tasirin insulin.

Amma wajibi ne don rage sashi, idan an ba da shawarar irin waɗannan kwayoyi:

Idan ba'a daidaita sashi ba, to shan waɗannan kwayoyi na iya haifar da tsotsar jini.

Analogues na miyagun ƙwayoyi

Wasu marasa lafiya dole ne su nemi maganin ana amfani da su ta Detemir insulin tare da hadewar wasu abubuwan da aka gyara. Misali, masu ciwon sukari wadanda suke da tasirin gaske game da abubuwan wannan magani. Akwai wasu analogues na Detemir, ciki har da Insuran, Rinsulin, Protafan da sauransu.

Amma yana da mahimmanci a tuna cewa likitan ɗin ana buƙatar zaɓin analog ɗin da sigar ta ta kowane yanayi. Wannan ya shafi kowane magani, musamman tare da irin wannan mummunan cututtukan.

Kudin magani

Farashin insulin din Detemir dan kasar Denmark ya kama daga 1300-3000 rubles. Amma yana da mahimmanci a tuna cewa zaku iya samun shi kyauta, amma a wannan yanayin, lallai ne ku sami takardar izini ta Latin wanda endocrinologist ya rubuta. Insemir insulin magani ne mai inganci don magance nau'in 1 da nau'in ciwon sukari na 2, babban abu shine bin duk shawarwarin, kuma kawai zai amfana da masu ciwon sukari.

Nazarin insulin

Masu ciwon sukari da likitoci suna ba da amsa da kyau ga Detemir. Yana taimakawa rage jini mai hawan jini, yana da mafi karancin abubuwan contraindications da bayyanuwar rashin so. Abinda kawai za'a yi la’akari da shi shine daidaiton aikinta da kuma yarda da duk shawarwari idan, banda insulin, ana bada shawarar wasu magunguna ga mai haƙuri.

A halin yanzu ciwon sukari mellitus ba magana bane, kodayake cutar ta kasance kusan mutuwa har sai an sami insulin roba. Ta bin shawarar likita da saka idanu kan matakin glucose a cikin jini, zaku iya kula da rayuwar yau da kullun.

Propertiesabi'ar magunguna ta Insulin detemir

Kayan fasahar DNA na zamani sun inganta bayanan martaba na aiki na insulin mai sauki (na yau da kullun). Ana samar da insulin din 'Detemir insulin' ta nazarin halittun DNA ta hanyar amfani da iri Saccharomyces cerevisiae, analog ne mai matukar narkewa na insulin ɗan adam na tsawaita aiki tare da bayanin martaba na aiki. Bayanan da ake amfani da su yana da matukar tasiri idan aka kwatanta da isofan-insulin da gulingine insulin. Tsawan aikin ya kasance saboda bayyanar da haɗin kai na kwayoyin ƙwararru daga detemir insulin a wurin yin allura da dauri kwayoyi zuwa albumin ta hanyar fili tare da sarkar acid mai gefe. Idan aka kwatanta da isofan-insulin, ana rarraba insulin cikin insulin a hankali a cikin kyallen makasudi na gefe. Waɗannan haɗin jinkirin rarraba jinkiri suna ba da ƙarin ƙari na haihuwa da bayanan aikin insulin na detemir. Insemir insulin ana nuna shi ta hanyar babban ƙarfin tsinkaya na aiki a cikin marasa lafiya idan aka kwatanta da insulin NPH ko gulingine insulin. Alamar da aka nuna na aiki shine saboda dalilai biyu: insulin detemir ya kasance cikin halin rushewa a kowane mataki daga nau'ikan sashirsa zuwa dauri ga mai karbar insulin da kuma tasirin jingina ga allurar albumin.

Ta hanyar yin hulɗa tare da takamaiman mai karɓa akan ƙwayar cytoplasmic na ƙwayoyin sel, yana samar da hadaddun insulin-receptor wanda ke motsa ayyukan ciki, gami da haɗakar enzymes da yawa (hexokinase, pyruvate kinase, glycogen synthetase, da sauransu). Rage glucose na jini yana faruwa ne saboda karuwa a cikin jijiyoyin zuciya, karuwar ƙwayar nama, haɓakar lipogenesis, glycogenogenesis, raguwa a cikin ƙimar samar da glucose ta hanta, da sauransu Don allurai na 0.2-0.4 U / kg 50%, matsakaicin sakamako yana faruwa a cikin kewayon daga 3 4 hours zuwa 14 hours bayan gudanarwa. Bayan subcutaneous gwamnatin, mai pharmacodynamic amsa kasance gwargwado ga kashi ana gudanar (mafi girman sakamako, tsawon lokaci na aiki, general sakamako). Bayan allurar SC, detemir ya ɗaure wa albumin ta hanyar sarkar acid mai kitse. Saboda haka, a cikin yanayin matakan kwanciyar hankali, rage yawan insulin marasa kyauta yana raguwa sosai, wanda ke haifar da matakan tsayayyen glycemia. Tsawon lokacin aikin detemir a kashi na 0.4 IU / kg shine kusan awanni 20, don haka ana wajabta magungunan sau biyu a rana ga yawancin marasa lafiya. A cikin karatun na dogon lokaci (watanni 6), ƙwayar plasma mai azumi a cikin marasa lafiya da nau'in ciwon sukari ya fi kyau idan aka kwatanta da isofan-insulin, wanda aka tsara a cikin tushen / bolus far. Gudanar da cutar glycemic (glycosylated haemoglobin - HbA1c) yayin kulawa tare da insulin detemir ya kasance daidai da wannan a cikin jiyya tare da isofan-insulin, tare da ƙananan haɗarin haɓakar ƙarancin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa da rashin haɓakar ƙashin jiki yayin amfani. Bayanin bayanan sarrafawar glucose na dare yana da fadi kuma har ma don detemir insulin idan aka kwatanta da insulin isofan, wanda aka nuna a cikin ƙananan haɗarin haɗarin hypoglycemia.

Matsakaicin ƙwayar detemir insulin a cikin jijiyoyin jini ya kai awoyi 6-8 bayan gudanarwa. Tare da tsarin kulawa na yau da kullum sau biyu, ana samun ingantaccen haɗarin ƙwayoyi a cikin jijiyoyin jini bayan allura ta 2-3.

Inactivation yana kama da na shirye-shiryen insulin na mutum, duk metabolites da aka kafa basa aiki. Karatun Bindiga a cikin vitro da a cikin vivo nuna rashin kyakkyawar mu'amala a asibiti tsakanin insulin detemir da kitse mai kitse ko wasu magunguna da suka danganta da kariyar jini.

Rabin rayuwar bayan allura sc an ƙaddara shi da ƙimar sha daga ƙwaƙwalwar subcutaneous kuma shine tsawon awanni 5-7, gwargwadon kashi.

Lokacin da s / zuwa gabatarwar taro a cikin ƙwayar jini ya kasance daidai gwargwado ga adadin da aka gudanar (mafi yawan maida hankali, matakin ɗaukar).

An yi nazarin abubuwan da ke cikin Pharmacokinetic a cikin yara (shekaru 6-12) da matasa (13-17 years) kuma idan aka kwatanta da manya tare da nau'in ciwon sukari na Iell. Babu wani bambance-bambance na asibiti mai mahimmanci a cikin kantin magunguna na detemir insulin tsakanin tsofaffi da matasa marasa lafiya, ko tsakanin marasa lafiya da ke fama da rauni na aiki da hepatic da lafiya marasa lafiya.

Yin amfani da miyagun ƙwayoyi Insulin detemir

An tsara shi don gudanar da subcutaneous. An ƙayyade kashi ɗaya akayi daban-daban a kowane yanayi. Ya kamata a ba da insulin na Detemir sau 1 ko sau 2 a rana dangane da bukatun mai haƙuri. Marasa lafiya waɗanda suke buƙatar yin amfani da sau biyu a rana don ingantaccen iko na matakan glucose na jini na iya shiga cikin maraice na yamma ko dai lokacin abincin dare, ko kafin lokacin bacci, ko kuma awanni 12 bayan lokacin alfijir. Insulin din insemir yana allurar sc a cikin cinya, bangon ciki ko kafada. Ya kamata a canza wuraren allurar koda lokacin allura a cikin wannan yanki. Kamar yadda yake a cikin sauran insulins, a cikin tsofaffi marasa lafiya da marasa lafiya tare da renal ko hepatic insufficiency, ya kamata a kula da matakan glucose na jini sosai kuma ana iya daidaita sashin disemir daban daban. Gyaran matsakaita na iya zama dole yayin da ake inganta ayyukan jikin mai haƙuri, canza yanayin abincinsa na yau da kullun, ko tare da ciwo mai haɗari.

Abubuwan hulɗa da miyagun ƙwayoyi Insulin detemir

Akwai kwayoyi da yawa waɗanda ke shafar buƙatar insulin.

Ana inganta tasirin insulin hypoglycemic ta: baka hypoglycemic kwayoyi, Mao hanawa, ACE hanawa, carbonic anhydrase hanawa, ba zabe β-blockers, bromocriptine, sulfonamides, anabolic steroids, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lithium, kwayoyi dauke da ethanol.

Sakamakon rashin lafiyar insulin ya raunana: maganin hana haihuwa, corticosteroids, hormones thyroid, thiazide diuretics, heparin, tricyclic antidepressants, tausayi ajuju, danazole, clonidine, jigilar allurar tasirin alli, diazoxide, morphine, phenytoin, nicotine. A ƙarƙashin rinjayar reserpine da salicylates, yana yiwuwa a raunana ko haɓaka aikin miyagun ƙwayoyi Octreotide / lanreotide, wanda duka biyu zasu iya haɓakawa da rage buƙatar jikin mutum na insulin. Ckers-adrenergic blockers na iya rufe alamun hypoglycemia da jinkirta murmurewa bayan hypoglycemia. Alcohol na iya haɓakawa da tsawaita sakamako na insulin.

Wasu kwayoyi, alal misali, dauke da thiol ko sulfite, lokacin da aka kara detemir a cikin maganin insulin, na iya haifar da lalata. Sabili da haka, kada ku ƙara insulin detemir a cikin mafita na jiko.

Aikin magunguna na kayan

Ana yin insulin ta insemir ta amfani da kwayoyin halitta na deoxyribonucleic acid (DNA) da ƙasan halayyar da ake kira Saccharomyces cerevisiae.

Insulin shine babban sinadarin Levemir flekspen, wanda aka saki a cikin hanyar mafita a cikin alkalami 3 sirinji mai dacewa (300 PIECES).

Wannan analog na mutum ɗan adam yana ɗaure wa masu karɓar sel kuma yana haifar da hanyoyin ƙirar halitta.

Analog na insulin na mutum yana inganta kunnawar hanyoyin da ke gaba a jikin mutum:

motsawar glucose din ta sel da ke jikin tsoka,
sarrafa gulukul metabolism,
hanawa na gluconeogenesis,
proteinarin haɓakar furotin,
rigakafin lipolysis da proteolysis a cikin ƙwayoyin mai.

Godiya ga duk waɗannan hanyoyin, akwai raguwa a cikin yawan sukari jini. Bayan allurar insulin, Detemir ya sami babban tasiri bayan sa'oin 6-8.

Idan kun shigar da mafita sau biyu a rana, to ana samun daidaituwa na insulin bayan kashi biyu ko uku. Bambancin rushewar cikin gida na Detemir insulin ya ragu sosai da na wasu magungunan insulin basal.

Wannan kwayar tana da tasiri iri daya a jikin namiji da mace. Matsakaicin rarrabuwarsa kusan 0.1 l / kg.

Matsakaicin rabin rayuwa ta ƙarshe na insulin allura a ƙarƙashin fata ya dogara da sashi na ƙwayoyi kuma yakai kimanin awanni 5-7.

Umarnin don amfani da miyagun ƙwayoyi

Likita yayi lissafin sashi na maganin, la'akari da yawan sukari a cikin masu ciwon suga.

Dole ne a daidaita allurai idan akwai wani batun cin abincin mara lafiya, karuwar ayyukan jiki ko kuma bayyanar wasu cututtukan. Ana iya amfani da insulin Detemir a matsayin babban magani, hade tare da insalin '' bolus insulin 'ko tare da magunguna masu rage sukari.

Za a iya yin allura a cikin awanni 24 a kowane lokaci, babban abin lura shi ne kiyaye lokaci ɗaya kowace rana. Ka'idojin ka'idodi na gudanar da sinadarin hormone:

Ana yin allura a karkashin fata zuwa cikin yankin, abar, kafada ko cinya.
Don rage yiwuwar lipodystrophy (cutar nama mai ƙiba), ya kamata a canza yankin allura a kai a kai.
Mutanen da suka haura shekara 60 da marasa lafiya da koda ko ƙwanƙwasa hanta na buƙatar tsayayyen glucose da kuma daidaita matakan insulin.
Lokacin canja wurin daga wani magani ko kuma a farkon matakin maganin, yana da mahimmanci don saka idanu sosai a matakin matakin glycemia.

Ya kamata a lura cewa a cikin lura da insulin Detemir ba ya ɗaukar ƙaruwa a cikin nauyin mai haƙuri. Kafin tafiye-tafiye masu tsawo, mai haƙuri yana buƙatar yin shawara da ƙwararrun masu kulawa game da amfani da miyagun ƙwayoyi, tun lokacin da aka canza bangarorin lokaci yana rikita jadawalin shan insulin.

Cutar kwantar da hankali na iya haifar da yanayin hauhawar jini - saurin haɓaka matakan sukari, ko da cutar ketoacidosis mai ciwon sukari - cin zarafin ƙwayar carbohydrate a sakamakon rashin insulin. Idan ba'a tuntuɓi likitan likita da sauri ba, sakamako na mutuwa zai iya faruwa.

Hypoglycemia yana kasancewa ne lokacin da jiki ya cika ko bai ishe ta abinci ba, kuma sinadarin insulin, bi da bi, yana da girma sosai. Don haɓaka tarin glucose a cikin jini, kuna buƙatar cin ɗan sukari, mashaya cakulan, wani abu mai daɗi.

zazzabi ko ciwace-ciwace daban-daban sau da yawa suna kara buƙatar hormone. Sauya kashi na maganin zai iya zama dole a cikin ci gaban cututtukan ƙwayoyin cuta na hanta, hanta, glandon gland, glandon gland da glandon adrenal.

Lokacin haɗuwa da insulin da thiazolidinediones, wajibi ne don yin la'akari da gaskiyar cewa zasu iya ba da gudummawa ga ci gaban cututtukan zuciya da gazawar jiki.

Lokacin amfani da miyagun ƙwayoyi, canje-canje a cikin taro da halayyar psychomotor yana yiwuwa.

Contraindications da yiwu cutar

Saboda haka, babu magungunan hana amfani da insulin Detemir. Iyakar iyakoki yana danganta ne kawai ga mai yiwuwa ga abu kuma shekara biyu saboda gaskiyar cewa binciken da aka yi akan tasirin insulin akan ƙananan yara har yanzu ba a gudanar da su ba.

A lokacin haihuwar ɗa, ana iya amfani da miyagun ƙwayoyi, amma a ƙarƙashin kulawar likita.

Yawancin karatu ba su bayyana sakamako masu illa ba a cikin mahaifiya da jaririnta tare da gabatarwar allurar insulin a lokacin haihuwarsa.

An yi imanin cewa za a iya amfani da maganin tare da shayarwa, amma ba a gudanar da binciken ba. Don haka, ga uwaye masu juna biyu da masu shayarwa, likita ya daidaita yadda ake amfani da insulin, yana yin nauyi a gaban sa da amfani ga uwa da kuma hadarin da ke tattare da jaririnta.

Amma game da halayen da ba su dace da jiki ba, umarnin yin amfani da su sun ƙunshi jerin abubuwa:

Halin hauhawar jini wanda ke alamta da alamomi kamar suma, zafin rai, fatar jiki, rawar jiki, ciwon kai, ruɗani, raɗaɗi, fainting, tachycardia. Wannan yanayin ana kuma kiransa insulin shock.
Tsarin ciki na gida - kumburi da jan launi na allura, itching, da kuma bayyanar liyst dystrophy.
Allergic halayen, angioedema, urticaria, rashes fata da kuma wuce kima gumi.
Take hakkin narkewar fili - tashin zuciya, amai, ciwon mara, zawo.
Rage numfashi, rage karfin jini.
Rashin gani na gani - canji ne na tunani wanda ke haifar da kwayar cutar retinapathy (kumburin retina).
Haɓaka ƙwayar jijiyoyin mahaifa.

Yawan shaye-shaye na miyagun ƙwayoyi na iya haifar da raguwar sukari cikin sauri. Tare da hypoglycemia mai sauƙi, mutum ya kamata ya cinye samfurin a cikin carbohydrates.

A cikin matsanancin hali na mai haƙuri, musamman idan bai san komai ba, ana buƙatar asibiti da gaggawa. Likita ya saka maganin kwanciyar hankali ko glucagon a karkashin fata ko a karkashin tsoka.

Lokacin da mai haƙuri ya murmure, ana ba shi ɗan sukari ko cakulan don hana sake komawa sukari.

Kudin, sake dubawa, makamantan hakan

Magungunan Levemir flekspen, mai aiki wanda shine insulin Detemir, ana siyar dashi a shagunan magunguna da kuma kantin magani na kan layi.

Zaka iya siyan magungunan kawai idan kana da takardar izinin likita.

Magungunan suna da tsada sosai, farashinsa ya bambanta daga 2560 zuwa 2900 rubles na Rasha. A wannan batun, ba kowane mai haƙuri ne zai iya ba.

Koyaya, sake duba insulin na insulin na da inganci. Yawancin masu ciwon sukari da aka allura tare da hormone kamar mutum sun lura da wadannan fa'idodin:

saukar da jini a hankali,
adana aikin da miyagun ƙwayoyi na kusan a rana,
sauƙi na amfani da sirinji,
da wuya abin ya faru na m halayen,
rike da nauyin mai ciwon sukari a daidai matakin.

Don cimma ƙimar glucose na yau da kullun za a iya bin duk ka'idodin magani don maganin ciwon sukari. Wannan ba wai kawai allurar insulin bane, amma har da motsa jiki, wasu takunkumi na abinci da kuma tsayayyen iko na sanya sukari cikin jini. Yarda da ingantattun sashi na da matukar muhimmanci, tunda ana cire jini, da kuma mummunan tasirinsa, ba a ciki.

Idan magani don wasu dalilai bai dace da mai haƙuri ba, likitan na iya ba da wani magani. Misali, insulin Isofan, wanda shine kwatancen kwayar halittar dan adam, wanda injiniyan kwayoyin halitta ne yake samarwa. Ana amfani da Isofan ba kawai a cikin ciwon sukari na mellitus na farko da na biyu ba, har ma a cikin tsarin gestational (a cikin mata masu juna biyu), cututtukan cututtukan zuciya, da na ayyukan tiyata.

Tsawon lokacin aikinsa yana da ƙasa da na Detemir insulin, duk da haka, Isofan shima yana da kyakkyawan tasirin hypoglycemic. Yana da kusan halayen masu illa iri ɗaya, wasu kwayoyi na iya shafar tasiri. Ana samun sashin Isofan a cikin magunguna da yawa, alal misali, Humulin, Rinsulin, Pensulin, Gansulin N, Biosulin N, Insuran, Protafan da sauransu.

Ta hanyar amfani da insulin din Detemir da kyau, zaku iya kawar da alamun cutar sankarau. Ana amfani da magungunan analogues, shirye-shiryen dauke da insulin Isofan, zasu taimaka lokacin da aka haramta amfani da maganin. Yadda yake aiki da kuma dalilin da yasa kuke buƙatar insulin - a cikin bidiyo a cikin wannan labarin.

Saki siffofin da abun da ke ciki

Ana samun maganin ta hanyar maganin allura wanda aka yi nufin gudanarwa ƙarƙashin fata. Sauran nau'ikan sashi, gami da allunan, ba a ƙera su ba. Wannan ya faru ne saboda gaskiyar cewa a cikin narkewar hanzarin ƙwayar cuta ana rushe shi zuwa cikin amino acid kuma ba zai iya cika aikinsa ba.

Insulin Detemir daidai yake da insulin mutum.

Abubuwa masu aiki suna wakiltar insulin detemir. Abunda ke cikin 1 ml na maganin shine 14.2 MG, ko raka'a 100. Comarin abun da ke ciki ya haɗa da:

sinadarin sodium
glycerin
hydroxybenzene
metacresol
sodium hydrogen phosphate foda,
zinc acetate
tsarma hydrochloric acid / sodium hydroxide,
ruwan allura.

Ya yi kama da tsattsauran ra'ayi, wanda ba a shafa ba, mai haɗa kai. An rarraba shi cikin katako 3 ml (Penfill) ko sirinji na alkalami (Flexspen). Kayan katako na waje. Umarni a haɗe yake.

Pharmacokinetics

Don samun mafi yawan maida hankali na plasma, awanni 6-8 ya kamata ya murmure daga lokacin gudanarwa. Bioavailability kusan kashi 60%. An ƙididdige daidaituwa tare da gudanarwa na lokaci biyu bayan inje 2-3. Matsakaicin rarraba kashi 0.1 l / kg. Mafi yawan inulin inulin ya zagaya tare da jini. Magungunan ba sa hulɗa tare da mai mai kitse da wakilai na magunguna waɗanda ke ɗaukar sunadarai.

Metabolization ba ya bambanta da sarrafa insulin na halitta. Cire rabin rayuwa yana yin sa'o'i 5 zuwa 7 (gwargwadon yawan da aka yi amfani da shi). Pharmacokinetics bai dogara da jinsi da shekarun mai haƙuri ba. Halin da kodan da hanta kuma baya tasiri ga waɗannan alamun.

Yadda ake ɗaukar Insulin Detemir

Ana amfani da mafita don gudanar da aikin subcutaneous, jiko na ciki na iya haifar da matsanancin rashin ƙarfi na hypoglycemia. Ba a allurar dashi intramuscularly kuma ba'a amfani dashi a cikin magungunan insulin ba. Za'a iya yin allurar ta fannin:

kafada (jin dadi),
kwatangwalo
bango na gaban ƙasa,
gindi

Dole ne a canza wurin allurar koyaushe don rage yiwuwar alamun lipodystrophy.

Zaɓin jigilar hanyar sashi ne aka zaɓa akayi daban-daban. Dos sun dogara ne akan glucose din plasma na azumi. Daidaitawar sashi na iya zama dole don motsa jiki, canje-canje a cikin abincin, cututtuka masu haɗuwa.

Ana amfani da miyagun ƙwayoyi a wurare daban-daban, ciki har da bangon bango na peritoneum.

An yarda da amfani da maganin:

a kashin kaina
tare da hadin allurar insalin 'bolus',
ban da yin abinci na liraglutid,
tare da wakilai na maganin antidiabetic na baka.

Tare da hadaddun maganin cututtukan zuciya, ana bada shawara don gudanar da maganin sau 1 a rana. Kuna buƙatar zaɓar kowane lokacin da ya dace kuma ku mance da shi lokacin yin allurar yau da kullun. Idan akwai buƙatar yin amfani da maganin sau 2 a rana, ana gudanar da kashi na farko da safe, kuma na biyu tare da tazara na awanni 12, tare da abincin dare ko kafin lokacin kwanciya.

Bayan allurar subcutaneous na kashi, rike da abin da aka sa na alkairin, an kuma bar allurar a cikin fata na aƙalla 6 seconds.

Lokacin juyawa daga wasu shirye-shiryen insulin zuwa Detemir-insulin a cikin makonni na farko, yakamata a kula da mahimmancin ma'aunin glycemic. Yana iya zama mahimmanci don sauya tsarin magani, sashi da lokacin shan magungunan antidiabetic, gami da na baka.

Wajibi ne a kula da matakin sukari da kuma daidaita sashi a tsofaffi.

Wajibi ne a kula da matakin sukari da kuma daidaita sashi a tsofaffi da marasa lafiya da cututtukan koda.

Tsarin juyayi na tsakiya

Wani lokacin jijiyoyin jijiyoyin jiki suna tasowa. A mafi yawan lokuta, ana juyawa. Mafi sau da yawa, alamunta suna bayyana tare da ƙaƙƙarfan ƙa'idar tsarin glycemic index.

Daga gefen metabolism

Sau da yawa akwai rage yawan sukari a cikin jini. Wata ƙarancin hypoglycemia yana haɓaka a cikin kawai 6% na marasa lafiya. Zai iya haifar da bayyananniyar bayyanar, kasala, aikin kwakwalwa mai rauni, mutuwa.

Wani lokaci wani abu yakan faru a wurin allura. A wannan yanayin, itching, jan launi na fata, kumburi, kumburi na iya bayyana. Canza wurin allurar insulin na iya rage ko kawar da waɗannan bayyanannun; ƙin yarda da miyagun ƙwayoyi ana buƙatar a lokuta mafi wuya. Cutar rashin lafiyar jiki mai yuwuwarwa mai yiwuwa ne (rashin damuwa na hanji, gajeriyar numfashi, yawan jijiya, rashin daidaituwa, zufa, tachycardia, anaphylaxis).

Yi amfani da lokacin daukar ciki da lactation

Lokacin gudanar da karatun, ba a gano sakamako mara kyau ga yara waɗanda iyayensu mata sun yi amfani da miyagun ƙwayoyi ba yayin bayyanar ciki. Koyaya, yi amfani da shi lokacin ɗaukar yaro ya kamata a yi amfani dashi da taka tsantsan. A farkon lokacin daukar ciki, matar tana bukatar insulin ya ragu kaɗan, daga baya kuma tayi ƙaruwa.

Babu tabbacin ko insulin ya shiga cikin nono. Bai kamata ayi amfani da abin da ya sha a cikin jariri ba, saboda a cikin tsarin narkewar abinci da sauri magungunan ya watsar kuma jiki ya karbe shi ta hanyar amino acid. Mahaifa mai shayarwa na iya buƙatar gyara sashi da sauƙin abinci.

Yin hulɗa tare da wasu kwayoyi

Ba za a iya hade abun da ke ciki tare da magudanan ruwa da magunguna na jiko ba. Thiols da sulfites suna haifar da rushewar tsarin wakili a cikin tambaya.

Strengtharfin magungunan yana ƙaruwa tare da amfani da layi daya:

Clofibrate
Fenfluramine,
Pyridoxine
Bromocriptine
Santabankan,
Mebendazole
Ketoconazole
Kalamunda
magungunan baka na maganin antidiabetic
ACE masu hanawa
maganganun maganganu na IMAO,
ba zaɓin beta-blockers ba,
hana masu aiki na carbonic anhydrase aiki,
shirye-shiryen lithium
sulfonamides,
abubuwanda ake amfani da su a cikin salicylic acid,
tetracycline
anabolics.

A hade tare da Heparin, Somatotropin, Danazole, Phenytoin, Clonidine, Morphine, corticosteroids, hormones thyroid, sympathomimetics, antagonists na alli, thiazide diuretics, TCAs, maganin hana haihuwa, nicotine, tasirin insulin ya ragu.

An bada shawara a guji shan giya.

Karkashin tasirin Lanreotide da Octreotide, tasirin magungunan na iya raguwa da haɓaka. Amfani da beta-blockers yana haifar da sauƙaƙe bayyanar cututtuka na hypoglycemia kuma yana hana dawo da matakan glucose.

Abun dacewa

An bada shawara a guji shan giya. Ayyukan ethyl barasa yana da wuya a hango ko hasashen, saboda yana da ikon haɓakawa da raunana tasirin maganin ƙwaƙwalwar ƙwayar cuta.

Cikakkun analogues na Detemir-insulin sune Levemir FlexPen da Penfill. Bayan tattaunawa tare da likita, ana iya amfani da sauran insulins (glargine, Insulin-isophan, da sauransu) azaman madadin magungunan.