Detemir: umarnin don amfani, analogues
Tebur 1. Canji a jikin mutum yayin aikin insulin
| Tsawon lokacin karatu | Insulin yakan ɓata lokaci guda | Insulin ya ɓata sau biyu | Isofan insulin | Insulin glargine |
| 20 makonni | + 0.7 kg | + 1.6 kilogiram | ||
| 26 makonni | + 1.2 kilogiram | + 2.8 kg | ||
| Makonni 52 | + 2.3 kg | + 3.7 kg | + 4.0 kg |
A cikin binciken, yin amfani da maganin haɗin gwiwa tare da Levemir ® FlexPen ® da magungunan maganganu na baki ya rage haɗarin haɓakar haɓakar rashin bacci a cikin dare ta hanyar 61-65%, sabanin isofan-insulin.
An gudanar da gwajin asibiti mai buɗewa, bazuwar marasa lafiya tare da marasa lafiya da masu ciwon sukari na nau'in 2 waɗanda ba su cimma burin su da glycemic matakan ba tare da maganin maganin magana na baki.
Nazarin ya fara ne daga lokacin shiri na mako-mako 12, a lokacin da marasa lafiya suka karɓi magani tare da liraglutide a hade tare da metformin, kuma a kan wannan ne kashi 61% na marasa lafiya suka samu HbA1cFlexPen ® a cikin adadin guda ɗaya na yau da kullun, ɗayan haƙuri ya ci gaba da karɓar ƙwayar liraglutide a hade tare da metformin don makonni 52 na gaba. A wannan lokacin, ƙungiyar warkewa, wanda ya karɓa, ban da liraglutide tare da metformin, allurar yau da kullun na Levemir ® FlexPen ®, ya nuna ƙarin raguwa a cikin tsarin HbA1c daga farkon 7.6% zuwa 7.1% a ƙarshen lokacin makonni 52, a cikin rashin ɓarkewar ƙwayar cuta. Ta hanyar ƙara adadin Levemir ® FlexPen ® zuwa maganin ƙwaƙwalwar ƙwayar ƙwaƙwalwar ƙwayoyin cuta, ƙarshen ɗayan ya sami damar dangane da ƙididdigar mahimmancin ƙididdigar jiki a cikin marasa lafiya, duba Jadawalin 2.
Bayanin gwaji na tebur 2 - magani tare da Levemir ®, an tsara shi ban da haɗarin kulawa da magani tare da liraglutide tare da metformin
| Makonni na jiyya | Marasa lafiya marasa lafiya don karɓar magani tare da Levemir ® FlexPen ® ƙari ga liraglutide + metformin N = 160 | Marasa lafiya bazuwar don karɓar maganin rage ƙwayar ƙwaƙwalwar ƙwayar cuta ta jiki + metformin | Abin dogaro mai ƙarfi na canje-canje P-darajar | |
| Matsakaicin canji a cikin ƙimar ma'anar HbA1c idan aka kwatanta da fara gwajin (%) | 0–26 | - 0,51 | + 0,02 | |
| 0–52 | - 0,50 | 0,01 | ||
| Matsakaicin marasa lafiya waɗanda suka kai darajar maƙasudin HbA1c0–26 | 43,1 | 16,8 | ||
| 0–52 | 51,9 | 21,5 | ||
| Canji a cikin nauyin jikin marasa lafiya idan aka kwatanta da alamu a farkon lokacin gwajin (kg) | 0–26 | - 0,16 | - 0,95 | 0,0283 |
| 0–52 | - 0,05 | - 1,02 | 0,0416 | |
| Abubuwa masu saurin ɗagawa cikin jini (cikin adadi na shekaru 0 na haƙuri-shekaru na haɗuwa da ƙwayar gwajin) | 0–26 | 0,286 | 0,029 | 0,0037 |
| 0–52 | 0,228 | 0,034 | 0,0011 |
A cikin karatun na dogon lokaci (≥ watanni 6) wanda ya shafi marasa lafiya da nau'in ciwon sukari na 1 na sukari, yawan ƙwayar glucose na jini ya fi kyau idan aka kwatanta da magani tare da Levemir ® FlexPen ® idan aka kwatanta da isofan-insulin da aka tsara don maganin basus / bolus. Glycemic iko (HbA1c) yayin yin jiyya tare da Levemir ® FlexPen ® ya kasance daidai da wannan tare da isofan-insulin, amma tare da ƙananan haɗarin rashin lafiyar hypoglycemia kuma babu karuwa a cikin nauyin jiki tare da Levemir ® FlexPen ®.
Sakamakon bincike na asibiti wanda ke tantance tsarin basal-bolus na maganin insulin yana nuna yiwuwar kamuwa da cutar hypoglycemia a gaba ɗaya yayin aikin jiyya tare da Levemir ® FlexPen ® da isofan-insulin. Binciken ci gaban cutar rashin daidaituwa na maraice a cikin marasa lafiya da ke da nau'in ciwon sukari na 1 na ciwon sukari ya nuna mummunan yanayin tashin hankali mara nauyi na nocturnal hypoglycemia tare da yin amfani da Levemir ® FlexPen ® (lokacin da mai haƙuri zai iya kawar da yanayin hypoglycemia da kansa, kuma lokacin da aka tabbatar da cutar hypoglycemia ta hanyar rage yawan glucose a cikin jini sama da 2) , 8 mmol / L ko sakamakon ma'aunin taro na glucose a cikin jini na jini da ƙasa da 3.1 mmol / L), idan aka kwatanta da wannan lokacin amfani da isofan-insulin, yayin tsakanin biyu binciken magani bai bayyana bambance-bambance a cikin abin da ya faru mita na aukuwa na nocturnal da qarancin ruwa da huhu a marasa lafiya tare da irin 2 ciwon sukari.
Bayanan martaba na dare na glycemia suna daɗaɗa kuma ƙari tare da Levemir ® FlexPen ® idan aka kwatanta da isofan-insulin, wanda aka nuna a cikin ƙananan haɗarin haɓakar rashin lafiyar dare.
Lokacin amfani da Levemir ® FlexPen ®, an lura da samarwa da kayan maye. Koyaya, wannan gaskiyar bata shafi sarrafawar glycemic.
Ciki
A cikin gwajin asibiti da aka sarrafa bazuwar, wanda ya haɗa da mata masu ciki 310 da ke da nau'in 1 na ciwon sukari, da inganci da amincin Levemir ® FlexPen ® a cikin tsarin basus-bolus (marasa lafiya 152) idan aka kwatanta da isofan-insulin (marasa lafiya 158) a haɗuwa tare da insulin insulin, wanda aka yi amfani dashi azaman prandial insulin.
Sakamakon binciken ya nuna cewa a cikin marasa lafiya da ke karbar maganin Levemir ® FlexPen ®, an lura da raguwa iri ɗaya idan aka kwatanta da ƙungiyar da ke karbar isofan-insulin HbA1c a makonni 36 na gestation. Rukunin marasa lafiya da ke karɓar magani tare da Levemir ® FlexPen the, kuma rukunin da ke karɓar maganin isofan-insulin, a duk lokacin haihuwar, sun nuna kamanni a cikin tsarin HbA na gaba ɗaya.1c.
Matsayi HbA Level1c ≤ 6.0% a cikin 24th da 36th mako na ciki an sami nasara a cikin 41% na marasa lafiya a cikin rukunin jiyya na Levemir ® FlexPen and kuma a cikin 32% na marasa lafiya a cikin rukuni na maganin isofan-insulin.
Thearfafa yawan glucose mai azumi a cikin makonni 24 da 36 na haihuwar ya kasance ƙididdiga ta ragu sosai a cikin ƙungiyar matan da suka ɗauki Levemir ® FlexPen ® idan aka kwatanta da ƙungiyar da aka kula da isofan-insulin.
A duk tsawon lokacin daukar ciki, babu wasu bambance-bambance masu mahimmancin ra'ayi tsakanin marasa lafiyar da suka karɓi Levemir ® FlexPen ® da isofan-insulin a cikin yanayin tashin hankali.
Dukkan kungiyoyin biyu na mata masu juna biyu da aka yi wa Levemir ® FlexPen ® da isofan-insulin sun nuna irin wannan sakamako a cikin abubuwan da suka faru a cikin yanayin rayuwarsu, duk da haka, an gano cewa cikin sharuddan adana yanayin mummunan yanayin da ke faruwa a cikin marasa lafiya yayin duk shekarun haihuwa (61 (40%) a kan 49 (31%)), a cikin yara yayin ci gaban cikin ciki da bayan haihuwa (36 (24%) a kan 32 (20%)) ya kasance mafi girma a cikin rukunin jiyya tare da Levemir ® Fle Spenny ® kamar yadda idan aka kwatanta da kungiyar isophane insulin far.
Yawancin yaran da aka haifa daga uwaye wadanda suka sami juna biyu bayan an raba su cikin rukuni na warkewa don karbar magani tare da ɗayan magungunan da aka gwada shine 50 (83%) a cikin rukunin magani na Levemir ® FlexPen and da 55 (89%) a cikin rukunin jiyya na isofan. insulin. Yawancin yaran da aka Haifa tare da cutar nakasar ciki sun haɗu 4 (5%) a cikin rukunin jiyya na Levemir ® FlexPen and da 11 (7%) a cikin rukunin jiyya na isofan-insulin. Daga cikin waɗannan, an lura da mummunan rikice-rikice a cikin yara 3 (4%) a cikin rukunin jiyya na Levemir ® FlexPen and da 3 (2%) a cikin rukunin jiyya na isofan-insulin.
Yara da matasa
An yi nazarin inganci da amincin amfani da Levemir ® FlexPen children a cikin yara a cikin gwaji na asibiti guda biyu da aka dawwama tare da matasa da yara kanana shekaru biyu da ke fama da nau'in ciwon sukari na 1 (marasa lafiya 694 a duka), ɗayan waɗannan karatun sun haɗa jimlar yara 82 da ke da nau'in ciwon sukari guda 1 a cikin rukunin mutane na shekara biyu zuwa biyar. Sakamakon waɗannan nazarin ya nuna cewa sarrafa glycemic control (HbA1c) a kan asalin aikin jiyya tare da Levemir ® FlexPen ® ya kasance daidai da wannan a cikin jiyya tare da isofan-insulin, tare da alƙawarin da suka dace da tushen maganin ƙwaƙwalwar ƙwayar cuta (bolus therapy). Bugu da ƙari, akwai ƙananan haɗarin rashin jini a cikin dare (dangane da dabi'un glucose na jini na plasma wanda aka auna ta hanyar marasa lafiya) kuma babu karuwa a cikin nauyin jiki (daidaitaccen daidaituwa don nauyin jikin da aka daidaita bisa ga jinsi na haƙuri da shekaru) yayin jiyya tare da Levemir ® Flexpen®, a kwatanta shi da isofan-insulin.
Extendedaya daga cikin karatun asibiti an tsawaita shi zuwa wani watanni 12 (an samo adadin watanni 24 na bayanan asibiti) don samun ƙarin cikakkun bayanai don kimanta samuwar ƙwayoyin cuta a cikin marasa lafiya da keɓaɓɓen magani tare da Levemir ® FlexPen ®.
Sakamakon da aka samu yayin binciken yana nuna cewa a cikin shekarar farko ta magani yayin shan Levemir ® FlexPen ®, an sami ƙaruwa a matakin ƙwayoyin cuta zuwa insulin detemir, duk da haka, a ƙarshen shekara ta biyu na magani, matakin ƙirƙirar ƙwayoyin rigakafi zuwa Levemir ® FlexPen ® ya ragu a cikin marasa lafiya zuwa matakin dan kadan ya zarce na farko a lokacin qaddamar da jiyya tare da Levemir ® FlexPen ®. Don haka, an tabbatar da cewa samuwar ƙwayoyin cuta a cikin marasa lafiya da masu ciwon sukari yayin cutar tare da Levemir ® FlexPen ® ba ya cutar da matakin kula da glycemic da yawan insulin detemir
Pharmacokinetics
Baƙon
Matsakaicin maida hankali na plasma an kai shi awanni 6-8 bayan gudanarwa.
Tare da tsarin kulawa na yau da kullum sau biyu, ana samun daidaitattun magungunan ƙwayar cuta a cikin jini na jini bayan allurar 2-3.
Bambancin ɗaukar ciki na cikin ƙananan ya kasance na Levemir ® FlexPen ® idan aka kwatanta da sauran shirye-shiryen insulin basal. Babu bambance-bambance tsakanin jinsi tsakanin likitanci na Levemir ® FlexPen ®.
Rarraba
Matsakaicin rarrabuwar Levemir ® FlexPen ® (kimanin 0.1 L / kg) yana nuna cewa babban adadin insulin disemir yana kwance cikin jini.
Tsarin rayuwa
Inacmir na miyagun ƙwayoyi Levemir ® FlexPen ® ya yi 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 tsakanin asibiti tsakanin insulin detemir da kitse mai kitse ko wasu magunguna da suka danganta da sunadarai.
Kiwo
Matsakaicin rabin rayuwar bayan allurar subcutaneous an ƙaddara ta da girman ɗaukar daga ƙwayar subcutaneous kuma tana awanni 5-7, gwargwadon yawan.
Rashin layi
Tare da gudanarwa na subcutaneous, yawan ƙwayoyin plasma sun kasance daidai da adadin da aka gudanar (mafi yawan maida hankali, digiri na ɗaukar).
Babu wata hulɗa ta pharmacokinetic ko pharmacodynamic tsakanin liraglutide da miyagun ƙwayoyi Levemir ® FlexPen ®, a cikin daidaitawa, tare da gudanarwa na lokaci ɗaya ga marasa lafiya da ke da nau'in ciwon sukari na 2 na Levemir ® FlexPen ® a cikin kashi ɗaya na 0.5 U / kg da liraglutide 1.8 mg.
Groupsungiyoyin haƙuri na musamman
An yi nazarin abubuwan da ke cikin pharmacokinetic na Levemir lex FlexPen in a cikin yara (shekaru 6-12) da matasa (shekaru 13 zuwa 17) kuma an kwatanta su da kanfanin pharmacokinetic na manya da ke da nau'in ciwon sukari na 1. Ba a sami bambance-bambance ba. Babu bambance-bambance mai mahimmanci na asibiti a cikin kantin magani na Levemir ® FlexPen ® tsakanin tsofaffi da matasa marasa lafiya, ko tsakanin marasa lafiya da ke fama da rauni game da aikin hepatic da marasa lafiya masu lafiya.
Karatun Tsaro na Lafiya
Bincike a cikin vitro, a cikin layin sel na ɗan adam, ciki har da bincike kan ɗaure wa masu karɓar insulin da IGF-1 (insulin-like insulin factor), ya nuna cewa detemir insulin yana da kusancin kusanci ga masu karɓa kuma yana da ɗan tasiri kan haɓakar sel idan aka kwatanta da insulin ɗan adam. Bayanai na asibiti dangane da karatun yau da kullun game da lafiyar kayan aikin magani, yawan guba, ƙwayoyin cuta, yuwuwar ƙwayar cuta, tasirin mai guba kan aikin haifuwa, bai bayyana wani haɗari ga ɗan adam ba.
Menene wannan maganin?
Yin amfani da fasahar sake sarrafa DNA ta zamani ya taimaka wa masana kimiyya sau da yawa ƙara haɓaka haɓakar wakilai tare da insulin na yau da kullun.
An ƙirƙiri maganin allurar rigakafin ta amfani da hanyar aiwatar da ilimin halitta na sarƙoƙi na sarƙoƙi na DNA.
Ana amfani da wani irin iri na Saccharomyces cerevisiae - wannan wani samfurin basal ne na dogaro insulin na mutum, wanda bashi da wani babban aiki a tsarin aikin.
Detemir shine mafita tare da pH tsaka tsaki, bayyananne ne kuma bashi da launi. Wannan wakilin antidiabetic yana cikin yawancin insulins da yawa da suka dade suna aiki. A cikin kasuwa, ana siyar da insulin detemir a ƙarƙashin sunan Levimir.
Marufi yana kama da wannan: A cikin kantin magunguna, ana siyar da shi ta hanyar katako, a kowane ɗayan 0.142 ml na detemir. A matsakaici, farashi yana ɗaukar kimanin 3,000 rubles. Kamar sauran nau'ikan kwayoyi masu ɗauke da insulin, ana sayar da wannan magani ta takardar sayan magani.
Gaskiyar aikin Detemir
Detemir yana aiki sosai fiye da insulin glargine da isofan. Tasirin lokaci na wannan wakili yana faruwa ne saboda kyakkyawan haɗin kai na tsarin kwayoyin da kuma haɗarsu tare da sarkar acid mai guba tare da kwayoyin albumin. Idan aka kwatanta da sauran insulins, detemir yakan bazu a hankali cikin jiki. Irin wannan kayan aikin yana tsawaita aikin miyagun ƙwayoyi, kuma yana haɓaka shashi.
Hakanan, ba kamar wasu hanyoyi ba, wannan insulin shine mafi tsinkaye, saboda haka yana da sauƙin sarrafa tasirin sa.
Wannan ya faru ne saboda dalilai da yawa:
- Detemir ya kasance cikin yanayin ruwa daga kasancewa cikin ampoule har zuwa lokacin da aka gabatar da wakili a cikin jiki,
- Abubuwan da ke cikin jikinta an ɗaure su da ƙwayoyin albumin a cikin ƙwayar jini ta hanyar saiti.
Kayan aiki yana hulɗa tare da masu karɓa na waje waɗanda suke kan membrane na cytoplasmic. An kirkiro hadadden insulin-receptor wanda ke karfafa hanyar ayyukan cikin aiki. Akwai ingantaccen kira na glycogen synthetase, hexokinase da enzymes pyruvate kinase.
Concentarfafa yawan ƙwayoyin glucose yana raguwa saboda karuwar jigilar sukari a cikin sel, yana farawa da mafi kyawun kyallen takarda. Hakanan an inganta Glycogenogenesis da lipogenesis. Hankalin yana fara samar da glucose sosai a hankali.
Wannan wakili yana da ƙarancin tasiri akan haɓakar sel fiye da sauran insulins. Ba shi da maganin cutar daji, mai guba da cutarwa a cikin dukkan ayyukan jiki, gami da jima'i.
Kinetic Properties na wakili
Bayan gabatarwar detemir a cikin jiki, an fi mayar da hankali ne a cikin ruwan plasma bayan 7 hours. Idan an ba wa mai haƙuri allura sau biyu a rana, to yanayin glycemic ya kwantar da hankali bayan 'yan kwanaki na rashin lafiya. Lokacin da aka saka fiye da 3 MG cikin jikin mutum, gabatarwar aikin shine kusan awanni 15 kuma an sami isasshen inganci bayan awa 2.
Tunda detemir yana da kyawawan abubuwan rarrabewa, yakan zub da jini cikin jini mai mahimmanci.
An hada shi da babban danshi, kuma dukkanin metabolites suna da cikakken kariya ga jiki. Rabin rayuwar miyagun ƙwayoyi ya bambanta da sashi wanda aka gudanar wa mai haƙuri. A matsakaici, awa 6.
Umarnin don amfani
Zaɓin maganin da ake buƙata don mai haƙuri an zaɓi daban. Ana iya gudanar da Detemir sau 1-2 a rana. Idan an wajabta detemir don inganta ikon sarrafa glycemia, ana amfani da miyagun ƙwayoyi sau biyu. Ana yin kashi 1 na safe da safe, da kuma 2 da yamma kafin lokacin bacci ko kuma bayan awanni 12 bayan allurar safe.
Marasa lafiya waɗanda suka girmi shekaru 50 kuma suna wahala daga hanta ko raunin koda suna buƙatar zaɓar kashi sosai a hankali. Additionari ga haka, suna buƙatar a sa musu idanu koyaushe don glucose jini.
An sanya allurar insulin daga ciki a cikin kafada, cinya, ko yanki na bangon ciki. Intensarfin aikin (ɗaukar) magungunan zai dogara ne akan wurin allurar. Idan akayi allura a yanki daya, dole ne a canza wurin shigar allurar yayin kowane zama. Wannan ya faru ne saboda gaskiyar cewa lipodystrophy na iya faruwa - waɗannan sune cones na peculiar, waɗanda suke da wuyar kawar da su.
Da fatan za a kula: idan an saka insulin a cikin ciki, to, kuna buƙatar sake juyawa 5 cm daga cibiya kuma kuyi da'ira.
Yana da matukar muhimmanci a yi allura daidai. Don wannan zaka buƙaci: insulin zafin jiki na ɗakin (sami shi a cikin rabin awa), wani sirinji (idan ya cancanta), maganin ƙwari da huhun auduga.
Bugu da ari, duk abin da aka yi bisa ga algorithm:
- An kula da shafin da maganin maganin cututtukan ciki, ragowar aikinsa dole ne ya bushe akan fatar,
- An kama fata a cikin ruwan shafa
- An saka allura a wani kusurwa. Ba'a tura karfi mai karfi ba, wanda bayan haka piston ya shimfida dan baya kadan. Idan ka buga jirgin ruwa, to, kana buƙatar canza wurin allurar.
- Ruwan yana gabatar da ruwa a hankali kuma ana auna shi. Idan piston ba ya motsa da kyau, fatar kan allurar ta kumbura ta yi rauni - kuna buƙatar tura allura cikin zurfi.
- Bayan allurar insulin, kuna buƙatar barin allura a ƙarƙashin fata na tsawon dakika 4-6. Bayan wannan, an cire allura tare da motsi mai kaifi, za a sake shafa allurar tare da maganin maganin kashe kwayoyin cuta.
Don yin allurar kamar ba mai iya ciwo ba, zai zaɓi ya fi guntu da sikelin, lokacin wrinkling, kada ku matse fatar da ƙarfi, saka da hannun amintacce.
Mahimmanci! Idan mai haƙuri ya shigar da nau'ikan ƙwayoyin insulin, dole ne a fara buga ɗan gajeren, sannan sai tsayi.
Me ya kamata nema kafin shigar da kuɗi?
Kafin ka yi allura, dole ne ka:
- Sake gwada nau'in samfurin
- Cutar da membrane na roba tare da barasa ko wata maganin antiseptik,
- Sake cin amanar ƙasa. Idan ya lalace ta waje ko kuma yanki mai gani wanda yake jikin membrane ya wuce fadin farin tsiri, baza'a iya amfani dashi ba kuma dole ne a mayar dashi kantin magani.
Lura cewa a baya mai sanyi ko adana shi wanda bai dace dashi ba, jaka mai dauke da ruwa mai tsauri da ruwa mai launi a ciki, bai kamata a yi amfani dashi ba. Bai kamata a yi amfani da Detemir a cikin famfan insulin ba.
Lokacin yin allura, dole ne a bi waɗannan ƙa'idodin:
- Ana amfani da miyagun ƙwayoyi ne kawai a ƙarƙashin ƙasa.
- Bayan kowace allura, canza allura (idan aka yi amfani da insulin a cikin ampoule), saboda samfurin na iya yaduwa saboda zazzabi.
- Ba za a iya cika kwantena ba. Wannan hanya mai yiwuwa ne kawai tare da sirinjirorin da za'a sake amfani dasu.
Yawan shaye-shayen kwayoyi
A magani, manufar insulin yawan zubar jini kamar haka ba a kafa ta. A lokaci guda, lokacin da mai haƙuri ya cinye sashi mai zurfi fiye da wanda aka ɗauke shi, yana haɓaka hoton asibiti na hypoglycemia (ƙarancin sukari mai yawa).
Mai haƙuri yana da alamu masu zuwa:
- Pallor
- Girma
- Tinnitus
- Rashin maida hankali
- Jin tashin zuciya
- Sharparin raguwar hangen nesa,
- Damuwa da rashin tausayi.
Yawancin lokaci mutum ba zato ba tsammani mutum yana rashin lafiya. Za'a iya kawar da alamun sassauci na wannan yanayin ta hanyar ɗaukar ɗan sukari kaɗan ko kowane samfurin glucose. Akwai magunguna na musamman waɗanda ke taimakawa shawo kan rashin zubar jini mai tsanani.
A cikin mawuyacin hali, yawan sukari yana raguwa mai mahimmanci wanda mai haƙuri na iya fadawa cikin rashin lafiyar glycemic.
Wannan yanayin yana tare da alamu:
- Rashin hankali
- Dizziness
- Rashin magana
- Rashin daidaituwa
- Kyakkyawan ma'anar tsoro na ciki.
Ana magance tsananin rashin ƙarfi ta hanyar inramuscular ko subcutaneous allura na 1 mg na glucagon. Idan jikin mutum bai amsa wannan allura ba ta kowace hanya a cikin minti 20, ana sarrafa maganin glucose ne a cikin ciki. A cikin mafi yawan lokuta masu haƙuri, mai haƙuri na iya mutuwa ko samun cuta ta kwakwalwa.
Side sakamako
Fitowar su kai tsaye ya dogara da matakin insulin da aka dauka. A cikin mutane, irin wannan halayen ga Detemir na iya faruwa:
- Take hakkin hanyoyin rayuwa. Mai haƙuri na iya shan wahala daga raunin gastrointestinal da rashin daidaituwa na abubuwa daban-daban a cikin jini.
- Janar da halayen gida na jiki. Na iya zama ja, ƙaiƙayi, da kumbura. Wataƙila haɓakar lipodystrophy da edema a sassa daban daban na jiki.
- Tsarin rigakafi. Wasu marasa lafiya suna da rashin lafiyan, urtikaria. Jinyar rashin lafiyan ƙwayar cuta na iya haifar da ƙwayar Quincke da sauran halayen da ke haifar da mutuwa.
- Rashin sakewa. Hasken rana ba daidai ba ne a cikin ruwan tabarau, wanda saboda hakan akwai cutarwa game da hangen nesa da tsinkaye launi.
- Rhinopathic cuta.
- Lalacewa daga cikin farji na gefe, saboda wanda akwai ƙetarewar ƙwayar fata, tsokoki sun zama marasa ƙarfi kuma kada ku saurare. Neuropathy kuma na iya zama mai raɗaɗi.
Idan mutum yana rashin kulawa ga wasu daga cikin abubuwan na Detemir, wadannan halayen na iya faruwa koda bayan sun sha kananan allurai na maganin. Za su kasance da ƙarfi sosai fiye da sauran marasa lafiya.
Kamar yadda aka riga aka ambata, detemir na iya haifar da hypoglycemia, wanda ke cutar da taro sosai. Tare da irin wannan cuta, ana ba da shawarar iyakance tuki, sarrafa abubuwa masu rikitarwa da wasu nau'ikan ayyuka, saboda suna iya zama haɗari ga mutane.
A cikin wasu marasa lafiya, hypoglycemia na iya haɓaka ba tare da alamu ba ko tare da bayyanar rashin ƙarfi.. Idan akwai haɗarin cewa mai haƙuri na iya haɓaka wannan sabon abu asymptomatally, ya kamata a dauki matakan don hana raguwar sukari kuma kuyi la'akari da shawarar tuki da gudanar da aiki mai haɗari ga tsawon lokacin maganin.
Shin zai yiwu ga masu jinya, mata masu juna biyu da yara?
Babu wani bambancin teratogenic ko tayi a yayin amfani da insulin Detemir da na mutane. A wannan yanayin, mata masu juna biyu da waɗanda ke cikin lokacin lactation, lokacin gudanar da aikin jiyya, suna buƙatar zama a koyaushe a ƙarƙashin kulawar likita da saka idanu kan yawan sukari.
A cikin mata masu fama da ciwon sukari mellitus, matakan glucose dinsu yana daidaita dan kadan a cikin sau 2-3, don haka buƙatar insulin ya ragu. Lokacin da mace ta haihu kuma ta daina shayarwa, jiki zai sake zama rashin insulin. Don haka ba za ku iya barin kari na shan kwayoyi iri ɗaya ba a cikin irin waɗannan yanayi, kuna buƙatar daidaita sashi.
Akwai ƙuntatawa akan amfanin detemir ga ƙananan marasa lafiya. Bai kamata yara da 'yan ƙasa ba su yi amfani da shi ba.
Ga yara masu tsufa, insulin therapy yana yiwuwa, yayin da idan yaro yana da hanta, koda da sauran abubuwan gabobin, kula da glucose da yanayin tsarin da abin ya shafa ya kamata a sa ido akai-akai.
Yarda da wasu kwayoyi
Wasu kwayoyi na iya haɓaka sakamakon Detemir:
- Rage magungunan baka
- Monoamine oxidase da angiotensin suna canza enzyme yana hana kwayoyi,
- Rashin tallata b-rukunin masu tallatawa.
Giya kuma yana shafan insulin a daidai wannan hanyar. Hakanan suna kara tsawon lokacin tasirin hypoglycemic.
Abubuwa masu zuwa suna hana aikin wannan abun:
- Bazuwar girma daban-daban,
- Gagarinas,
- Sympathomimetics na rukuni b,
- Ciwon glandon,
- Magunguna tare da danazol.
Lancreotides da octreodites na iya shafar tasirin biyu biyu. A cikin yanayi daban-daban, suna zuga shi ko ya yi birgima. Ba za a iya amfani da Sulfites da thiols tare da insulin detemir ba, saboda suna lalata tsarin insulin kuma suna rage sakamako. Ba za a iya ƙara wannan kayan aikin zuwa mafita na jiko ga masu watsi ba.
Sauyawa zuwa Detemir tare da sauran nau'in insulin
Dole ne a aiwatar da irin wannan tsari a karkashin kulawar kwararrun. Canji a cikin maida hankali, canji a cikin nau'in wakili (daga mutum zuwa dabba / isharar insulin analogues da ƙari) da sauran abubuwan na iya buƙatar canji a cikin yanayin motsa jiki na ilimin insulin.
Lokacin layi
Lokacin da za ku je Detemir, kuna buƙatar kula da matakin sukari mai haƙuri na haƙuri koyaushe. Ana aiwatar da irin wannan iko a fewan makonnin farko.
Lokacin gudanar da hadaddun magani na ciwon sukari, kuna buƙatar ɗaukar hutu tsakanin allurai daban-daban na kwayoyi. Zasu iya shafar shaye shaye da ɗaukar juna.
Kwatankwacin insulin-ciki
Insulin na Detemir yana da manyan analogues guda biyu waɗanda babban sinadaran aiki (insulin detemir) iri ɗaya ne.
Ga sunayensu da kimanta farashin:
- Levemir Flekspen a cikin hanyar injections - farashin kowace kunshin ta 100 ml shine 4500 rubles.
- Levemir Penfil kuma yana cikin hanyar warwarewa - daidai wannan adadin yana biyan 5,000 rubles.
Rukunin magunguna iri ɗaya sun haɗa da kudade tare da insulin glargine. Sunaye na kasuwanci da kuma kayan sawa:
- Maganin allurar Aylar - har zuwa 3500 rubles,
- Latus Optiset da Latus Standard - 2900 rubles,
- Latus Solostar - 3000 rubles,
- Tozheo Solostar daga 1000 zuwa 2700 rubles.
Sauran misalai na detemir:
- Monodar Ultralong (dakatarwar allura) - a matsayin wani ɓangare na insulin alade.
- Tresiba Flekstach - bayani tare da insulin degludec, farashin kimanin 5000 rubles.
Kafin canza nau'in insulin da aka yi amfani da shi, kuna buƙatar tuntuɓi likita, tunda wasu kuɗaɗen kudaden da aka nuna za a iya ba contra haƙuri.
Detemir yana daya daga cikin mafi kyawun magungunan insulin dangane da sigogi na jiki da sunadarai. Yana da kusanci da zuwa ga insulin na ɗan adam. Samfurin baya barin kowane abu mai aiki a cikin jiki wanda zai haifar da mummunan tasiri ga jikin mutum. Farashinsa ba ya fin sauran nau'in insulin.
Saboda haka, matsakaicin tsadar wannan ma'anar da ɗaukacin abubuwa ya sa ya yiwu a yi amfani da shi don nau'ikan nau'ikan marasa lafiya.
Yarjejeniyar:
Yi amfani yayin ciki da shayarwa
Ciki
Lokacin amfani da Levemir ® FlexPen ® yayin daukar ciki, ya zama dole a yi la’akari da girman amfanin amfanin sa fiye da yuwuwar haɗari.
Ofaya daga cikin gwaje-gwaje na asibiti da aka sarrafa ba tare da mata masu juna biyu da nau'in ciwon sukari na 1 na ciki ba, a yayin da inganci da amincin haɗuwa tare da Levemir ® FlexPen ® tare da insulin aspart (152 mata masu juna biyu) an kwatanta da isofan-insulin a hade tare da insulin aspart (158 mata masu juna biyu), basu bayyana bambance-bambance ba a cikin bayanan lafiyar gaba gaba a lokacin daukar ciki, sakamakon ciki, ko cikin lafiyar tayin da jarirai (duba sashe “
Sashi da gudanarwa:
| Matsayin glucose na plasma ana auna kansa daban kafin karin kumallo | Gyaran gyaran magunguna Levemir ® FlexPen ®, ED |
| > 10.0 mmol / L (180 mg / dL) | + 8 |
| 9.1-10.0 mmol / L (163-180 mg / dl) | + 6 |
| 8.1-9.0 mmol / L (145-162 mg / dL) | + 4 |
| 7.1-8.0 mmol / L (127- 144 mg / dl) | + 2 |
| 6.1-7.0 mmol / L (109-126 mg / dl) | + 2 |
| 4.1-6.0 mmol / L | Babu canji (darajar manufa) |
| Idan kowane darajar glucose guda daya ne: | |
| 3.1-4.0 mmol / L (56-72 mg / dl) | - 2 |
| - 4 | |
Idan aka yi amfani da Levemir ® FlexPen part a matsayin wani ɓangaren tsarin kulawa na ƙoshin lafiya na bolus, ya kamata a tsara shi sau 1 ko 2 a rana gwargwadon bukatun masu haƙuri. Matsakaicin Levemir ® FlexPen ® an ƙaddara akayi daban-daban a kowane yanayi.
Marasa lafiya waɗanda ke buƙatar yin amfani da miyagun ƙwayoyi sau biyu a rana don inganta yanayin ƙarfin su na glycemia na iya ɗaukar kashi ɗaya na yamma ko dai a abincin dare ko lokacin bacci. Daidaitawar digiri na iya zama dole tare da kara yawan motsa jiki na mai haƙuri, canza tsarin abincinsa na yau da kullun ko tare da cuta mai haɗuwa.
Ana iya amfani da miyagun ƙwayoyi Levemir ® FlexPen ® duka biyu azaman monotherapy kuma hade tare da insulin bolus. Hakanan za'a iya amfani dashi a hade tare da magungunan maganin hypoglycemic na baki, kazalika da ƙari ga maganin da ke gudana tare da liraglutide.
A hade tare da magungunan maganin hypoglycemic na baki ko ƙari ga liraglutide, ana bada shawara don amfani da Levemir ® FlexPen ® sau ɗaya a rana, farawa da kashi 10 PIECES ko 0.1-0.2 PIECES / kg. Za'a iya gudanar da magani na Levemir en FlexPen ® a kowane lokaci wanda ya dace da mara lafiyar yayin rana, kodayake, lokacin da aka ƙayyade lokacin allurar yau da kullun, ya kamata ku bi tsarin allurar da aka kafa.
Levemir ® FlexPen ® an yi shi ne don gudanar da subcutaneous kawai.
Levemir ® FlexPen ® bai kamata a gudanar dashi ta hanyar ciki ba, kamar yadda wannan na iya haifar da matsanancin rashin ƙarfi a jiki. Kuma lallai ne a guji sarrafa intramuscular na miyagun ƙwayoyi. Levemir ® FlexPen ® ba ayi amfani da shi a cikin matukan insulin ba.
Levemir ® FlexPen ® yana allurar subcutaneously cikin cinya, bangon ciki, kafada, yanki ko gluteal. Ya kamata a canza wuraren allurar ta yau da kullun ko da ana yin su a cikin yanki ɗaya don rage haɗarin lipodystrophy. Kamar yadda yake tare da sauran shirye-shiryen insulin, tsawon lokacin aiki ya dogara da kashi, wurin gudanarwa, yawan zubar jini, yawan zafin jiki da kuma matakin motsa jiki.
Groupsungiyoyin haƙuri na musamman
Kamar sauran shirye-shiryen insulin, a cikin tsofaffi marasa lafiya da marasa lafiya da keɓaɓɓen renal ko hepatic insufficiency, yakamata a kula da yawan hawan glucose a cikin jini kuma a daidaita yawan abubuwan disemir daban daban.
Yara da matasa
An tabbatar da inganci da amincin Levemir ® FlexPen ® a cikin matasa da yara kanana sama da shekaru 2 a gwaje gwajen asibiti har zuwa watanni 12.
Canja wuri daga sauran shirye-shiryen insulin:
Canja wuri daga shirye-shiryen insulin na matsakaici kuma daga shirye-shiryen insulin mai tsawo zuwa Levemir ® FlexPen ® na iya buƙatar kashi da daidaita lokaci.
Kamar yadda yake tare da sauran shirye-shiryen insulin, yin saurin kulawa da maida hankali kan ƙwayar glucose jini yayin canja wuri kuma a farkon makonni na rubuta sabon magani ana bada shawara.
Ana iya buƙatar gyaran concomitant na maganin cututtukan zuciya (kashi da lokacin gudanar da shirye-shiryen insulin gajere ko kuma magunguna na magana da baki).
Side sakamako:
Abubuwan da ba a sani ba sun lura a cikin marasa lafiya da ke amfani da miyagun ƙwayoyi Levemir ® FlexPen ® sune yawanci-dogaro kuma suna haɓakawa sakamakon tasirin magunguna na insulin. Hypoglycemia yawanci shine sakamako mafi yawan lokuta. Hypoglycemia yana haɓaka idan an ba da kashi mai yawa na miyagun ƙwayoyi dangane da buƙatar jikin insulin. Daga nazarin asibitoci an san cewa tsananin hypoglycemia, yana buƙatar shigarwar ɓangarori na uku, haɓaka cikin kusan 6% na marasa lafiya da ke karɓar Levemir ® FlexPen ®.
Ra'ayoyi a wurin allurar za'a iya lura da mafi yawan lokuta tare da Levemir ir FlexPen ® fiye da gabatarwar insulin mutum. Wadannan halayen sun hada da redness, kumburi, kumburi, kumburi, da itching a wurin allurar. Yawancin halayen da ke faruwa a wuraren allurar sun kasance ƙananan kuma na ɗan lokaci a yanayi, i.e. ɓace tare da ci gaba da jiyya na 'yan kwanaki zuwa makonni da yawa.
An kiyasta yawan marasa lafiyar da ke karbar magani kuma waɗanda ake tsammanin haɓaka sakamako masu illa sun kasance kashi 12%. Halin tasirin sakamako, wanda aka kiyasta yana da alaƙa da Levemir ® FlexPen ® yayin gwaji na asibiti, an gabatar da ke ƙasa.
Tsarin abinci na rayuwa da rashin abinci mai gina jiki
Akai-akai (> 1/100, 1/100, 1/1 000, 1/1 000, 1/1 000, 1/10 000, ® FlexPen ®, na iya haifar da lalata insulin tirmiir. Levemir ® FlexPen ® bai kamata a kara wa jiko ba mafita.
Yanayin ajiya:
Karku ajiye firinjin da aka yi amfani dashi a cikin firiji. Amfani ko canja shi azaman sirinji na sauran tare da miyagun ƙwayoyi ya kamata a adana shi don makonni 6 a zazzabi da bai wuce 30 ° C.
Bayan amfani, rufe murfin sirinji tare da hula don kare shi daga haske.
Ayi nesa da isar yara.
Mai masana'anta:
Novo Nordisk A / S
Novo Alle,
DK-2880 Baggswerd, Denmark
Ofishin Wakilin "Novo Nordisk A / S"
119330, Moscow,
Lomonosovsky Prospekt 38, ofis 11
Levemir ®, FlexPen ®, NovoFayn ®, NovoTvist ® - alamun kasuwanci mallakar Novo Nordisk A / S, Denmark
Umarnin don marasa lafiya kan amfani da Levemir ® FlexPen ®
Karanta waɗannan umarnin a hankali kafin amfani da levemir. ® Sanya ®
Levemir ® FlexPen ® ne na musamman game da aikin alkalami da injin din wutan lantarki. Matsayin insulin wanda aka gudanar, wanda ya fara daga raka'a 1 zuwa 60, za'a iya canza shi a cikin yawan rukunin 1. Levemir ® FlexPen ® an tsara don amfani da allurar NovoFine ® da allurar NovoTvist up har zuwa tsawon mm 8 mm. A matsayin kiyayewa, koyaushe ka ɗauki tsarin sauyawa na insulin wanda idan ka rasa ko lalata Levemir ® FlexPen ®.
Launin allon alkalami wanda aka nuna a wannan hoton na iya bambanta da launi na Levemir ® FlexPen ®. 
Farawa
Bincika taken don tabbatar cewa Levemir ® FlexPen ® ya ƙunshi nau'in insulin da ya dace.
 | A
Cire kwalkwali daga alkairin sirinji. Cutar da membrane na roba tare da swab na auduga. |
 | B
Cire kwali na kariya daga allura wanda za'a iya cirewa. Fitar da allura a hankali da tam a kan Levemir ® FlexPen ®. |
 | Tare da
Cire babban hula daga allura, amma kada a jefar dashi. |
 | D
Cire ka zubar da kwarin ciki na allura. |
 | Fitar da iska ta farko daga kicin
Ko da tare da amfani da alkalami da kyau, karamin adadin iska zai iya tarawa a cikin kicin kafin kowane allura. Don hana shigowar kumfa iska da tabbatar da bayyanar da daidai ƙwayar magani: E Buga raka'a 2 na miyagun ƙwayoyi. |
 | F
Yayin riƙe Levemir ® FlexPen ® tare da allura sama, taɓa maɓallin katako a ɗan 'yan yatsunka don iska kuzari ta hau saman katun. |
 | G
Yayin riƙe alkalami na syringe tare da allura sama, danna maɓallin farawa gaba ɗaya. Mai za ~ i zai dawo zuwa sifili. Wani digo na insulin yakamata ya bayyana a ƙarshen allura. Idan wannan bai faru ba, maye gurbin allura kuma maimaita hanya, amma ba fiye da sau 6. Idan insulin bai fito daga allura ba, wannan yana nuna cewa alkairin sirinji yana da lahani kuma bai kamata a sake amfani dashi ba. |
 | Sashi saiti
Tabbatar cewa an saita mai zaɓi zuwa “0”. N Kira lambar rakarorin da ake buƙata don allurar. Za'a iya yin gyaran ta hanyar juyawa mai zaɓin sashi a kowane bangare har sai an saita madaidaicin kashi a gaban mai nuna sashi. Lokacin juyawa da zaɓin sashi, yi hankali kar a danna maɓallin farawa ba da gangan ba don hana sakin ƙwayar insulin. Ba zai yiwu ba saita adadin da yawansu ya rage adadin adadin sassan da ke cikin kicin. • Kada a yi amfani da ragowar don auna alluran insulin. |
 | Gudanar da insulin
Saka allura a ƙarƙashin fata. Yi amfani da dabarar allura ta likitanka ya ba ka shawarar. Don yin allura, danna maɓallin farawa gaba ɗaya har sai “0” ta bayyana a gaban mai nuna sashi. Yi hankali da hankali: lokacin gudanar da maganin, danna maɓallin farawa. Lokacin da zaɓin sashi zai juya, tsarin kulawa ba zai faruwa ba. |
 | J
Lokacin cire allura daga ƙarƙashin fata, riƙe maɓallin farawa da bacin rai sosai. |
 | Zuwa
Nuna allura a cikin mabulen bayan allura ba tare da taɓa hula ba. Lokacin da allura ta shiga, saka hula kuma cire allurar. Adanawa da kulawa Levemir ® FlexPen ® an tsara shi don ingantaccen amfani mai aminci kuma yana buƙatar kulawa da hankali. Idan ya kasance digo ko damuwa mai ƙarfi na injin, ana iya lalata alkairin mai sihiri kuma insulin na iya zuba. Za'a iya tsabtace saman Levemir ® FlexPen with tare da auduga mai tsami a cikin barasa. Kada a nutsar da alkairin sirinji a cikin barasa, kar a wanke ko sanya mai, kamar yadda wannan na iya lalata injin. Kar a sake cika Levemir ® FlexPen ®.
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