Ciwon sukari insulin farji

Irina KISHKO, endocrinologist, Cibiyar Endocrinology ta Yara

Insulin hormone ne wanda yake da mahimmanci don ci gaba da aiki na yau da kullun, amma a cikin mutumin da ke da nau'in ciwon sukari na 1 ba a samar dashi da isasshen yawa a jiki. Insulin yana da tsarin furotin kuma an lalata shi a cikin ciki a ƙarƙashin rinjayar enzymes, don haka ba za'a iya amfani dashi a cikin kwamfutar hannu ba. Babban hanyar kula da insulin shine allurar subcutaneous.

Yin amfani da magunguna na insulin na jijiyoyin jiki, muna ƙoƙarin yin kwaikwayon aikin yau da kullun. Abin takaici, wannan yawanci yana da wahala a cimma koda tare da taimakon insulin na zamani. Sabili da haka, mutanen da ke da ciwon sukari ya kamata su san ka'idodi na jiyya don haka a cikin yanayi daban-daban na rayuwa akwai damar daidaita yanayin da ake buƙatar insulin kansu.

Pancreas yana samar da insulin a cikin yanayin basal (kullun cikin adadi kaɗan) kuma a cikin yanayin bolus (asirin mai yawa insulin a cikin martanin abinci). Dangane da wannan, shirye-shiryen insulin da likitanka ya tsara sun kasu kashi biyu: tsawan tsawo da yin gajere.

Kashi na yau da kullun na insulin ya kasu kashi kashi (“tsawon lokaci” insulin a ciki ya kai 40-69%) da kashi wanda yake hade da abinci. An kiyasta rarraba kashi na insulin na yau da kullun: 2/3 - a cikin rana, 1/3 - da maraice da dare.

Akwai shirye-shirye daban-daban na gudanarwar insulin, amma ya kamata ku sani cewa allurar guda daya ta insulin kowace rana ba zata iya ba ku jin daɗin rayuwa koyaushe kuma ba zai taɓa bayar da ƙoshin lafiya na rayuwa ba.

Dokar insulin ta hanyar maganin insulin an zabi shi ne don yaro ta likita-endocrinologist a hankali daban-daban.

Don lura da ciwon sukari, ana amfani da wasu hanyoyi na asali na ilimin insulin.

1. Tsarin gargajiya na gudanarwar insulin shine allura biyu na gajeren insulin gajere da dogon aiki a kowace rana - kafin karin kumallo da kuma abincin dare. Wannan tsari ne wanda ba zai yuwu ba na tsarin insulin; yana buƙatar tsayayyen tsarin abinci da ɗaukar abinci a lokaci guda. Tare da irin wannan tsarin kulawa, kusan babu wuya a sami biyan diyya mai kyau da rage haɗarin rikitarwa.
2. Ingantaccen tsarin insulin lokacin da ake yin allurar insulin gajere da dogon aiki kafin karin kumallo da kuma abincin dare, kuma a takaice insulin allura kafin abincin rana. A halin yanzu, tsawon lokaci insulin cikin dare shine mafi yawan lokuta ana jure shi daga abincin dare don 22-25 hours. Irin wannan kulawar cutar sankara na daidaita yanayin insulin, kamar yadda yake cikin mutum lafiya.

An yi amfani da tsarin injections da yawa tun 1984. Don saukaka wa marasa lafiya, alkalami na farko ya bayyana a 1985.

Tsarin allura mai yawa yana ba da ƙarin 'yanci a rayuwar yau da kullun, yana ba ku ƙarin zaɓi kuma yana sa ku ji kwarin gwiwa da kuma sassaucin ciwon sukari.

Dole ne ku sami cikakkiyar fahimta game da yadda ɗayan ko insulin yake aiki: tsawon lokacin da allura ta fara "aiki", lokacin girmanta ya faru kuma gaba ɗaya menene tsawon lokacin aikinsa. Menene wannan don? Idan, alal misali, sukarin jininka ya yi ƙasa (ko kuma, ta wataƙila, babba), to ayyukanku ya kamata su bambanta a matakin insulin da ƙarshen aikinsa.

Insulin bolus (“gajere”) wanda kuka yiwa allurai kafin abinci ya fara aiki tsawon mintuna 20-30 bayan allurar subcutaneous kuma ya kai kololuwa a cikin awanni 1,5-2. Sakamakon rage yawan glucose na jini yana kimanin awa 5.

Wannan yana nufin cewa lokacin amfani da shi, hutu tsakanin manyan abinci da injections na ɗan gajeren insulin bai kamata ya zama 5 hours (idan ba ku shiga insulin basal da safe).

Analog na matsanancin insulin-gajere lokaci-lokaci yana fara aiki bayan minti 10, kuma matsakaicin tasirinsa yana tasowa bayan awa daya. Lokacin amfani da shi, ba za ku iya cin abinci sosai da awa ba (idan har kun shiga insulin basal da safe).

Akwai wani babban bambanci tsakanin insulin “gajere” da analog na “ultrashort” a tsarin kulawa da muke tattaunawa yanzu. Tare da insulin “gajere”, kuna buƙatar ƙarin abinci (kayan ciye-ciye) tsakanin babban abincin don guje wa hypoglycemia. Ta hanyar analog "ultrashort", akasin haka shine lamarin: idan kun ci abinci mai yawa don abun ci da rana, kuna iya buƙatar ƙarin allura. Akwai banbanci ga wannan doka: bayan cin abincin rana, kun tafi darasi a sashin wasanni ko kuma za ku yi ta motsawa tare da abokai a kan titi - ba kwa buƙatar ƙarawa da gabatarwar ƙarancin ultrashort, aikin motsa jiki zai rage sukarin jini saboda shi.

Yawan insulin dare shine mafi wahalar ɗauka. Kodayake ba mu ci abinci da daddare, kullun jikinmu yana buƙatar ƙaramin insulin don musanya glucose, wanda hanta ke samarwa. Tare da tsarin injections da yawa, insulin na matsakaici shine mafi yawan lokuta ana gudanar da su cikin dare.

Yana da mahimmanci yin allurar matsakaici a lokaci ɗaya kowace rana. Abu mafi mahimmanci shine samun insulin aiki har zuwa safiya, saboda haka ya fi kyau a yi allura har zuwa ƙarshen lokaci, tun kafin lokacin barci.

Ga manya, 23.00 ya fi dacewa, yayin da yaran da suka manyanta sun fi gamsu da 22.00.

Abinda yakamata ku sani

Kowane mutumin da ya dogara da insulin yakamata ya gudanar da cikakken ikon sarrafa sukari na jini a cikin mako guda. Dangane da sakamakonsa, endocrinologist yana yin lissafin kashi don ciwon sukari, yana tattara tsarin aikin insulin na mutum.

Idan kwararren likita ya tsara ingantaccen tsari wanda ya kunshi 1-2 injections na insulin kowace rana da kuma ajiyayyun allurai, duk da sakamakon aikin sa-ido, ya zama dole a nemi wani likita. Don hana gazawar koda a cikin haƙuri, aikin likita shine yanke hukunci wane nau'in insulin ake buƙata: tsawaita azumi don kula da sukari na al'ada ko azumin kafin cin abinci. Wani lokaci mai haƙuri yana buƙatar nau'ikan insulin guda biyu, wani lokacin magunguna masu rage sukari.

Baya ga yin rikodin matakan sukari na jini, marasa lafiya ya kamata su yi rikodin abubuwan da ke canza alamomi irin su wuce gona da iri ko rashin abinci, haɗar da sabbin samfura a cikin menu, ƙara yawan aiki na jiki, rashin lura da lokaci da kuma yawan ƙwayoyi don ciwon sukari, kamuwa da cuta, mura da sauran cututtuka. Sashi don rana ko dare ya dogara da alamun sukari kafin lokacin bacci da azumi, akan ƙara ko rage bayanai ga daren.

Yana da mahimmanci a sani. Don tabbatar da cewa yawan sukari a cikin jini akan komai a ciki ya zama al'ada a cikin kullun, ana ba da allurar insulin-dare a cikin dare. Ana sarrafa insulin mai sauri, gajere ko ultrashort kafin kowane abinci don kada sukari ya yi tsalle bayan cin abinci.

Rukunin insulin

Yaya ake bayar da shirye-shiryen insulin a cikin tebur 1:

Magungunan kwalliyar kwalliya na kwalliya akan ɗan gajeran fallasa

Kwayoyi kamar su Actrapid ana allurar subcutaneously a cikin cinya, a cikin tsokoki na gindi, deltoid ko kafada, zuwa bango na ciki a gaba da cikin jijiya. Ana lissafin sashi ne ta likita, kuma yawanta na yau da kullun na iya zama 0.5-1 IU / kg.

An gabatar da magani a zazzabi a daki na mintina 30 kafin a ci abinci tare da sinadarin carbohydrate. Don ware lipodystrophy, ana sarrafa magunguna kowane lokaci a wani wuri daban.

Yana da mahimmanci. Magunguna ba za su kasance cikin hasken rana kai tsaye ba, a cikin haske, overheat da supercool. KADA kayi amfani da daskararre, da gajimare, rawaya, da opaque.

Matsakaici tsawon ɗan adam injiniyan ƙwayoyi

Irin waɗannan kwayoyi suna shiga cikin fata, basu dace da gabatarwar cikin jijiyoyin jiki ba. Kafin sanya maganin a cikin sirinji, murfin ya kamata a girgiza don ya zama ɗaya.

Wuraren allurar shima yana canzawa saboda lipodystrophy bai inganta ba. Hasken rana bai kamata ya shiga wurin ajiya ba, bai kamata ya zama mai daskarewa ba, zazzabi ɗin ajiya kada ya wuce + 2-8 ° C, kuma bayan an fara amfani da shi bai kamata ya wuce + 25 ° C ba, bai kamata a ajiye shi a cikin firiji ba.

Ultratard NM dakatarwa ya dogara ne da insulin din zinc din mutum mai daukar hancin mutum. Suna cikin allurar ciki, kwalban ya girgiza kuma ya cika nan da nan ya zama cikin sirinji.

A gaban nau'in ciwon sukari na 1, ana amfani dashi azaman mahimman basal kuma an haɗe shi da insulin mai sauri. A nau'in ciwon sukari na 2, ana amfani dashi don monotherapy kuma a hade tare da magunguna masu sauri.

Kada kuyi amfani da tsawan gudanarwa ƙarƙashin fata a cikin famfanan insulin. Guji daga injin daskarewa a cikin kayan lambu na firiji a zazzabi na + 2-8 ° C.

Magunguna masu dadewa

Tsarin insulin na insulin

Likita yayi lissafin yawan insulin din yau da kullun gwargwadon matakin glucose a cikin jini da fitsari. An rarraba maganin ne zuwa allura 3-4 a kowace rana. Don daidaita adadin, marasa lafiya suna ba da bayanan kula ko bayar da gudummawar jini a cikin dakin gwaje-gwaje da fitsari don bincike, ya ƙunshi sabis 3: kwana 2 (8-14 da 14-20 hours) da dare 1, wanda aka tattara tsakanin 20,00 hours da 8.00 da safe washegari.

Idan likita ya tsara wani yanayin aikin insulin na tazara wanda ya ƙunshi allura 3, to, ana gudanar da aikin ne tare da gajeriyar magana da gajeriyar magana kafin karin kumallo da abincin dare, da kuma kafin abincin rana - kawai tare da ɗan gajeren magani, kamar yadda aka nuna a tebur 2.

Idan marasa lafiya da masu ciwon sukari ba sa aiki kuma suna cin abincin rana da ƙarfi, amma ku ci abincin dare a gida tare da abinci mai kuzari, to ana ba da magani na gajeren lokaci da na tsaka-tsaki a gabanin karin kumallo, kuma ana gudanar da ɗan gajeren insulins kafin abincin dare, da kuma tsaka-tsaki a cikin dare. Tare da gabatar da tsari na asali na allurar bolus, ana gabatar da gajeren shiri kafin karin kumallo, abincin rana da abincin dare, da kuma tsawaita magunguna da daddare.

Iri far

Nau'in kwantar da hankali na insulin: na gargajiya da na al'ada. Tsarin gargajiya na yau da kullun ya hada da:

• jadawalin aiki na gudanar da magani,
• carbohydrate-ƙidaya hours na cin abinci
• aiki na jiki a wani lokaci.

Adadin da lokacin abinci ya dogara da kashi na maganin a cikin maganin T1DM da T2DM.

Tsarin m, a akasin haka, ana nuna shi ta wani ɗan gajeren insulin, wanda ya dogara da yawan abinci. A wannan yanayin, ana gudanar da tsawan magunguna 1-2 sau / rana da gajere / ultrashort - kafin kowane abinci.

Wannan yanayin yana ba da izinin watsi, motsi na abinci, shirya ƙarin kayan ciye-ciye. Lokacin da IIT shine kwaikwayon cututtukan cututtukan ƙwayar cuta na mutum mai lafiya.

Ka'idodin abinci

Marasa lafiya yakamata su bi waɗannan ka'idodi:

• sau da yawa (sau 4-5) kuma a kai a kai ku ci,
• abinci ya kamata ya ƙunshi adadin adadin carbohydrates da adadin kuzari,
• yi amfani da tsari daban-daban ba tare da wadataccen sukari ba,
• maye gurbin 90% na yawan sukari na yau da kullun tare da sorbitol ko saccharin,
• ware cin kayan ciye-ciye, cakulan, kayan kwalliya da muffin,
• Kada a haɗa a cikin abincin abinci tare da rago da mai naman alade, mai daɗin yaji da yaji, mustard da barkono, giya mai sha,
• Kada ku ci 'ya'yan itatuwa masu daɗi, musamman raisins, inabi da ayaba.

Ka'idodin Insulin Therapy

A cikin lura da ciwon sukari, ana kiyaye waɗannan ka'idodi na insulin far:

• insulin mutum kawai yake amfani dashi,
• sarrafa glycemia har zuwa sau 8 a rana ko gudanar da aikin ci gaba,
• yi amfani da kara ko kwantar da insulin farji,
• daidaita kashi na insulin a endocrinologist 1-2 sau a mako.

1. An wajabta maganin insulin ba tare da la'akari da matakin glycemia ba. Aiwatar da gajeran abubuwan insulins: Actrapid NM, Humulin R, Homoral. Ana gudanar da shi ta hanyar ci gaba da jiko ta amfani da turare.
2. Ana gudanar da insulin a cikin 0.1 U / kg / awa don cire ketoacidosis. Rage matakin glycemia a gudun da bai wuce 5 mmol / awa ba.
3. Idan maida hankali na glucose ya ragu a cikin ƙimar fiye da 5 mmol / awa - rage kashi na miyagun ƙwayoyi. Idan matakin glycemia ya ragu zuwa 4 mmol / l - ana rage yawan maganin a sau 2. Matsakaicin glycemia a cikin nau'in 1 shine ciwon sukari na 8-10 mmol / L.
4. Tare da GOK (hyperosmolar coma), ana amfani da gajeren insulins (Actrapid), kafin hakan, an kawar da cin zarafin ruwa na ruwa. An saka allurar rigakafin cikin jet, sannan saita saurin 0.1 U / kg / awa (-6ungiyoyi 5-6 / awa). Kullum saka idanu kan matakin glycemia.
5. Tare da GOK da raguwar glucose, kashi na miyagun ƙwayoyi yana raguwa zuwa raka'a 2 / awa. Bayan allurar glucose (10% mafita) cikin magudanar cikin jijiya tare da saline. Idan mai haƙuri ya sha kuma ya ci da kansa, yanayinsa ya inganta, to, ana yin ɗan gajeren insulin (kashi na Unungiyoyi na 6) a ƙarƙashin kowane abinci.
6. Idan, bayan sa'o'i 2-3, yawan sukari bai ragu tare da GOK ba, adadin maganin yana ƙaruwa sau 2. An allura a cikin jet veins, sannan ana amfani da jiko a cikin adadin 10 raka'a / awa. Idan maida hankali kan sukari ya ragu, kashi na miyagun ƙwayoyi = 5 BIYU / awa, to 2 PIECES / awa.

Innovations a cikin Ciwon sukari

Sabuwar ilimin insulin yana bayyana babu tsammani, amma duk masu ciwon sukari nan da nan suka ji yadda yanayin rayuwarsu ya inganta.

Abin da ya faru shekaru biyu da suka gabata:

• bovine da naman alade an maye gurbinsu da ingantaccen aikin injiniyan ɗan adam, ba ya haifar da sakamako masu illa,
• ƙirƙirar ɗan gajeren abu mai amfani yana amfani da glucose, wanda ya zo tare da abinci, basal (yalwata) yana amfani da glucose, wanda aka saki saboda haɓakar hanta ta hanyar aiwatar da T1DM. Drugsara magunguna ba da izinin ci gaban hypoglycemia saboda ɗaukar kaya,
• Siffofin sashi sun bayyana wanda zai iya rama maganin metabolism a cikin T2DM. Magungunan Ultrashort zasu iya tayar da samar da insulin ta jikinku kuma ku ware abinci mai narkewa, tunda ba za a sami takamaiman abin da zai faru ba yayin tashin hankali,
• tare da nau'in ciwon sukari na 2, magunguna suna ba da gudummawa ga sakin abu mai aiki, wanda ya daɗe yana tallafawa ka'idodin sukari na jini kuma yana rage raguwa mai kaifi,
• wasu kwayoyi tare da T2DM na iya haɓaka jijiyar nama zuwa insulin ɗin su, yayin da inganta haɓaka metabolism, musamman a cikin mutanen da ke kiba,
• don farkon siffofin cutar, ana bayar da magunguna don iyakance sha daga cikin narkewar narkewar carbohydrates daga abinci. Lokacin shan irin waɗannan kuɗaɗen, mara lafiya ba zai iya karya abincin ko ya ci wani abu da ba bisa doka ba, saboda ƙwayar gastrointestinal zai nuna alama nan da nan,
• akwai allurar insulin wanda ke sauƙaƙa gudanar da maganin,
• beenaramin sikelin masu ƙarancin ƙananan ƙwayoyi waɗanda aka haɓaka kuma suna cikin buƙatu waɗanda za'a iya amfani dasu don gudanar da magani ta hanyar catheter da aka haɗa da fata,
• Akwai matakan glucose ko gani na gwaji na kai don yanke hukunci game da matakan suga.

A cikin kasuwar magunguna ta Amurka, masu yin insulin ya kamata su bayyana a cikin 2015. Sabuwar nau'in sashi zai baka damar sarrafa matakin cutar glycemia kuma kar a saka allurar hormone yau da kullun.

Inhaled insulin Aliexpress - Malin glucose na jini Marar jinin haila mai zubar da jini

Vationirƙirar bidi'a ta kasance glucose ba mai mamayewa ba kuma a cikin agogo.Sun dace da amfani kuma galibi suna ba ku damar sarrafa matakin sukari ba kawai a gida ba, har ma a wurin aiki, kan titi da kuma jigilar kayayyaki.

Ana samun insulin gajeriyar magana da gajarta na tsawon lokaci don maganin cututtukan type 1 da masu ciwon sukari na 2. Yana maye gurbin nau'in ruwa na miyagun ƙwayoyi, gaba ɗaya ko a cikin ɓangaren, kuma yana da ƙaddara sakamako hypoglycemic don samun cikakken yanayin glycemic. Ka samar da allunan Russia da Indiya.

Cutar sankarar mahaifa

Idan kuna shirin daukar ciki yadda yakamata, ku bi shawarar likita, to cutar sankara ba zata tsoma baki tare da jariri ba kuma ku sami nasara ga jariri. Ba a hana maganin insulin ciki ba idan kwayoyin hana daukar ciki da tsaftataccen abinci ba su taimakawa rage yawan sukarin jini.

An tsara adadin magungunan kuma likita ya ƙididdige shi daban-daban ga kowace mace mai ciki. A ranar haihuwa da lokacin shayarwa, ana yin gwajin matakan glucose a koyaushe. Bayan haihuwa, ana tsara magunguna tare da tsawan lokaci.

Saurin Ciwon Lafiya a cikin Ilimin Jiki

Insulinocomatous far (ICT) ko kuma insulin shock therapy wata hanya ce wacce ake amfani da cutar sikari na hypoglycemic cocin ta hanyar wucin gadi sakamakon gudanarwar insulin. Ana amfani dashi don schizophrenia wani ɗan gajeren lokaci na iyakance da psychosis.

Yana taimaka cirewa daga yanayin catatonic da catatonic-oneiric, polymorphic, rashin tsari mai kyau tare da matsanancin kwanciyar hankali da alaƙar damuwa. Hakanan yana taimakawa masu shan maye don dakatar da bayyanar cututtuka.

Idan yanayin juyayi da yanayin paraphrenic suna haɗuwa tare da ci gaba mai ɗorewa na tsari, to, maganin insulin a cikin ilimin halin ƙwaƙwalwar ƙwayar cuta ba ya bayar da tasirin da ake tsammani.

Tashin hankali

Hadarin insulin far yana bayyana:

• rashin lafiyan halayen da itching, rashes, ja itchy spots tare da rashin kula da miyagun ƙwayoyi: rauni mai wucewa zuwa lokacin farin ciki ko m, ƙaddamar da shirye-shiryen sanyi, zaɓi mara kyau na yankin allura,
• yanayin rashin karfin jiki tare da karancin matakan sukari: bayyanar tsananin yunwa, gumi mai yawa, rawar jiki da bugun jini idan ana yawan samun insulin, rashin abinci mai gina jiki,
• post-insulin lipodystrophy (lipoatrophy): canji a launi fata, bacewar tso adi nama a karkashin fata a wurin allura,
• lipohypertrophy - fitowar kyawawan filaye a wurin allura,
• labule na wucin gadi a gaban idanu da kuma maganin cututtukan fata - lalacewar ido a cikin ciwon sukari,
• kumburi na ɗan lokaci na kafafu saboda ruwa da riƙewar sodium da haɓaka hawan jini a farkon farawar,

Yin rigakafin rikice-rikice kamar haka:

1. Tare da yanayin hypoglycemic, kuna buƙatar cin gurasa 100 g tare da sukari guda 3-4 kuma ku sha shayi mai dadi - 1 kofin.
2. Rashin farin ciki da damuwa, damuwa ta jiki.
3. Daidai gudanar da insulin da kuma abubuwan da ake amfani dasu a kullun.
4. Hara Hydrocortisone a murfin tare da insulin don ƙoshin rashin lafiyan ciki da itching.
5. Yi motsa jiki kuma yi menu a kan shawarar kwararru don rage nauyi.

Matsalolin mai haƙuri da ke da alaƙa da insulin an cire su ta hanyar lura da duk ka'idodin maganin cututtukan cututtukan cututtukan ƙwaƙwalwar ƙwayar cuta, yin amfani da maganin a cikin mafi kyawun allurai kuma kamar yadda ya dace da yanayin motsa jiki na asirin.

A cikin yara da matasa, hanyar cutar za a iya inganta kuma ana iya samun biyan kuɗi ta hanyar gabatarwar analogues ana insulin ɗan adam. Ana shigar da famfunan insulin na kasashen waje a cikin kasar, kodayake farashin su yayi matukar hauhawa.

Tambaya

Sannu. Shin kwayoyi don gudanarwa ga yara suna da wasu siffofi? Shin zaka iya kwatanta insulins daban-daban da kuma misalin kashi ɗaya na yau da kullun don ciwon sukari na 1?

Sannu. Tebur 2 yana ba da halayen magungunan magungunan. Tebur 3 yana nuna kashi na yau da kullun na insulin: gajere da tsawaita lokacin maganin insulin na zamani, nau'in ciwon sukari na 1.