Tikukufotokozerani kumasulira kuchokera ku Chingerezi cha nkhani yomwe madokotala aku Poland adalemba mu Seputembara 2012. Ichi ndi chimodzi mwazinthu zothandiza kwambiri za insulin dilution. Owerenga tsamba lathu, kuphatikiza achikulire omwe amawongolera matenda awo a shuga ndi zakudya zamafuta ochepa, ayenera kuchepetsa insulini, chifukwa mukapanda apo matendawa amakhala ochuluka kwambiri. Tsoka ilo, mankhwala ovomerezeka, komanso opanga insulin ndi ma syringe, amanyalanyaza nkhaniyi. Werengani malingaliro athu kumapeto kwenikweni, mutatha kuwerenga nkhaniyo.
Kwa ana aang'ono kwambiri omwe ali ndi matenda amtundu wa 1, mlingo wa insulin wa tsiku ndi tsiku nthawi zambiri umakhala wochepa kwambiri kuposa 5-10 magawo. Izi zikutanthauza kuti odwala oterewa patsiku amafunika kulowa osakwana 0,05-0.1 ml ya insulin pochita 100 IU / ml. Ana ena amangofunika ma insulin a 0-0-0.3 a inshuwaransi (yaifupi) kuti abise 10 magalamu a chakudya chomwe amadya. Uwu ndi woperewera, microscopic mlingo wa 0.002-0.003 ml wa yankho la insulin pamsasa wa 100 PIECES / ml.
Chifukwa chiyani ndikufunika kuchepetsa insulini?
Ngati matenda ashuga amafuna inshuwaransi yochepa kwambiri, izi zimadzetsa mavuto poyesa kutsimikizira insulin yokhala ndi syringe kapena pampu ya insulin. Pakupopera, ma alarm nthawi zambiri amayamba.
Matenda a shuga 1 amadziwika ndi ana adakali aang'ono. Chifukwa chake, vuto la kuperekera mankhwala ochepa kwambiri a insulin limakhudza odwala ochulukirapo. Nthawi zambiri, insulin lyspro (Humalog) yovutitsidwa ndi madzi apadera omwe amapangidwa ndi wopanga amagwiritsidwa ntchito popopa insulin mankhwala mu makanda. M'nkhani ya lero, timapereka chidziwitso chogwiritsa ntchito lyspro insulin (Humalog), kuchepetsedwa ndi saline yokhudza thupi maulendo 10 - kuundana wa 10 PIECES / ml, piritsi la insulin mwana wakhanda.
Chifukwa chiyani mudaganiza zoyesa kuthira Humalog ndi saline?
Mnyamata wazaka 2.5, wakhala akudwala matenda ashuga amtundu woyamba kwa miyezi 12, kuyambira pachiwonetsero pomwe adalandira chithandizo cha mankhwala a insulin. Choyamba adagwiritsa ntchito NovoRapid insulin, kenako asinthana ndi Humalog. Mwanayo anali ndi vuto losowa chakudya, ndipo kutalika kwake ndi kulemera kwake zinali pafupi kwambiri ndi masiku ake komanso msinkhu wake. Glycated hemoglobin - 6.4-6.7%. Mavuto aukadaulo ndi pampu ya insulin amachitika pafupipafupi - kangapo pa sabata. Chifukwa cha izi, kulowetsedwa kulikonse kumatha kugwiritsidwa ntchito osaposa masiku awiri. Kusintha kwa shuga m'magazi anali okwera (9.6 ± 5.16 mmol / L), shuga anali kuyesedwa kangapo 10 mpaka 175 pa tsiku. Mlingo wa insulin anali 4.0-6.5 IU patsiku (0.41-0.62 IU / kg thupi), omwe 18-25% anali oyambira.
Mavuto omwe adatipangitsa kuyesa kuchepetsa insulin ndi saline anali awa:
- Mafuta osungidwa "otchedwa" a insulin ochokera ku wopanga sanali kupezeka.
- Wodwalayo adawonetsa kuchepa kwapang'onopang'ono mu mulingo wa bilirubin ndi bile acid m'magazi. Izi zitha kutanthauza kuti zoteteza ku insulin ndi proprietary dilution fluid (metacresol ndi phenol) ndizovuta kwa chiwindi chake.
Komiti ya Ethics idavomereza kuyesayesa kugwiritsa ntchito insulin yovomerezeka ndi saline kuti ichiritsidwe. Makolo adasaina chikalata chodziwitsa. Adalandila malangizo atsatanetsatane amomwe angapangitsire insulin ndi saline komanso momwe angakhazikitsire phukusi la insulin.
Zotsatira zamapulogalamu a insulin
Makolo adayamba kugwiritsa ntchito mankhwala othandizira pampu ndi insulin kuchepetsedwa ndi saline maulendo 10, kutuluka, i.e. kunyumba, osayang'anira nthawi zonse akatswiri. Njira yothetsera insulin Humalog yovutitsidwa idakonzedwanso masiku atatu aliwonse. Tsopano, pogwiritsa ntchito insulin pump, madzi okwanira 10 anailowetsa mthupi la mwana kuposa momwe insulin inaliri.
Kuyambira m'masiku oyamba a matenda a shuga pansi pa regimen yatsopano, pafupipafupi mavuto aukadaulo ndi pampu ya insulin anachepa kwambiri. Magazi a shuga m'magazi anachepa ndikuwonetseratu, mpaka 7.7 ± 3.94 mmol / L. Izi ndi zizindikiro molingana ndi zotsatira za kuyeza shuga m'magazi 13 mpaka 14 patsiku. M'miyezi 20 yotsatira, kufalikira kwa cannula ya pampu ndi makhristulo a insulin kumachitika katatu kokha. Nkhani imodzi ya hypoglycemia yoopsa inachitika (shuga m'magazi anali 1.22 mmol / L), omwe amafunikira kuyamwa kwa glucagon. Pankhaniyi, mwana adatha kuzindikira kwa mphindi 2-3. Glycated hemoglobin m'miyezi 15 yoyambirira inali 6.3-6.9%, koma m'miyezi isanu yotsatira idakwera mpaka 7.3-7,5% motsutsana ndi maziko a matenda omwe amayamba chifukwa cha chimfine.
Mlingo wa Humalog insulin, wowonjezera maulendo 10, ndikujowina ndi pampu, anali 2.8-4.6 U / tsiku (0.2-0.37 U / kg kulemera kwa thupi), omwe 35-55% anali oyambira, kutengera chidwi cha kudya komanso kupezeka kwa matenda opatsirana. Mwana amakhalanso ndi vuto la kudya, ndipo izi zimakhudza kayendedwe ka shuga. Koma ikukula mwachizolowezi, yopezedwa kutalika ndi kulemera, ngakhale zizindikirozi zimatsalabe pamlingo wotsika wazaka. Mlingo wa bilirubin ndi ma asidi a bile m'magazi unachepa kukhala wabwinobwino. Kukula kwa mavuto aukadaulo ndi pampu ya insulin kwatsika kwambiri. Makolo ndi okondwa. Amakana kusamutsa mwana kupita ku insulin pa ndende ya 100 IU / ml.
Mapeto
Tangowerenga mlandu umodzi wokha, koma zomwe takumana nazo zingakhale zothandiza pamachitidwe ena. Tikuwonetsa kuti kuphatikiza humalog insulin maulendo 10 kuti mugwiritse ntchito ndi insulin-based insulin therapy kungakhale kothandiza pakuthana ndi zovuta zamaluso. Njira zamankhwala zoterezi ndizotetezeka kwa mwana yemwe akufunika inshuwaransi yochepa kwambiri. Chofunikira kwambiri pakuthandizira bwino ndikugwirizana ndi makolo ndikuwunika mosamala njirayi ndi akatswiri. Njira ya insulin dilution ikhoza kukhala yothandiza pokhazikitsa njira zotsekera insulin. Kuti mumve mawu omaliza, kafukufuku wofunikira akufunika, komanso ndemanga kuchokera kwa opanga insulin.
Ndemanga patsamba la Diabetes-Med.Com
Humulin Yosavomerezeka - yamphamvu kwambiri. Zimakhudza kwambiri ana aang'ono, ndikuwapangitsa kuti azilumphira m'magazi a magazi, zochitika pafupipafupi za hypoglycemia, komanso thanzi labwino. Sizingatheke kugula yankho lochokera kwa wopanga kuti athetse insulin m'maiko olankhula Chirasha. Europe ikuwoneka kuti ilinso ndi vuto lomweli. Vutoli mwina limapezeka ku United States kokha kwa odwala matenda ashuga. Chifukwa chake, makolo a ana aang'ono omwe ali ndi matenda amtundu wa 1 amagula saline kapena madzi a jekeseni mu mankhwala ndipo amayesa kuchepetsa insulin. Werengani nkhaniyo, "Momwe Mungayeretsere Insulin Kuti Muli Poyenera Mankhwala Oyenera."
Kwa mitundu yazifupi ndi ya insulin, inshuwarayi silivomerezedwa ndi opanga, komanso siyoletsedwa. M'mabwalo a shuga, mutha kudziwa kuti zimapereka zambiri kapena zochepa zotsatira zabwino. Mutha kusintha kuchokera ku Humalog kupita ku Actrapid musanadye chakudya chomwe chimayamba pang'onopang'ono komanso bwino. Koma ngati mukufuna kuthana ndi matenda ashuga mwa mwana, muyenera kuyipiranso.
Zatsimikiziridwa mwatsatanetsatane kuti ana aang'ono omwe ali ndi matenda amtundu woyamba wa shuga ayenera kuchepetsedwa ndi insulin kuti athe kubaya jekeseni yaing'ono bwinobwino. Ndipo ngati tichita pulogalamu yathu yachiwiri ya matenda ashuga kapena mtundu wa matenda ashuga 1, ndiye kuti, kutsatira zakudya zamagulu ochepa, ndiye kuti mwina ndi ana okha komanso akuluakulu adzafunikira kuchepetsa insulin. Chifukwa ngati mutayambitsa kuchuluka kwa insulin yayikulu, izi zimapangitsa shuga m'magazi komanso pafupipafupi a hypoglycemia.
Tsoka ilo, mankhwala ovomerezeka sanyalanyaza mutu wa insulin dilution. Mpaka pano, buku lovomerezeka kwambiri pankhani yothandizira odwala matenda ashuga ku mayiko olankhula Chirasha ndilo buku lowonjezera la buku la 2011 lomwe analemba A. I Dedov ndi M. V. Shestakova.
Ili ndi mtundu wolimba, pafupifupi masamba 1,400. Kalanga, silinenapo kanthu za momwe mungathandizire insulin, ngakhale pagawo la chithandizo cha matenda a shuga 1 kwa ana aang'ono kwambiri. Osanena za akulu. Olembawo amanyalanyaza kwathunthu zakudya zamafuta ochepa, ngakhale kuti iyi ndi njira yothandiza kwambiri yothanirana ndi shuga komanso kupewa zovuta za matenda ashuga. Uku ndi kupenga konse.
Mwachilungamo, tikuwona kuti misala yomweyo yomweyo ikuchitika kunja. Zolemba zatsopano za chilankhulo cha Chingerezi komanso mabuku owerengera othandizira odwala matenda a shuga samayankhulanso za zakudya zamagulu ochepa kapena kuchepetsedwa kwa insulin. Ndikukupemphani kuti muphunzire nkhani yathu yayikulu, "Momwe Mungapangire Insulin Kuti Mukhale Ndi Mankhwala Opanda Mankhwala Oyenera." Gwiritsani ntchito njira zomwe zikuwoneka kuti zikuthandizadi, ndipo dziyeseni.
Mu 1970s, mankhwala ovomerezeka adaletsa mawonekedwe a magazi a kunyumba kwa zaka zosachepera zisanu, zomwe zimapangitsa kuti odwala matenda ashuga azitha kudziimira okha shuga. Zaka zonsezi, madokotala akhala akunena kuti kudwala matenda ashuga, kukhalabe ndi shuga ngati momwe amakhalanso athanzi labwino ndikosathandiza komanso koopsa. Werengani mbiri ya Dr. Bernstein mwatsatanetsatane. Masiku ano, mbiriyakale imadzibwereza yokha ndi zakudya zama carb ochepera kuwongolera mtundu woyamba wa 1 ndikulembera matenda ashuga a 2.
Werengani chifukwa chomwe sitipangira izi kuti muthe kugwiritsa ntchito insulin pump, ngakhale kwa ana aang'ono omwe ali ndi matenda a shuga 1. Tengani mwana wanu pachakudya chamoto chochepa kwambiri mukamamuyamwitsa. Kusintha ma insulini ndi insulini kudzakhala koyenera pokhapokha mapampu akaphunzira kuyeza shuga m'magazi ndikusintha mwanjira yake insulin molingana ndi zotsatira za izi. M'nkhaniyi, mapampu a insulin apamwamba amtsogolo amatchedwa "machitidwe otsekeka." Ndipo komabe, mavuto ena osakwaniritsidwa omwe amachititsa satha.
Mudzathandizira gulu lalikulu la anthu olankhula Chirasha odwala matenda ashuga ngati mungagawane zotsatira za zoyesa zanu pa insulin dilution m'mawu omwe alembedwa.
