Ochita zinthu mwachidule: mayina a mankhwala abwino kwambiri

Kukhazikitsidwa kwa insulin ngati njira yothanirana ndi matenda ashuga lero ndi njira yokhayo yothanirana ndi matenda a hyperglycemia mu mtundu 1, komanso mu mtundu wa matenda a shuga a insulin.

Mankhwala a insulin amachitika m'njira yoti ubweretse mtundu wa mahomoni m'magazi momwe ungathere.

Chifukwa chake, mankhwala osokoneza bongo osiyanasiyana omwe amalumikizidwa ku minofu yapamtunda amagwiritsidwa ntchito. Ma insulin omwe amatenga nthawi yayitali amatengera kutsekemera kwa mahomoni, komwe sikumakhudzana ndi kulowa kwa chakudya m'matumbo, ndipo ma insulin amafupikitsa komanso a ultrashort amathandiza kutsika glycemia atatha kudya.

Insulin yachilengedwe komanso yapangidwe

Insulini imatchula mahomoni okhala ndi magawo angapo ophunzitsira. Poyamba, m'masamba achikopa, omwe amakhala m'maselo a beta, amapanga unyolo wa ma amino acid 110, womwe umatchedwa preproinsulin. Puloteni yamkati imalekanitsidwa ndi iyo, ma proinsulin amawonekera. Puloteni iyi imayikidwa mu granules, pomwe imagawidwa mu C-peptide ndi insulin.

Njira yapafupi kwambiri ya amino acid ndi porcine insulin. M'malo mwa threonine mmenemo, unyolo B umakhala ndi alanine. Kusiyana kwakukulu pakati pa bovine insulin ndi insulin yaumunthu ndi zotsalira za 3 amino acid. Ma antibodies amapangidwa pama insulin a nyama mthupi, omwe angayambitse kukana kwa mankhwala omwe amaperekedwa.

Kuphatikizika kwamakonzedwe amakono a insulini mu ma labotale kumachitika pogwiritsa ntchito ma genetic engineering. Biosynthetic insulin ndi yofanana mumapangidwe amino acid amunthu, amapangidwa pogwiritsa ntchito ukadaulo wa DNA. Pali njira ziwiri zazikulu:

1. Kaphatikizidwe kabakiteriya wosinthika ma genetic.
2. Kuchokera ma proinsulin opangidwa ndi bacterium yosinthidwa ma genetic.

Phenol ndi cholembera choteteza ku kuipitsidwa kwakanthawi kochepa ka insulini; insulin yayitali imakhala ndi paraben.

Cholinga cha Insulin
Kupanga kwa mahomoni m'thupi kumapitilira ndipo kumatchedwa secaltion basal kapena maziko. Udindo wake ndikuwonetsetsa kuti shuga azikhala momasuka kunja kwa chakudya, komanso kuyamwa kwa glucose obwera kuchokera ku chiwindi.

Mukatha kudya, zakudya zamafuta zimalowa m'magazi kuchokera m'matumbo monga glucose. Kuti mumvetsetse pamafunika insulin yowonjezera. Kutulutsa kwa insulini m'magazi kumatchedwa secretion ya chakudya (postprandial), chifukwa pambuyo pake kwa maola 1.5-2, glycemia imabweranso muyeso wake, ndikalandira glucose kulowa m'maselo.

Mtundu 1 wa shuga, insulini silingapangidwe chifukwa cha kuwonongeka kwa autoimmune m'maselo a beta. Kuwonetsedwa kwa matenda ashuga kumachitika panthawi yomwe pafupifupi chiwonongeko chotheratu cha minofu ya islet. Mtundu woyamba wa matenda ashuga, insulin imabadwa kuyambira masiku oyamba a matendawa komanso moyo.

Mtundu wachiwiri wa matenda ashuga umatha kulipiriridwa ndi mapilitsi, ndikapita nthawi yayitali matendawa, kapamba amataya mphamvu kuti apange mahomoni akeawo. Zikatero, odwala amalowetsedwa ndi insulin limodzi ndi mapiritsi kapena ngati mankhwala.

Insulin imapangidwanso kuti ivulaze, kuchita opaleshoni, kutenga pakati, matenda, ndi zina zomwe shuga sangathe kuchepetsedwa pogwiritsa ntchito mapiritsi. Zolinga zomwe zimakwaniritsidwa ndikuyambitsa insulin:

• Sinthanso magazi a shuga, komanso kupewa kuti achulukane kwambiri mukatha kudya chakudya.
• Chepetsa shuga mkodzo.
• Pewani maulendo obwera chifukwa cha hypoglycemia ndi matenda a shuga.
• Muzikhala ndi thupi lokwanira.
• Sinthani mafuta kagayidwe.
• Sinthani moyo wabwino kwa anthu odwala matenda ashuga.
• Pofuna kupewa misempha komanso mitsempha ya matenda ashuga.

Zizindikiro zoterezi zimadziwika ndi njira yabwino yophunzirira matenda a shuga. Ndi chiphuphu chokwanira, kuchotsedwa kwa zizindikiro zazikuluzikulu za matendawa, hypo- ndi hyperglycemic coma, ndi ketoacidosis amadziwika.

Nthawi zambiri, insulini yochokera ku kapamba imadutsa mu chotupa cha chotupa mu chiwindi, pomwe imawonongeka hafu, ndipo yotsalayo imagawidwa mthupi lonse. Zomwe zimayambitsa insulin pansi pa khungu zimawonetsedwa chifukwa zimalowa m'magazi mochedwa, komanso m'chiwindi ngakhale pambuyo pake. Chifukwa chake, shuga wamagazi amakwezedwa kwakanthawi.

Motere, mitundu yosiyanasiyana ya insulini imagwiritsidwa ntchito: insulin yofulumira, kapena insulin yochepa, yomwe muyenera kubayidwa musanadye, komanso kukonzekera insulin yayitali (insulin yayitali), yogwiritsidwa ntchito kamodzi kapena kawiri pakukhazikika kwa glycemia pakati pa chakudya.

Kodi insulin imagwira ntchito bwanji?

Kukonzekera kwa insulini, monga mahomoni achilengedwe, kumangiriza zolandilira pa membrane wa cell ndikulowa nawo. Mchipindamo, motsogozedwa ndi timadzi tating'onoting'ono tomwe timayambitsa ma biochemical reaction. Ma receptor otere amapezeka mu minofu yonse, ndipo pa ma cell aku chandamale nthawi zambiri. Kuti zimadalira insulin zikuphatikizira maselo a chiwindi, adipose ndi minofu minofu.

Insulin ndi mankhwala ake imayang'anira pafupifupi ma metabolic onse omwe amalumikizidwa, koma kuthana ndi shuga pamagazi ndikofunikira. Hormoni imapereka kusuntha kwa glucose kudzera mu membrane wa khungu ndikulimbikitsa kugwiritsa ntchito njira yofunikira kwambiri yopangira mphamvu - glycolysis. Glycogen imapangidwa kuchokera ku glucose m'chiwindi, ndipo mapangidwe a mamolekyulu atsopano amachepetsedwa.

Zotsatira za insulin zimawonekera chifukwa chakuti kuchuluka kwa glycemia kumatsika. Malangizo a insulin kaphatikizidwe ndi katulutsidwe amathandizidwa ndi shuga ndende - kuchuluka kwa glucose kumayambitsa, ndipo otsika amalepheretsa katulutsidwe. Kuphatikiza pa shuga, kaphatikizidwe kamakhudzidwa ndi zomwe zimakhala m'magazi (glucagon ndi somatostatin), calcium ndi amino acid.

Mphamvu ya kagayidwe ka insulin, komanso mankhwala osokoneza bongo omwe ali ndi zomwe zili mkati mwake, amawonetsedwa motere:

1. Imaletsa kuchepa kwamafuta.
2. Imalepheretsa mapangidwe a matupi a ketone.
3. Mafuta ocheperako amalowa m'magazi (amawonjezera ngozi ya atherosulinosis).
4. Mu thupi, kuwonongeka kwa mapuloteni kumalephereka ndipo kapangidwe kawo kamathandizira.

Mayamwidwe ndi kufalitsa insulin mthupi

Kukonzekera kwa insulin kumalowetsedwa m'thupi. Kuti muchite izi, gwiritsani ntchito ma syringe omwe amatchedwa insulin, syringe pens, pampu ya insulin. Mutha kubayira mankhwala pansi pa khungu, m'misempha ndi m'mitsempha. Pakulamulira kwa intravenous (pankhani ya chikomokere), ma insulin okhazikika pokhapokha (ICD) ndi omwe ali oyenera, ndipo njirayi imagwiritsidwa ntchito nthawi zambiri.

The pharmacokinetics ya insulin zimatengera jakisoni malo, Mlingo, ndende ya yogwira mankhwala. Komanso, magazi akamayenda pamalo a jakisoni, zochitika za minofu zimatha kukhudza kuchuluka kwa kulowa m'magazi. Kuthiridwa mwachangu kumaperekedwa ndi jakisoni kukhoma lamkati lamkati, mankhwalawa omwe amawaika m'thumba kapena pansi pa phewa.

M'magazi, inshuwaransi ya 04-20% imamangidwa ndi ma globulins, kuwoneka kwa ma antibodies kwa mankhwalawa kumatha kuyambitsa zotsatira zoyanjana ndi mapuloteni, ndipo, chifukwa chake, insulin. Kutsutsa kwa mahomoni kumakhala kotheka ngati nkhumba kapena inshuwaransi ya bovine ndi mankhwala.

Mawonekedwe a mankhwalawa sangakhale omwewo mwa odwala osiyanasiyana, ngakhale mwa munthu m'modzi amasinthasintha.

Chifukwa chake, pamene deta pazomwe zimachitika ndikuchotsa theka la moyo zimaperekedwa, ma pharmacokinetics amawerengedwa molingana ndi zowonetsa pafupifupi.

Zosiyanasiyana za insulin

Ma insulin, omwe amaphatikizapo porcine, bovine, bovine, insulin, sanagwiritsidwe ntchito kwambiri kupanga mankhwala opangira - analogues a insulin ya anthu. Malinga ndi magawo ambiri, omwe ambiri ndi allergenicity, insulini yabwino kwambiri imapangidwa kuchokera ku majini.

Kutalika kwa nthawi ya kukonzekera kwa insulin kumagawidwa mu ultrashort ndi insulin yochepa. Amaberekanso zakudya zomwe zimapangitsa kuti thupi lizikhala ndi chakudya chambiri. Mankhwala a nthawi yayitali, komanso ma insulin amatengera momwe chinsinsi chake chimakhalira. Insulin yocheperako imatha kuphatikizidwa ndi insulin yayitali pakaphatikizidwe.

Ndibwino kuti mupeze insulin - yayifupi, yapakatikati kapena yayitali, imatsimikiziridwa ndi mtundu wa insulin yothandizira, zomwe zimatengera zaka za wodwalayo, kuchuluka kwa hyperglycemia komanso kupezeka kwa matenda okhudzana ndi matenda a shuga.

Gulu la ma ultrashort insulin limadziwika ndi kuyambika mwachangu - pambuyo pa mphindi 10-20, shuga amachepetsa kwambiri pambuyo pa maola 1-2.5, nthawi yonse ya hypoglycemic zotsatira ndi maola 3-5. Mayina a mankhwala: Humalog, NovoRapid ndi Apidra.

Insulin yochepa imachitika pambuyo pa mphindi 30-60, zotsatira zake zimatha maola 6-8, ndipo pazokwanira zimawonedwa kwa maola awiri atatha kutsata. Ndikofunikira kubaya insulini yocheperako mphindi 20-30 musanadye chakudya, chifukwa izi zimapereka kuchuluka kwa mahomoni m'magazi panthawi yomwe shuga imakhala ndi mtengo wokwera kwambiri.

Insulin yochepa imapezeka pansi pa dzina lotsatira:

• Actrapid NM, Rinsulin R, Humulin Regular (genetic engineering insulin pokonzekera)
• Khumudar R, Biogulin R (semi-syntulin insulin).
• Actrapid MS, Monosuinsulin MK (wowerengeka wa nkhumba).

Zomwe insulin ndiyabwino kusankha pamndandandawu imatsimikiziridwa ndi dokotala yemwe amaganizira za chizolowezi chokhala ndi chifuwa, kuikidwa kwa mankhwala ena. Mukamagwiritsa ntchito insulin yamitundu yosiyanasiyana palimodzi, zimakhala bwino ngati mungasankhe wopanga mmodzi. Mtengo wa mitundu ingapo ya insulini umatsimikiziridwa ndi wopanga.

Kuchita insulin mwachangu kumasonyezedwera kukonzekera tsiku lililonse musanadye kwambiri, komanso chithandizo cha matenda a shuga pamankhwala ochita opaleshoni. Mlingo wocheperako, mankhwalawa amagwiritsidwa ntchito ndi othamanga kuti apange minofu, komanso kutopa kambiri, thyrotoxicosis, cirrhosis.

Mankhwala othandizira nthawi yayitali komanso nthawi yayitali amagwiritsidwa ntchito kuti asungidwe pafupipafupi kapena a insulin.

Malangizo ogwiritsira ntchito amakhala ndi malangizo pakumwedwa kwa mankhwalawa, nthawi zambiri amafunika kuti azidulidwa kamodzi kapena kawiri patsiku, kutengera mtundu wa glycemia.

Kuwerengetsa kwa insulin

Kusankhidwa koyenera kwa chithandizo kumapangitsa odwala omwe ali ndi matenda osokoneza bongo kuti asasiye zakudya zomwe amakonda, kupatula zinthu zomwe zimakhala ndi shuga ndi ufa woyera. Kukoma kokoma kumatha kupezeka pogwiritsa ntchito shuga.

Pofuna kumvetsetsa momwe mungawerengere mlingo, womwe ndi wabwino kuposa insulini, momwe mungapangire insulin, mankhwalawa amachotsedwa poganizira zomwe zili zamagulu a mkate (XE). Chigawo chimodzi chimatengedwa wofanana ndi 10 g wamafuta. Ma mkate a Mkate, owerengedwa molingana ndi matebulo amtundu wina wa mankhwala, mupeze zomwe insulin iyenera kutumikiridwa musanadye.

Pafupifupi 1 IU ya insulin imayendetsedwa pa XE. Mlingo ukuwonjezeka ndi kukana kwa munthu payekha mankhwalawo, komanso ndi munthawi yomweyo ma steroid mahomoni, kulera, Heparin, antidepressants komanso okodzetsa ena.

Mphamvu ya hypoglycemic ya insulin imatheka chifukwa cha mankhwala ochepetsa shuga m'mapiritsi, ma salicylates, anabolic steroids, androgens, furazolidone, sulfonamides, theophylline, mankhwala okhala ndi lithiamu, calcium.

Ethanol amalepheretsa kupangika kwa shuga mu chiwindi. Pankhaniyi, kumwa zakumwa zoledzeretsa kumbuyo kwa mankhwala a insulin kumabweretsa mkhalidwe woopsa wa hypoglycemic. Ndizowopsa kumwa mowa pamimba yopanda kanthu.

Malangizo othandiza kudziwa kuchuluka kwa insulin:

1. Kuwerengera kumachitika pa kilogalamu imodzi ya kulemera. Ndi misa yochulukirapo, chokwaniracho chimachepetsedwa ndi 0,1, ndikusowa - ndikuwonjezeka kwa 0,1.
2. Kwa odwala omwe ali ndi vuto la matenda a shuga 1, masamu 0,4-0,5 pa 1 kg.
3. Mtundu wa 1 wa matenda ashuga, ndi chiphuphu chosakhazikika kapena kuwonongeka, mankhwalawa amawonjezeka mpaka 0.7-0.8 U / kg.

Mlingo wa insulin nthawi zambiri umachulukitsidwa kwa achinyamata chifukwa chobisika kwambiri chotulutsa timadzi timene timatulutsa timadzi tambiri timagazi. Pakati pa mimba mu gawo lachitatu, chifukwa cha mphamvu ya mahomoni a placental komanso chitukuko cha kukana insulin, mlingo wa mankhwalawa umasinthidwira m'mwamba.

Kwa odwala omwe amadziwitsidwa kuti apange insulini, chinthu choyambirira ndi kusintha kwa mankhwalawa, poganizira kuyang'anira shuga. Ngati mulingo wa glycemia mukatha kudya umaposa zomwe zimachitika, ndiye kuti tsiku lotsatira mlingo wa insulin umadzuka ndi gawo limodzi.

Ndikulimbikitsidwa kamodzi pa sabata kuti mupeze mawonekedwe osintha a shuga m'magazi, kuyeza magazi isanayambe komanso itatha chakudya, komanso asanagone. Zambiri pa glycemia ya tsiku ndi tsiku, kuchuluka kwa magawo omwe amadya mkate, kuchuluka kwa insulin yomwe ingaberekedwe kungathandize kusintha machitidwe a insulin kuti akhale ndi thanzi la wodwalayo.

Insulin yochepa komanso ya ultrashort ikufotokozedwa mu kanema munkhaniyi.