Insulin yowonjezera, basal ndi bolus: ndi chiyani?

Glucose ndiye gwero lalikulu lamphamvu kwa thupi lonse. Ndi shuga osakwanira, munthu amatha kupeza kufooka kwakukulu, kusokonekera kwa ntchito ya ubongo komanso kuwonjezeka kwa gawo la acetone m'magazi, zomwe zimatsogolera kukula kwa ketoacidosis.

Kuchuluka kwa chakudya chamagulu omwe munthu amalandila ndi chakudya, kudya zipatso, ndiwo zamasamba, mbewu zosiyanasiyana, buledi, pasitala, komanso, maswiti. Komabe, zakudya zamafuta zimakonda kunyamula mwachangu chifukwa chake, pakati pa chakudya, kuchuluka kwa glucose m'thupi kumayambiranso.

Poletsa dontho lakuthwa la shuga m'magazi, munthu amathandizira chiwindi, chomwe chimatulutsa glycogen yapadera, yomwe, ikalowa m'magazi, imasinthidwa kukhala glucose yoyera. Pakulowetsedwa bwino, kapamba amapanga insulini yaying'ono, yomwe imathandizira kukhala ndi mphamvu m'thupi.

Insulin yotereyi imatchedwa basal, ndipo kapamba imayiyika muyezo wa zigawo 24-28 patsiku, ndiye pafupifupi 1 unit. pa ola limodzi. Koma mwanjira imeneyi izi zimachitika mwa anthu athanzi okha, odwala matenda a shuga, insulini ya basal siisungidwe konse, kapena siziwoneka ndi ziwalo zamkati chifukwa chotukula insulin.

Pachifukwa ichi, odwala matenda ashuga amafunika jakisoni wa tsiku ndi tsiku wa basal kuti athandize kuyamwa glycogen komanso kupewa kuchuluka kwa shuga m'magazi. Chofunika kwambiri ndikusankha mulingo woyenera wa insulin ndi kuyigwiritsa ntchito pogwiritsa ntchito ma insulin afupikitsa nthawi yayitali.

Katundu wa basal insulin kukonzekera

Oyambira kapena, monga amatchedwanso, ma insulin oyambira kumbuyo ndi mankhwala osokoneza bongo kapena ochita zinthu kwa nthawi yayitali. Amapezeka ngati kuyimitsidwa komwe kumapangidwira jakisoni wongoganiza kokha. Kuyambitsa basulin insulin mu mtsempha kumakhala kofowoka.

Mosiyana ndi ma insulin omwe amangokhala osakhalitsa, ma insulin a basal samawonekera komanso amawoneka ngati madzi amtambo. Izi ndichifukwa choti ali ndi zosafunika zosiyanasiyana, monga zinc kapena protamine, zomwe zimasokoneza kuyamwa mwachangu kwa insulin ndipo potero imathandizira kuchitapo kanthu.

Pakasungidwa, zinthu zakudyazi zimatha kuwongolera, kotero, musanalowe jakisoni ayenera kukhala wosakanikirana ndi zinthu zina za mankhwalawa. Kuti muchite izi, gubuduzani botolo m'manja mwanu kapena mutembenuzire kangapo. Kugwedeza mankhwala koletsedwa.

Mankhwala amakono kwambiri, omwe amaphatikiza Lantus ndi Levemir, ali ndi mawonekedwe owonekera, popeza alibe zopanda pake. Kuchita kwa ma insulin kumeneku kunapitilira chifukwa cha kusintha kwa maselo a mankhwalawa, omwe samawalola kuti amwe mofulumira.

Kukonzekera kwa insulin ndi nthawi yayitali:

Kuchuluka kwa jakisoni wa basal insulin patsiku kumatengera mtundu wa mankhwala omwe amagwiritsidwa ntchito ndi odwala. Chifukwa chake mukamagwiritsa ntchito Levemir, wodwalayo ayenera kupanga jakisoni awiri a insulin patsiku - usiku komanso nthawi yayitali pakati pa chakudya. Izi zimathandizira kukhala ndi basulin insulin yambiri mthupi.

Kukonzekera kwa insulin kwakanthawi, monga Lantus, kumachepetsa jakisoni jakisoni imodzi patsiku. Pachifukwa ichi, Lantus ndi mankhwala otchuka kwambiri kwa odwala matenda ashuga. Pafupifupi theka la odwala omwe amapezeka ndi matenda a shuga amagwiritsa ntchito.

Momwe mungawerengere mlingo wa basal insulin

Insulin insal ndi yofunika kwambiri pakuwongolera odwala matenda ashuga. Ndikusowa kwa insulini yakumbuyo yomwe imayambitsa zovuta kwambiri mthupi la wodwalayo. Popewa kukula kwa ma pathologies omwe angakhalepo, ndikofunikira kusankha mulingo woyenera wa mankhwalawa.

Monga tafotokozera pamwambapa, mlingo wa insulin ya tsiku ndi tsiku uyenera kukhala wa 24 mpaka 28. Komabe, muyezo umodzi wa insulin yoyambira wabwino kwa odwala onse omwe alibe matenda a shuga kulibe. Aliyense wodwala matenda ashuga ayenera kudziwa kuchuluka kwa mankhwalawo.

Pankhaniyi, zinthu zambiri zosiyanasiyana ziyenera kukumbukiridwa, monga zaka za wodwalayo, kulemera kwake, kuchuluka kwa shuga m'magazi ndi zaka zingati zomwe akudwala matenda ashuga. Pokhapokha ngati izi, chithandizo chonse cha matenda a shuga chitha kukhala chothandizadi.

Kuti awerenge mlingo woyenera wa insulin, wodwalayo ayenera kudziwa kaye kuchuluka kwa thupi. Izi zitha kuchitika pogwiritsa ntchito njira iyi: Thupi lamphamvu = = (kg) / kutalika (m²). Chifukwa chake, ngati kukula kwa wodwala matenda ashuga ndi 1.70 m ndipo kulemera kwake ndi makilogalamu 63, ndiye kuti kuchuluka kwake kwa thupi kudzakhala: 63 / 1.70² (2.89) = 21.8.

Tsopano wodwala amafunika kuwerengetsa thupi lake labwino. Ngati index ya thupi lake lenileni ili pamtunda kuchokera pa 19 mpaka 25, ndiye kuti muwerenge kuchuluka kwabwino, muyenera kugwiritsa ntchito kalozera wa 19. Izi ziyenera kuchitika malinga ndi njira yotsatira: 1.70² (2.89) × 19 = 54.9≈55 kg.

Inde, kuti muwerenge kuchuluka kwa insulin ya basal, wodwalayo amatha kugwiritsa ntchito thupi lake lenileni, komabe, izi sizoyenera pazifukwa zingapo:

• Insulin imatanthauzira ma anabolic steroids, zomwe zikutanthauza kuti zimathandiza kuwonjezera kulemera kwa munthu. Chifukwa chake, kukula kwamlingo wa insulin, momwe wodwalayo angachiritsire;
• Kuchuluka kwa insulini ndizowopsa kuposa kuperewera kwawo, chifukwa kungayambitse kwambiri hypoglycemia. Chifukwa chake, ndibwino kuyamba ndi ochepa, kenako ndikuwonjezera pang'onopang'ono.

Mlingo wa insulin ya basal imatha kuwerengedwa pogwiritsa ntchito njira yosavuta, motere: Kulemera kwa thupi × 0,2, i.e. 55 × 0.2 = 11. Chifukwa chake, tsiku lililonse mlingo wa insulin woyambira uyenera kukhala magawo 11. Koma mawonekedwe oterewa samakonda kugwiritsidwa ntchito ndi anthu odwala matenda ashuga, chifukwa ali ndi zolakwika zambiri.

Palinso mtundu wina wovuta wowerengera kuchuluka kwa insulin ya maziko, omwe amathandiza kuti adziwe zoyenera. Kuti izi zitheke, wodwalayo ayenera kuwerengera muyeso wa insulin yonse ya tsiku ndi tsiku, basal ndi bolus.

Kuti adziwe kuchuluka kwa insulin yonse yomwe wodwala amafunikira tsiku limodzi, ayenera kuchulukitsa kulemera koyenera kwa thupi ndi chinthu chofanana ndi nthawi yayitali ya matenda ake:

1. Kuyambira chaka chimodzi mpaka zaka 5 - mgwirizano wa 0,5;
2. Kuyambira zaka 5 mpaka 10 - 0,7;
3. Zoposa zaka 10 - 0,9.

Chifukwa chake, ngati wodwalayo ali ndi makilogalamu 55, ndipo wakhala akudwala matenda ashuga kwa zaka 6, ndiye kuti awerenge kuchuluka kwake kwa insulin kuli kofunikira: 55 × 0.7 = 38.5. Zotsatira zomwe zimapezeka zimafanana ndi mulingo woyenera wa insulin tsiku lililonse.

Tsopano, kuchokera ku kuchuluka kwathunthu kwa insulini, ndikofunikira kupatula gawo lomwe liyenera kukhala pa insal insulin. Izi sizovuta kuchita, chifukwa monga mukudziwa, kuchuluka kwathunthu kwa insulin sikuyenera kupitirira 50% ya kuchuluka kwa insulin yokonzekera. Ndipo ndibwino kwambiri ngati zingakhale 30 40% ya mlingo watsiku ndi tsiku, ndipo 60 yotsalayo idzatengedwa ndi insulin.

Chifukwa chake, wodwalayo ayenera kuwerengera zotsatirazi: 38.5 ÷ 100 × 40 = 15.4. Powonjezera zotsatira zake, wodwalayo alandira mlingo woyenera kwambiri wa insulin, yomwe ndi magawo 15. Izi sizitanthauza kuti kumwayu sikufuna kusintha, koma kuyandikira kwambiri ku zosowa za thupi lake.

Momwe mungasinthire mlingo wa basal insulin

Pofuna kudziwa kuchuluka kwa insulini yakumbuyo zamankhwala pochiza matenda amishuga 1, wodwalayo ayenera kuyesa mayeso apadera oyambira. Popeza chiwindi chimapangitsa glycogen kuzungulira wotchi, muyezo woyenera wa insulin uyenera kuyesedwa usana ndi usiku.

Kuyesaku kumachitika kokha pamimba yopanda kanthu, kotero panthawi ya wodwalayo ayenera kukana kwathunthu kudya, kudumpha chakudya cham'mawa, lumbiro kapena chakudya chamadzulo. Ngati kusinthasintha kwa shuga m'magazi panthawi yoyesedwa sikupereka zoposa 1.5 mmol ndipo wodwala sakusonyeza zizindikiro za hypoglycemia, ndiye kuti mlingo woyambira wa insulin ndiwofunika.

Ngati wodwala anali ndi dontho kapena kuchuluka kwa shuga m'magazi, Mlingo wa insulin wakumbuyo umafunika kuwongoleredwa mwachangu. Kuchulukitsa kapena kuchepera kwa mankhwalawa sikuyenera kupitirira 2 mayunitsi. nthawi imodzi osaposa 2 pa sabata.

Chizindikiro china chomwe chimagwiritsidwa ntchito ndi wodwala nthawi yayitali chimagwiritsidwa ntchito ndi shuga m'magazi nthawi yayitali. Pankhaniyi, sayenera kupitirira malire a 6.5 mmol.

Kuchita mayeso oyambira usiku:

• Patsikuli, wodwalayo ayenera kudya chakudya cham'mawa momwe angathere. Ndi bwino ngati chakudya chomaliza chichitike osaposa 6 pm. Izi ndizofunikira kuti panthawi yoyeserera, zochita za insulin yochepa, zoperekedwa pakudya chamadzulo, zitheke. Monga lamulo, izi zimatenga pafupifupi maola 6.
• Nthawi ya 12 a.m., jakisoni amayenera kuperekedwa poyendetsa subcutaneous sing'anga (Protafan NM, InsumanBazal, Humulin NPH) kapena insulin yayitali (Lantus).
• Tsopano mukuyenera kuyeza shuga wamagazi maola awiri aliwonse (2 koloko, 4:00, 6:00 ndi 8:00), kuzindikira kusinthasintha kwake. Ngati sizidutsa 1.5 mmol, ndiye kuti mankhwalawa amasankhidwa molondola.
• Ndikofunikira kuti musaphonye kuchuluka kwa insulin, yomwe mankhwala osokoneza bongo amapezeka patatha pafupifupi maola 6. Ndi mlingo woyenera pakadali pano, wodwalayo sayenera kuchepa kwambiri m'magulu a shuga komanso kukula kwa hypoglycemia. Mukamagwiritsa ntchito Lantus, zinthuzi zitha kudumphidwa, popeza zilibe ntchito zapamwamba.
• Kuyesaku kuyenera kutha ngati, isanayambe, wodwalayo anali ndi hyperglycemia kapena kuchuluka kwa glucose kukwera pamwamba pa 10 mmol.
• Pamaso pa mayeso, palibe chifukwa muyenera kuchita jakisoni waifupi wa insulin.
• Ngati pakuyesa wodwalayo akhala akukumana ndi hypoglycemia, ziyenera kuyimitsidwa, ndiye kuyesedwa kuyenera kuyimitsidwa. Ngati shuga yamagazi, m'malo mwake, yakwera pamlingo wowopsa, muyenera kupanga jakisoni wochepa wa insulin yochepa ndikulepheretsa mayeso mpaka tsiku lotsatira.
• Kukonza molondola kwa insulin ya basal ndikotheka pokhapokha pazotsatira zitatu zotere.

Kuchita zoyesa masana masana:

• Kuti muchite izi, wodwalayo ayenera kusiyiratu kudya m'mawa ndipo m'malo mwa insulin yochepa, jekeseni insulin.
• Tsopano wodwalayo ayenera kuyang'ana kuchuluka kwa shuga m'magazi ola lililonse asanadye chakudya chamadzulo. Ngati idagwa kapena kuchuluka, mulingo wa mankhwalawa uyenera kusinthidwa;
• Tsiku lotsatira, wodwalayo ayenera kudya chakudya cham'mawa nthawi zonse ndikupanga jakisoni wa insulin yochepa komanso yapakati.
• Chakudya chamasana ndi kuwombera kwina kwa insulin yayifupi kuyenera kudumphidwa. Maola 5 mutatha kadzutsa, muyenera kuyang'ana shuga wanu wamagazi koyamba.
• Kenako, wodwalayo ayenera kuyang'ana kuchuluka kwa shuga m'thupi ola lililonse mpaka chakudya chamadzulo. Ngati palibe kupatuka kwakukulu kunawonedwa, mulingo woyenera.

Kwa odwala omwe amagwiritsa ntchito insulin Lantus ya matenda ashuga, palibe chifukwa chochitira tsiku lililonse mayeso. Popeza Lantus ndi insulin yayitali, iyenera kuperekedwa kwa wodwala kamodzi kokha patsiku, asanagone. Chifukwa chake, ndikofunikira kuyang'ana kuchuluka kwake pamlingo wokha usiku.

Zambiri zamitundu ya insulin zimaperekedwa mu kanema munkhaniyi.