Chithandizo cha matenda ashuga ali m'malo obwezeretsanso mankhwala. Popeza insulini yeniyeni singathe kuthandiza kuyamwa kwa magazi m'magazi, ake analogue oyambitsa amayamba. Ndi matenda a shuga amtundu woyamba, iyi ndiyo njira yokhayo yolimbikitsira thanzi la odwala.
Pakadali pano, zikuwonetsa kuchuluka kwa mankhwalawa pokonzekera ma insulin, popeza mothandizidwa ndi iwo ndizotheka kuchepetsa shuga mu mtundu 2 wa matenda ashuga, wokhala ndi matenda opatsirana, pakati komanso njira zopangira opaleshoni.
Kuchita mankhwala a insulin kuyenera kufanana ndi zachilengedwe ndikupanga insulin kuchokera ku kapamba. Pachifukwa ichi, sikuti amangogwiritsa ntchito ma insulin okhazikika pokhapokha, komanso omwe amakhala nthawi yayitali, komanso insulin.
Malamulo a insulin
Ndi insulin yodziwika bwino ya insulin, imakhala m'magazi nthawi zonse monga mtundu woyambira (maziko). Amapangidwa kuti achepetse mphamvu ya glucagon, yomwe imapanganso maselo a alpha popanda kusokoneza. Kubisala kwakanthawi kochepa - pafupifupi 0,5 kapena 1 unit ola lililonse.
Kuwonetsetsa kuti insulini yofunikira kwambiri imapangidwa mwa odwala omwe ali ndi matenda osokoneza bongo, ogwiritsira ntchito mankhwala kwa nthawi yayitali amagwiritsidwa ntchito. Izi zikuphatikiza insulin Levemir, Lantus, Protafan, Tresiba ndi ena. Insulin yolimba-imatulutsidwa kamodzi kapena kawiri pa tsiku. Ikaperekedwa kawiri, nthawiyo ndi maola 12.
Mlingo wa mankhwalawa umasankhidwa payekhapayekha, popeza kufunika kwa insulin usiku kumatha kukhala kokulirapo, ndiye kuti mlingo wamadzulo umachulukitsidwa, ngati pakufunika kutsika kwabwino masana, ndiye kuti mlingo waukulu umasamutsidwa kumawa. Mlingo wonse wa mankhwala omwe amalandiridwa umatengera kulemera, zakudya, zolimbitsa thupi.
Kuphatikiza pa kut katemera wam'mbuyo, kupanga kwa insulini pazakudya zambiri kumapangidwanso. Mwazi wamagazi ukamakwera, kaphatikizidwe kamatenda ndi katulutsidwe ka insulin kamayamba kuyamwa chakudya. Nthawi zambiri, 12 g yamafuta amafunikira magawo awiri a insulin.
Monga cholowa m'malo mwa "chakudya" cha insulin, chomwe chimatsitsa hyperglycemia mutadya, mankhwalawa amagwiritsidwa ntchito mwachidule (Actrapid) ndi Ultra-Short (Novorapid) amagwiritsidwa ntchito. Ma insulini oterewa amaperekedwa katatu patsiku musanadye chakudya chachikulu chilichonse.
Insulin yochepa imafunikira chakudya pambuyo pake patatha maola awiri. Ndiye kuti, ndikuwonetsa nthawi 3, muyenera kudya zina katatu. Kukonzekera kwa Ultrashort sikufuna kudya kwapakatikati. Zochita zawo zapamwamba zimakuthandizani kuti muzitha kuyamwa zakudya zomwe adalandira ndi chakudya chachikulu, pambuyo pake ntchito yawo imatha.
Mitundu yayikulu yotsata insulin ikuphatikiza:
- Chachikhalidwe - choyamba, mlingo wa insulini amawerengedwa, kenako chakudya, chakudya m'matimu, zochitika zolimbitsa thupi zimasinthidwa kuti zitheke. Tsiku limakonzekera kwathunthu ndi ora. Palibe chomwe chingasinthidwe mmenemo (kuchuluka kwa chakudya, mtundu wa chakudya, nthawi yolowa).
- Cholimba - insulini imasinthana ndi boma la tsikulo ndikupereka ufulu wopanga dongosolo la insulin yoyendetsera zakudya ndi zakudya.
Njira yochizira kwambiri ya insulini imagwiritsa ntchito zonse zakumaso - zowonjezera insulin kamodzi kapena kawiri pa tsiku, komanso yochepa (ultrashort) musanadye.
Levemir Flexpen - katundu ndi mawonekedwe a ntchito
Levemir Flexpen amapangidwa ndi kampani yopanga mankhwala Novo Nordisk. Fomu yotulutsayo ndimadzuwa osapaka utoto, omwe cholinga chake ndi kupaka jekeseni wamkati.
Kapangidwe ka insulin Levemir Flexpen (analog ya insulin ya anthu) akuphatikizira ntchito yogwira - detemir. Mankhwalawa amapangidwa kuchokera ku genetic engineering, zomwe zimapangitsa kuti azitha kupereka mankhwala kwa odwala omwe ali ndi ziwengo kuti apange insulin ya nyama.
Mu 1 ml ya Levemir insulin ili ndi 100 PIECES, yankho limayikidwa mu cholembera, lomwe lili ndi 3 ml, ndiye kuti, 300 PIERES. Mu phukusi la zolembera 5 pulasitiki zotayika. Mtengo wa Levemir FlekPen ndiwokwera pang'ono kuposa mankhwala omwe amagulitsidwa m'mak cartridge kapena m'mabotolo.
Malangizo ogwiritsira ntchito Levemir akuwonetsa kuti insulin iyi ikhoza kugwiritsidwa ntchito ndi odwala omwe ali ndi mtundu woyamba komanso wachiwiri wa matenda osokoneza bongo, komanso kuti ndibwino kupezanso chithandizo chamankhwala a shuga mwa amayi apakati.
Kafukufuku wokhudza momwe mankhwalawa amathandizira odwala amapezeka. Pakaperekedwa kamodzi patsiku patatha milungu 20, kulemera kwa odwala kunawonjezeka ndi 700 g, ndipo gulu loyerekeza lomwe linalandira insulin-isophan (Protafan, Insulim) kuchuluka komweko kunali 1600 g.
Ma insulini onse amagawidwa m'magulu kutengera nthawi yomwe achitapo kanthu:
- Ndi ultrashort yotsitsa shuga - kumayambira kwa mphindi 10-15. Aspart, Lizpro, Khmumulin R.
- Zochita zazifupi - yambani pambuyo pa mphindi 30, nsonga pambuyo maola 2, nthawi yonse - maola 4-6. Actrapid, Farmasulin N.
- Nthawi yayitali yochita - maola 1.5 atayamba kutsika magazi, imafika pachimake patatha maola 4-11, zotsatira zimatha maola 12 mpaka 18. Insuman Rapid, Protafan, Vozulim.
- Kuphatikiza kachitidwe - ntchito imadziwonekera pakatha mphindi 30, nsonga ya 2 mpaka 8 maola kuyambira nthawi yoyang'anira, imatha maola 20. Mikstard, Novomiks, Farmasulin 30/70.
- Kuchitapo kanthu kwa nthawi yayitali kunayamba pambuyo pa maola 4-6, kuchuluka - maola 10-18, kutalika kwa zochitika mpaka tsiku. Gululi limaphatikizapo Levemir, Protamine.
- Insulin ya Ultra yotalika imagwira ntchito maola 36-42 - Tresiba insulin.
Levemir ndi insulin wautali wokhala ndi mbiri yabwino. Maonekedwe a mankhwalawa samasiyana poyerekeza ndi isofan-insulin kapena glargine. Kuchita kwa nthawi yayitali kwa Levemir ndi chifukwa chakuti mamolekyulu ake amapanga zovuta pamalo a jakisoni komanso amamangiriranso ku albumin. Chifukwa chake, insulin iyi imaperekedwa pang'onopang'ono kuzinthu zovuta.
Isofan-insulin adasankhidwa ngati chitsanzo pakuyerekeza, ndipo zidatsimikiziridwa kuti Levemir ali ndi kuyanjana kofananira kulowa m'magazi, komwe kumatsimikizira kuchitidwa kosalekeza tsiku lonse. Njira yotsitsa glucose imalumikizidwa ndikupanga insulin receptor zovuta pa membrane wa cell.
Levemir imakhudzanso zochita za metabolic:
- Imathandizira kaphatikizidwe ka michere mkati mwa selo, kuphatikiza mapangidwe a glycogen - glycogen synthetase.
- Amathandizira kayendedwe ka glucose mu cell.
- Imathandizira kupezeka kwa mamolekyulu am'magazi kuchokera kuzungulira magazi.
- Imalimbikitsa mapangidwe a mafuta ndi glycogen.
- Amalepheretsa kaphatikizidwe ka shuga m'chiwindi.
Chifukwa cha kusowa kwa chitetezo chazogwiritsira ntchito Levemir, sikulimbikitsidwa kwa ana osakwana zaka 2. Mukamagwiritsidwa ntchito mwa amayi apakati, sizinawonongeke pakapita nthawi yokhala ndi pakati, thanzi la mwana wakhanda, komanso kuwoneka kolakwika.
Palibe chidziwitso chokhudza makanda pakuyamwitsa, koma popeza ndi a gulu la mapuloteni omwe amawonongeka mosavuta m'mimba ndikugaya m'matumbo, zitha kuganiziridwa kuti sizilowa mkaka wa m'mawere.
Momwe mungagwiritsire ntchito Levemir Flexpen?
Ubwino wa Levemir ndizomwe zimapangitsa kuti pakhale kuchuluka kwa mankhwalawa m'magazi nthawi yonse yochitapo kanthu. Ngati Mlingo wa 0,2-0.4 IU pa 1 makilogalamu wodwala umaperekedwa, ndiye kuti zotsatira zoyenera zimachitika pambuyo pa maola 3-4, kufika pamtunda ndikuchitika mpaka maola 14 pambuyo pokhazikitsa. Kutalika konse kokhala m'mwazi ndi maola 24.
Ubwino wa Levemir ndikuti ulibe chiwonetsero chazithunzithunzi, chifukwa chake, mukakhazikitsidwa, palibe chiopsezo cha shuga wambiri wambiri. Zinapezeka kuti chiopsezo cha hypoglycemia masana chimachitika osakwana 70%, ndikuwukiridwa ndi usiku ndi 47%. Kafukufuku adachitika kwa zaka ziwiri mwa odwala.
Ngakhale kuti Levemir imagwira ntchito masana, ndikulimbikitsidwa kuti muziwongolera kawiri kuti muchepetse ndikuwonetsetsa kuti shuga ya magazi ikhale yolimba. Ngati insulini imagwiritsidwa ntchito kuphatikiza ndi insulin yochepa, ndiye kuti imayendetsedwa m'mawa ndi madzulo (kapena pogona) ndikupumula kwa maola 12.
Pochizira matenda a shuga a 2, Levemir akhoza kutumikiridwa kamodzi komanso nthawi yomweyo kumwa mapiritsi ndi kuchepetsa shuga. Mlingo woyamba wa odwala otere ndi mayunitsi a 0-0-0.2 pa 1 makilogalamu amalemu. Mlingo wa wodwala aliyense amasankhidwa payekha, kutengera mtundu wa glycemia.
Levemir imayang'aniridwa pansi pa khungu la kunja kwa ntchafu, phewa, kapena pamimba. Tsamba la jakisoni liyenera kusinthidwa nthawi iliyonse. Kupereka mankhwala ndikofunikira:
- Gwiritsani ntchito chosankha cha mankhwala kuti musankhe nambala yamagulu omwe mukufuna.
- Ikani singano pamtundu wa khungu.
- Dinani batani "Yambani".
- Dikirani 6 - 8 masekondi
- Chotsani singano.
Kusintha kwa Mlingo kumakhala kofunikira kwa okalamba omwe ali ndi kuchepa kwa aimpso kapena kwa chiwindi, omwe ali ndi matenda othandizirana, kusintha kwa zakudya kapena kuchita zolimbitsa thupi. Ngati wodwalayo asamutsidwa kupita ku Levemir kuchokera ku ma insulin ena, ndiye kuti kusankhidwa kwa mlingo watsopano ndi kuwongolera glycemic koyenera ndikofunikira.
Kukhazikika kwa ma insulin omwe amakhala nthawi yayitali, omwe amaphatikiza Levemir, sikuchitika mothandizidwa ndi chiwopsezo cha mitundu yoopsa ya hypoglycemia. Ndi kukhazikitsidwa kwa intramuscularly, kuyambika kwa zomwe Levemir amadziwonetsa kale kuposa jekeseni wa subcutaneous.
Mankhwalawa sanapangidwe kuti azigwiritsa ntchito mapampu a insulin.
Zotsatira zoyipa pogwiritsa ntchito Levemir Flexpen
Zotsatira zoyipa za odwala omwe amagwiritsa ntchito Levemir Flexpen zimadalira mlingo wa mankhwalawa ndipo zimayamba chifukwa cha mankhwala a insulin. Hypoglycemia pakati pawo imachitika nthawi zambiri. Nthawi zambiri zimagwirizanitsidwa ndi kusankha kosayenera kwa mankhwalawa kapena kuperewera kwa zakudya m'thupi.
Kotero limagwirira a hypoglycemic zochita za insulin ku Levemir ndi otsika kuposa mankhwala omwewo. Ngati shuga wambiri m'magazi apezekanso, ndiye kuti izi zimachitika ndi chizungulire, kumverera kwachuma, ndi kufooka kwachilendo. Kuwonjezeka kwa zizindikiro kumatha kudziwonetsa mukusokonezeka kwa chikumbumtima komanso kukula kwa chikumbumtima cha hypoglycemic.
Zomwe zimachitika mdelalo zimachitika m'malo a jakisoni ndipo ndizakanthawi. Nthawi zambiri, redness ndi kutupa, kuyabwa kwa khungu. Ngati malamulo opereka mankhwalawa ndi jakisoni pafupipafupi samayikidwa pamalo amodzi, lipodystrophy imatha kukhazikika.
Zambiri pazomwe zimagwiritsidwa ntchito ndi Levemir zimachitika kawirikawiri ndipo zimawonetsa kukomoka kwa munthu. Izi zikuphatikiza:
- Edema m'masiku oyamba a mankhwalawa.
- Urticaria, totupa pakhungu.
- Matenda Am'mimba
- Kupuma kovuta.
- Kuyabwa kwadzaonekera kwa khungu.
- Angioneurotic edema.
Ngati mlingo ndi wochepa kuposa kufunika kwa insulin, ndiye kuti kuchuluka kwa shuga m'magazi kungayambitse kukula kwa matenda ashuga ketoacidosis.
Zizindikiro zimawonjezeka pang'onopang'ono kwa maola angapo kapena masiku: ludzu, nseru, kuchuluka kwamkodzo, kugona, kufooka kwa khungu, komanso kununkhira kwa acetone kuchokera mkamwa.
Kuphatikiza kwa levemir ndi mankhwala ena
Mankhwala omwe amathandizira kutsitsa kwa Levemir pa shuga ya magazi amaphatikiza mapiritsi a antidiabetes, Tetracycline, Ketoconazole, Pyridoxine, Clofibrate, Cyclophosphamide.
Mphamvu ya hypoglycemic imakonzedwa ndi kuphatikizika kwa mankhwala othandizira ena a antihypertensive, mankhwala a anabolic, ndi mankhwala omwe amakhala ndi ethyl mowa. Komanso mowa ku matenda ashuga ungapangitse kuwonjezeka kwa magazi kwa nthawi yayitali.
Corticosteroids, kulera kwapakamwa, mankhwala okhala ndi heparin, antidepressants, diuretics, makamaka thiazide diuretics, morphine, nikotini, Clonidine, kukula kwa mahomoni, calcium blockers ikhoza kufooketsa mphamvu ya Levemir.
Ngati reserpine kapena salicylates, komanso octreotide, amagwiritsidwa ntchito limodzi ndi Levemir, ndiye kuti ali ndi mphamvu zambiri, ndipo amatha kufooketsa kapena kuwonjezera mphamvu ya mankhwala a Levemir.
Kanemayo munkhaniyi akuwonetsa mwachidule za insulin Levemir Flexpen.
