Muluble human insulin analogue yokhala ndi mphamvu yayitali (chifukwa chodziphatika mwamphamvu ndi insulir insulin mamolekyulu m'dera loyang'anira ndi kulumikizana kwa maselo am'mankhwala omwe ali ndi albumin polumikizana ndi acid-fat acid acid unyolo) wokhala ndi mawonekedwe osasunthika (osasinthika poyerekeza ndi insulin glargine ndi isofan) .
Poyerekeza ndi insulin-isofan, insulin detemir imabalalika pang'onopang'ono mu tinthu tomwe tikufuna kutsimikizira, zomwe zimapangitsa kuti timalowe ndi zipatso komanso zofunikira za wothandizira. Kuchita bwino ndi receptor ya membala wamkati wa cytoplasmic cell kumadziwika.
Mankhwalawa amapanganso zovuta za insulin-receptor zomwe zimayambitsa zomwe zimachitika mkati mwa maselo, kuphatikiza zimathandizira kaphatikizidwe kazinthu zina zazikulu (mwachitsanzo, syntlyase ya glycogen).
Kutsika kwa shuga m'magazi kumayambitsidwa ndi:
- kuchuluka kwa mayendedwe ake mkati mwa maselo;
- kutsegula kwa glycogenogeneis, lipogeneis;
- kuchuluka kugaya kwamisempha;
- kutsika kwa kuchuluka kwa shuga m'magazi.
Pambuyo jakisoni wa mankhwalawa (mayunitsi 0,2-0.4 / kg 50%), nsonga ya kukonzekera imatheka pambuyo pa maola 3-4 ndipo imatha mpaka maola 14. Kutalika kwa izi mpaka tsiku limodzi.
TCmax - kuyambira 6 mpaka 8 maola. Css, malinga ngati imathandizidwa kawiri tsiku lililonse, imatha kupezeka jakisoni wachiwiri. Kugawitsako ndi 0,1 l / kg.
Metabolism imafanana ndi kagayidwe ka insulin yaumunthu, ma metabolites onse opangidwa amangokhala chabe. T1 / 2 kuyambira maola 5 mpaka 7.
Kuchita ndi njira zina
Kulimbikitsa zochita za hypoglycemic kumathandizira:
- Mankhwala omwe ali ndi ethanol;
- mankhwala a hypoglycemic (mkamwa);
- Li +;
- Mao zoletsa;
- fenfluramine,
- ACE zoletsa;
- cyclophosphamide;
- kaboni anhydrase zoletsa;
- theophylline;
- osasankha beta-blockers;
- pyridoxine;
- bromocriptine;
- mebendazole;
- sulfonamides;
- ketonazole;
- othandizira a anabolic;
- onjezerani;
- manzeru.
Mankhwala ochepetsa Hypoglycemic
Nicotine, njira zakulera (pakamwa), ma corticosteroids, phenytoin, mahomoni a chithokomiro, morphine, thiazide diuretics, diazoxide, heparin, calcium blockchain (slow), antidepressants triceclic, clonidine, danazole ndi sympathomimets amachepetsa mphamvu ya hypoglycemic.
Ma salicylates ndi reserpine amatha kuwonjezera kapena kuchepetsa mphamvu zomwe zimapangitsa kuti insulini ikhale ndi insulin. Lanreotide ndi octreotide zimachulukitsa kapena kuchepa kwa insulini.
Tcherani khutu! Beta-blockers, chifukwa cha mawonekedwe ake apadera, nthawi zambiri amabisa zizindikiro za hypoglycemia ndikuchedwa kubwezeretsanso kuchuluka kwa shuga.
Mankhwala okhala ndi Ethanol amalimbikitsa ndikuwonjezera mphamvu ya insogulculin. Mankhwalawa sagwirizana ndi mankhwala ozikidwa pa sulfite kapena thiol (insulin detemir awonongedwa). Komanso, mankhwalawa sangaphatikizidwe ndi mayankho a kulowetsedwa.
Malangizo apadera
Simungathe kulowa m'malingaliro owonongera, chifukwa mawonekedwe a hypoglycemia angayambike. Kuchiza kwambiri ndi mankhwalawa sikuthandizira pakuphatikiza mapaundi owonjezera.
Poyerekeza ndi ma insulin ena, insulin detemir imachepetsa chiwopsezo cha hypoglycemia usiku ndipo imathandizira kusankha kwakukulu kwa mlingo womwe umakwaniritsidwa kuti pakhale kuchuluka kwa shuga m'magazi.
Zofunika! Kuyimitsa mankhwala kapena mlingo wolakwika wa mankhwalawo, makamaka mtundu wa matenda a shuga I, amathandizira kuwoneka kwa hyperglycemia kapena ketoacidosis.
Zizindikiro zazikulu za hyperglycemia zimachitika makamaka m'magawo. Amawoneka m'maola ochepa kapena masiku. Zizindikiro za hyperglycemia ndi monga:
- kununkhira kwa acetone atatha kutulutsa mpweya;
- ludzu
- kusowa kwa chakudya;
- polyuria;
- kumverera kowuma pamlomo wamkamwa;
- nseru
- khungu lowuma
- kuthawa;
- hyperemia;
- kugona kosalekeza.
Kuchita masewera olimbitsa thupi mwadzidzidzi komanso mwamphamvu, komanso kudya mosazolowereka kumathandizanso kuti hypoglycemia ikhale yabwino.
Komabe, atayambiranso kagayidwe kazakudya, mawonekedwe a chizindikiro cha hypoglycemia angasinthe, kotero wodwalayo ayenera kudziwitsidwa ndi adokotala. Zizindikiro zake zimachepetsa matenda a shuga. Matenda opatsirana omwe amaphatikizana amathandizanso kufunikira kwa insulin.
Kusamutsa wodwala kupita ku mtundu wina kapena insulin, yopangidwa ndi wopanga wina, nthawi zonse imachitika moyang'aniridwa ndi achipatala. Pakusintha kwa wopanga, mlingo, mtundu, mtundu kapena njira yopangira insulin, kusintha kwa mlingo kumafunika nthawi zambiri.
Odwala omwe amapitidwira ku chithandizo chomwe insulir ya insulin imagwiritsidwa ntchito nthawi zambiri imafuna kusintha kwa mlingo poyerekeza ndi kuchuluka kwa insulin yomwe idaperekedwa kale. Kufunika kusintha kwa mankhwalawa kumawonekera pambuyo pobweretsa jakisoni woyamba kapena mkati mwa sabata kapena mwezi. Njira mayamwidwe mankhwala ngati mu mnofu makonzedwe imathamanga kwambiri kuyerekeza ndi sc makonzedwe.
Detemir isintha mawonekedwe ake ochita ngati aphatikizidwa ndi mitundu ina ya insulin. Kuphatikiza kwake ndi insulin aspart kumabweretsa chidziwitso pazochita zochepa, zoyimitsidwa kwambiri poyerekeza ndi kayendetsedwe kosintha. Dermul wa Detemir suyenera kugwiritsidwa ntchito pamapampu a insulin.
Mpaka pano, palibe chidziwitso pakugwiritsa ntchito mankhwalawa panthawi ya pakati, kuyamwa ndi ana ochepera zaka zisanu ndi chimodzi.
Wodwalayo ayenera kuchenjeza za mwayi wa hyperglycemia ndi hypoglycemia poyendetsa galimoto ndikuwongolera njira. Makamaka, ndikofunikira kwa anthu omwe ali ndi zofowoka kapena zosakhalapo zomwe zimayambitsa hypoglycemia.
Zisonyezero zogwiritsira ntchito ndi Mlingo
Matenda a shuga ndi matenda akuluakulu omwe mankhwalawo akuwonetsedwa.
Ku kulowereraku kumachitika paphewa, pamimba pamimba kapena ntchafu. Malo omwe insulir ya insulin imalowetsedwa ayenera kusinthidwa pafupipafupi. Mlingo ndi pafupipafupi jakisoni zimakhazikitsidwa payekhapayekha.
Mukabayidwa kawiri kuti muwonjezere kuyamwa kwa shuga, ndikofunikira kuperekera mlingo wachiwiri pambuyo pa maola 12 itatha yoyamba, nthawi yamadzulo chakudya chamadzulo kapena musanagone.
Kusintha kwa Mlingo ndi nthawi yoyenera kutsata kungafunike ngati wodwalayo wasamutsidwa kuchokera kwa insulin yayitali komanso mankhwala osokoneza bongo mpaka kuyamba kunyansidwa ndi insulin.
Zotsatira zoyipa
Zotsatira zoyipa (1 mwa 100, nthawi zina 1 mwa 10) zimaphatikizapo hypoglycemia ndi zonse zomwe zimakhalapo: nseru, khungu, khungu, kuchuluka kwa chakudya, kusokonezeka, mantha am'mimba komanso matenda amtundu waubongo omwe angayambitse imfa. Zomwe zimachitika m'deralo (kuyabwa, kutupa, malo a jekeseni) ndizothekanso, koma ndizosakhalitsa ndipo zimatha panthawi yamankhwala.
Zotsatira zoyipa (1/1000, nthawi zina 1/100) zimaphatikizapo:
- jakisoni lipodystrophy;
- kutupa kwakanthawi komwe kumachitika kumayambiriro kwa chithandizo cha insulin;
- matupi awo saonekera (kuchepa kwa kuthamanga kwa magazi, urticaria, palpitations ndi kupuma movutikira, kuyabwa, kuperewera kwa chakudya cham'mimba, hyperhidrosis, etc.);
- koyambirira kwa mankhwala a insulin, kuphwanya kwakanthawi kochepa komwe kumachitika;
- matenda ashuga retinopathy.
Ponena za retinopathy, kuwongolera kwa glycemic kwa nthawi yayitali kumachepetsa mwayi wokhala ndi matenda, koma insulini yolimbitsa thupi ndi kuwonjezeka mwadzidzidzi kwa kayendedwe ka metabolism kungayambitse kuvuta kwakanthawi kwa boma la matenda ashuga.
Zowopsa kwambiri (1/10000, nthawi zina 1/1000) zoyipa zimaphatikizapo zotumphukira neuropathy kapena ululu wammbuyo, womwe nthawi zambiri umasinthidwa.
Bongo
Chizindikiro chachikulu cha mankhwala osokoneza bongo ndi hypoglycemia. Wodwalayo amatha kuchotsa mtundu wa hypoglycemia pawokha mwa kudya shuga kapena chakudya chamagulu.
Olw'okulwanyisa obukyayi s / c, i / m yaweebwa 0.5-1 mg wa glucagon oba eddirogosi eddamu mu / /. Ngati pambuyo pa mphindi 15 mutatha kudya glucagon, wodwalayo sanayambenso kudziwa, ndiye kuti yankho la dextrose liyenera kuperekedwa. Munthu akayambanso kuzindikira pofuna kupewa, ayenera kudya zakudya zokhala ndi chakudya.
