Njira zapamwamba kwambiri zochizira matenda amtundu wa shuga 1 zimaphatikizapo insulin. Zimaphatikiza njira zomwe zimayenerera kulipira zovuta za carbohydrate metabolism mu shuga ndikuperekera kukonzekera kwa insulin.
Mankhwala a insulin a matenda a shuga komanso matenda ena amisala amawonetsa zotsatira zabwino zamankhwala.
tiyeni tiwone komwe njirayi imagwiritsidwa ntchito
- Chithandizo cha odwala omwe ali ndi matenda a shuga omwe amadalira insulin.
- Njira zosakhalitsa zochizira matenda amitundu iwiri. Nthawi zambiri amatchulidwa wodwala akamachita opaleshoni chifukwa cha matenda opatsirana oyambitsidwa ndi ma virus komanso matenda ena.
- Chithandizo cha odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, ngati mankhwala ochepetsa shuga alibe ntchito.
- Anthu odwala matenda ashuga ketoacidosis (omwe ali ndi zovuta za matenda a shuga) odwala matenda ashuga nthawi zambiri amawonedwa.
- Chithandizo cha Schizophrenia.
Kuphatikiza apo, thandizo loyambirira la odwala matenda ashuga lingafunike.
Njira zochizira matenda a insulin zitha kuphunziridwa m'buku la "Virtuoso Insulin Therapy" lolemba a Jorge Kanales. Nkhaniyi yaphatikiza zonse zokhudza matenda zomwe zadziwika masiku ano, mfundo za matenda ndi zina zambiri zothandiza.
Folio iyi imalimbikitsidwa kuti iwerengere odwala omwe ali ndi matenda ashuga, kuti anthuwa athe kudziwa njira yoyenera yothandizira matenda awo ndikudziwa malamulo oyambira ndi kapangidwe ka chithandizo cha insulin.
Mitundu ya Insulin Therapy
Ngati wodwala alibe vuto la kunenepa kwambiri ndipo samakhala ndi nkhawa kwambiri, insulin imayikidwa mu ½ - 1 unit 1 nthawi patsiku malinga ndi 1 kg ya thupi. Nthawi yomweyo, insulin yokwanira imakhala ngati yoyendetsa chinsinsi cha mahomoni.
Malamulo a insulin chithandizo amafunika kukwaniritsidwa kwa zinthu izi:
- mankhwala ayenera kuperekedwa kwa wodwala muyezo wokwanira kugwiritsa ntchito shuga;
- insulin yakunja iyenera kukhala kutsanzira kwathunthu kwa secretion ya basal, ndiye kuti kapamba amatulutsa (kuphatikiza mfundo yapamwamba kwambiri atatha kudya).
Zofunikira zomwe zatchulidwa pamwambapa zimafotokozera mtundu wa insulin mankhwala, momwe mlingo wa tsiku ndi tsiku umagawidwira kukhala wautali kapena wosakhalitsa.
Ma insulin aatali nthawi zambiri amathandizidwa m'mawa ndi madzulo ndipo amayeserera mwamphamvu zochita zogwiritsira ntchito kapamba.
Kumwa insulini yochepa ndikofunikira mukatha kudya zakudya zopatsa mphamvu. Mlingo wa insulin yamtunduwu umatsimikiziridwa payekhapayekha ndipo umatsimikiziridwa ndi kuchuluka kwa ma XE (magawo a mkate) pachakudya chopatsidwa.
Kuchita zachikhalidwe insulin mankhwala
Njira yophatikiza ya mankhwala a insulin imaphatikizira kuyanjana kwa insulin yonse mu jakisoni imodzi ndipo imatchedwa setso insulin. Ubwino waukulu wa njirayi ndikuchepetsa kuchuluka kwa jakisoni pang'ono (1-3 patsiku).
Choipa cha mankhwala a insulini yachikhalidwe ndikuchepa kwa kuthekera kwa kutsanzira kwathunthu kwachilengedwe cha kapamba. Zolakwika izi sizimalola kuperekera kwathunthu chakudya cha odwala omwe ali ndi matenda 1 a shuga, chithandizo cha insulin pamenepa sichithandiza.
Njira yophatikizira mankhwala a insulin pankhaniyi imawoneka ngati iyi: wodwalayo amalandira jakisoni 1-2 patsiku, nthawi yomweyo amadzibaya ndi kukonzekera kwa insulini (izi zimaphatikizapo ma insulin apafupi komanso osakhalitsa).
Kutalika kwapakatikati kumapangitsa inshuwaransi pafupifupi 2/3 ya kuchuluka kwa mankhwalawa, 1/3 ya insulin yayifupi.
Ndikofunikira kunena za pampu ya insulin. Pampu ya insulin ndi mtundu wa zida zamagetsi zomwe zimapereka insulin nthawi zonse panthawi yopanga nthawi yayitali kapena yochepa.
Njira imeneyi imatchedwa pump insulin therapy. Pampu ya insulin imagwira ntchito m'njira zosiyanasiyana zoperekera mankhwala.
Mitundu ya Insulin Therapy:
- Kupitiliza kosalekeza kwa mahomoni a pancreatic omwe ali ndi microdoses yoyendetsa kuthamanga kwa thupi.
- Kuthamanga kwa Bolus - wodwalayo amatha kukonza kuchuluka ndi kuchuluka kwa mankhwala a insulini ndi manja ake.
Akalembetsedwa koyamba akaigwiritsa ntchito, inshuwaransi yakumbuyo imayesedwa, zomwe zimapangitsa kuti pakhale kusintha kwa mankhwalawa kwa nthawi yayitali. Kugwiritsidwa ntchito kwa regimen yachiwiri ndikofunikira musanadye kapena panthawi yomwe index ya glycemic ikwera.
Momwe mawonekedwe a bolus amayatsidwa, chithandizo chogwiritsira ntchito insulin chimapereka mwayi wosintha insulin yamitundu yosiyanasiyana.
Zofunika! Ndi kuphatikiza kwa mitundu yomwe ili pamwambapa, kuyerekeza kwakukulu kwazomwe zimachitika pachitetezo cha insulin ndi kapamba wamoyo ndizotheka. Wopereka catheter ayenera kusintha osachepera 1 nthawi yachitatu.
Kugwiritsa ntchito njira zamankhwala a insulin a matenda a shuga 1
Malangizo a odwala omwe ali ndi matenda a shuga 1 amathandizira kuti ayambe kugwiritsidwa ntchito ndi mankhwala oyambira 1-2 patsiku, ndipo asanadye - chakudya. Mtundu woyamba wa matenda ashuga, mankhwala a insulini amayenera kusintha kwathunthu kupangika kwa mahomoni omwe amapanga kapamba wa munthu wathanzi.
Kuphatikiza kwa mitundu yonseyi kumatchedwa "maziko-bolus therapy", kapena regimen yokhala ndi jakisoni angapo. Imodzi mwa mitundu ya mankhwalawa ndi othandiza kwambiri ku insulin.
Chiwembu ndi Mlingo, poganizira umunthu wake ndi zovuta zake, wodwala ayenera kusankha dokotala. Mankhwala oyambira amakhala ndi 30-50% ya okwanira tsiku lililonse. Kuwerengera kwa inshuwaransi yoyenera kuchuluka kwa insulin kumawonekera payekha.
Chithandizo cha matenda a shuga a 2
Chithandizo cha odwala matenda ashuga a mtundu 2 chimafunika chiwembu. Chofunika cha mankhwalawa ndikuti Mlingo wocheperako wa insulin amawonjezedwa pang'onopang'ono ku mankhwala ochepetsa shuga a wodwala.
Kwa nthawi yoyamba yomwe amakumana ndi kukonzekera koyambira, komwe kumapangidwira m'njira yopanda insulin (mwachitsanzo, insulin glargine), odwala ayenera kuyima pa 10 IU patsiku. Makamaka, jakisoni amaperekedwa nthawi yomweyo.
Ngati matenda a shuga akupitiliza kuyenda komanso kuphatikiza kwa mankhwala ochepetsa shuga (mawonekedwe a piritsi) ndi jakisoni wa basal samatsogolera pazotsatira zomwe zikufunidwa, mwanjira iyi, adokotala asankha kusamutsa kwathunthu wodwalayo kuma regimen.
Nthawi yomweyo, kugwiritsa ntchito mankhwala osiyanasiyana kumalimbikitsidwa, koma aliyense wa iwo ayenera kuvomerezedwa ndi adokotala.
Ana ndi gulu lapadera la odwala, chifukwa chake chithandizo cha insulini chokhudza matenda a shuga a ana nthawi zonse chimafunikira munthu payekha. Nthawi zambiri, pochizira ana, amagwiritsa ntchito maulamu atatu a insulin. Kuchepetsa kuchuluka kwa jakisoni kwa odwala ang'onoang'ono, kuphatikiza kwa mankhwala omwe amakhala ndi nthawi yochepa komanso yapakatikati kumachitika.
Ndikofunika kwambiri kuti mukwaniritse chiwembu chophweka chomwe mungathe kubwezeretsanso zabwino. Kuchuluka kwa jakisoni wa insulin sikukhudza kusintha kwa shuga m'magazi. Ana opitirira zaka 12 amatchulidwa kuti azichita insulin kwambiri.
Kuzindikira kwa ana kuti apange insulini ndikwambamwamba kuposa kwa odwala akuluakulu, motero kusintha kwa mankhwalawa kuyenera kuchitika m'magawo. Kusintha kwamitundu yambiri ya mahomoni kuyenera kuyikidwa mu ziwalo ziwiri nthawi imodzi. Mulingo wovomerezeka wa nthawi imodzi ndi zigawo zinayi.
Tcherani khutu! Zimatenga masiku angapo kuti mumvetsetse ndikusintha zotsatira zake. Koma madokotala mwapadera samalimbikitsa kuti nthawi yomweyo musinthe mankhwalawa m'mawa ndi madzulo.
Chithandizo cha insulin pa nthawi ya pakati
Chithandizo cha matenda osokoneza bongo pa nthawi ya bere cholinga chake ndi kusungitsa ndende ya magazi, yomwe iyenera kukhala:
- M'mawa pamimba yopanda kanthu - 3.3-5.6 mmol / l.
- Mutatha kudya, 5.6-7.2 mmol / L.
Kutsimikiza kwa shuga m'magazi kwa miyezi 1-2 kumakupatsani mwayi wowunika momwe mankhwalawo amathandizira. Kagayidwe kachakudya mthupi la mayi wapakati ndi chododometsa kwambiri. Izi zimafunikira kukonzanso pafupipafupi kwa regimen (regimen) ya insulin.
Kwa amayi apakati omwe ali ndi matenda a shuga 1, chithandizo cha insulin chimayikidwa motere: pofuna kupewa m'mawa ndi pambuyo pa hyperglycemia, wodwalayo amafunika jekeseni osachepera awiri patsiku.
Insulin yochepa kapena yapakati imayendetsedwa isanayambike chakudya cham'mawa choyamba komanso asanadye chakudya chomaliza. Mlingo wophatikiza ungagwiritsidwenso ntchito. Mlingo wa tsiku ndi tsiku uyenera kugawidwa moyenera: 2/3 ya voliyumu yonse imakonzekera m'mawa, ndipo gawo 1/3 - asanadye chakudya chamadzulo.
Popewa usiku ndi m'mawa hyperglycemia, mlingo "musanadye" umasinthidwa kukhala jakisoni wopangidwa asanagone.
Insulin pochiza matenda amisala
Nthawi zambiri, insulin m'matenda amisala imagwiritsidwa ntchito pochiza matenda a schizophrenics. M'mawa pamimba yopanda kanthu, wodwalayo amapatsidwa jakisoni woyamba. Mlingo woyambirira ndi magawo anayi. Tsiku ndi tsiku limachulukitsidwa kuchokera kumagawo anayi mpaka asanu ndi atatu. Chiwembuchi chili ndi mawonekedwe: Loweruka ndi Lamlungu (Loweruka, Lamlungu) musamamwe jakisoni.
Pachigawo choyamba, chithandizo chokhazikika chimapangitsa wodwala kukhala wa hypoglycemia pafupifupi maola atatu. Kuti achepetse kuchuluka kwa shuga, wodwalayo amapatsidwa tiyi wotsekemera, womwe umakhala ndi pafupifupi magalamu 150 a shuga. Kuphatikiza apo, wodwalayo amapatsidwa chakudya cham'mawa chambiri. Mwazi wamagazi pang'onopang'ono umabwerera mwakale ndipo wodwalayo amabwerera mwakale.
Pa gawo lachiwiri la chithandizo, mlingo wa mankhwalawa womwe umaperekedwa umawonjezeka, womwe umalumikizidwa ndi kuwonjezeka kwa kuzindikira kwa wodwalayo. Pang'onopang'ono, kudabwitsaku kumayamba kusinthika (kuzunzidwa). Kuwonongeka kwa hypoglycemia kumayamba pafupifupi mphindi 20 pambuyo pa kuyamba kwa sopor.
Wodwalayo amabweretsedwa kumalo abwinoko ndi dontho. Amabayidwa kudzera m'mitsempha 20 mg ya 40% ya shuga. Wodwala akayambanso kuzindikira, amapatsidwa madzi kuchokera ku shuga (150-200 g ya mankhwala ku chikho cha madzi ofunda), tiyi wokoma ndi chakudya cham'mawa chopatsa thanzi.
Gawo lachitatu la chithandizo ndikupitiliza kuwonjezeka kwa tsiku ndi tsiku kwa insulin, yomwe imapangitsa kuti pakhale kusiyana pakati pa stupor ndi chikomokere. Matendawa sangathe kupitirira mphindi 30, pambuyo pake kuimitsidwa kwa matenda a hypoglycemia kuyimitsidwa. Dongosolo lochotseka ndi lofanana ndi lakale lomwe, ndiye kuti, lomwe limagwiritsidwa ntchito mu gawo lachiwiri.
Njira iyi ya mankhwalawa imakhudza magawo 20-30 pomwe comorbid coma imatheka. Pambuyo poti chiwerengero chofunikira chazovuta ngati izi zitheke, mlingo wa mahomoni tsiku ndi tsiku umachepetsedwa, kufikira utatha.
Kodi insulin imathandizidwa bwanji?
Chithandizo cha insulin chimachitika mogwirizana ndi dongosolo lotsatirali:
- Musanapange jekeseni wapansipansi, tsamba lamalowo limapindika.
- Kudya pambuyo jakisoni sikuyenera kupitilira theka la ola.
- Mlingo waukulu kwambiri sungadutse mayunitsi 30.
Munthawi zonsezi, dongosolo lenileni la insulin liyenera kukhala dokotala. Posachedwa, zolembera za insulini zakhala zikugwiritsidwa ntchito pochiza, mutha kugwiritsa ntchito syringes yanthawi zonse ndi singano yochepa thupi kwambiri.
Kugwiritsa ntchito zolembera za syringe kumakhala koyenera pazifukwa zingapo:
- Chifukwa cha singano yapadera, kupweteka kwa jakisoni kumachepetsedwa.
- Kusavuta kwa chipangizocho kumakulolani kuti mupange jakisoni kulikonse komanso nthawi iliyonse.
- Mapensulo ena a syringe ali ndi mbale za insulin, zomwe zimapangitsa kuti mankhwalawa aphatikizidwe komanso kugwiritsa ntchito njira zosiyanasiyana.
Zomwe zimapangidwira mu insulin regimen yamtundu wa 1 komanso mtundu wa 2 wa shuga ndi motere:
- Asanadye chakudya cham'mawa, wodwalayo ayenera kupereka mankhwala osakhalitsa kapena a nthawi yayitali.
- Jakisoni wa insulin musanadye chakudya chamadzulo ayenera kukhala ndi mahomoni osakhalitsa.
- Jakisoni yemwe asanachitike chakudya chamadzulo amaphatikizapo insulin yochepa.
- Asanagone, wodwalayo ayenera kukonzekera kwa nthawi yayitali.
Pali madera angapo oyendetsera thupi la munthu. Kuchuluka kwa mankhwalawa kwa mankhwala m'gawo lililonse ndi kosiyana. Mimba imayamba kugwira chisonyezo ichi.
Ndi malo osankhidwa bwino, makonzedwe a insulin sangapereke zotsatira zabwino.
Mavuto a Insulin Therapy
Chithandizo cha insulin, monga china chilichonse, chimatha kukhala ndi zotsutsana komanso zovuta. Maonekedwe a thupi lawo siligwirizana pamalo a jakisoni ndi zitsanzo zowoneka bwino za zovuta za insulin.
Nthawi zambiri, kupezeka kwa matupi awonetsero kumalumikizana ndi kuphwanya teknoloji ndikukhazikitsa mankhwala. Izi zitha kukhala kugwiritsidwa ntchito ngati singano yolakwika kapena yowonda, insulin yambiri, malo olakwika a jakisoni, ndi zina.
Kutsika kwa kuchuluka kwa shuga m'magazi ndikutukuka kwa hypoglycemia ndizomwe zimayambitsa matenda, zomwe zimawonetsedwa ndi zizindikiro zotsatirazi:
- kumva kwamphamvu kwa njala;
- thukuta;
- kugwedezeka kwamiyendo;
- tachycardia.
Vutoli limatha kupweteka chifukwa cha kuchuluka kwa mankhwala a insulin kapena kufa nthawi yayitali. Nthawi zambiri, hypoglycemia imayamba chifukwa cha kusangalala m'maganizo, kupsinjika, kapena kugwira ntchito zolimbitsa thupi.
Vuto linanso la mankhwala a insulin ndi lipodystrophy, limodzi ndi kutha kwa gawo logundana lamafuta pamalo opaka jekeseni. Popewa izi, wodwalayo asinthe malo a jakisoni, koma pokhapokha ngati izi sizikulepheretsa kuthandizira.
