Insulin analogues: cholowa m'malo anu mankhwalawo

Kuti muchepetse matenda a shuga m'mankhwala, ndimakonda kugwiritsa ntchito insulin analogues.

Popita nthawi, mankhwalawa atchuka kwambiri pakati pa madokotala ndi odwala awo.

Izi zitha kufotokozedwanso:

• zokwanira bwino za insulini popanga mafakitale;
• mbiri yayikulu chitetezo;
• ntchito mosavuta;
• kutengera kulumikizira jakisoni wa mankhwalawo ndi chinsinsi chake cha mahomoni.

Pakapita kanthawi, odwala omwe ali ndi matenda a shuga 2 amakakamizidwa kuti asinthe mapiritsi ochepetsa shuga m'magazi kuti alowe jakisoni wa insulin. Chifukwa chake, funso loti musankhe mankhwalawa ndiwofunika kwambiri.

Zokhudza insulin yamakono

Pali zolephera zina pakugwiritsira ntchito insulin ya anthu, mwachitsanzo, kuyang'ana pang'onopang'ono (wodwala matenda ashuga ayenera kupereka jakisoni kwa mphindi 30 mpaka 40 asanadye) komanso nthawi yayitali kwambiri yogwira (mpaka maola 12), yomwe imakhala chinthu chofunikira pakuchedwa kuchepa kwa hypoglycemia.

Kumapeto kwa zaka zana zapitazi, kufunikira kwakakulitsa mapangidwe a insulin omwe sangakhale opanda zophophonya izi. Ma insulin omwe amagwira ntchito mwachidule adayamba kupangidwa ndi kuchepetsedwa kwakukulu kwa theka-moyo.

Izi zinawabweretsa pafupi ndi mphamvu za insulin yakunja, yomwe imatha kulumikizidwa pambuyo pa mphindi 4-5 mutalowa m'magazi.

Mitundu ya insulin yopanda chopanda kanthu imatha kukhala yofanana komanso yodziwika bwino kuchokera ku mafuta osakanikirana ndipo osaputa hypoglycemia yausiku.

Zaka zaposachedwa, pakhala kusintha kwakukulu mu pharmacology, chifukwa akuti:

• kusintha kuchokera acidic yothetsera ndale;
• kupeza insulin yaumunthu pogwiritsa ntchito tekinoloje ya DNA;
• kupanga kwa insulin mmalo wapamwamba kwambiri ndi mawonekedwe atsopano a pharmacological.

Ma insulin analogi amasintha nthawi ya zochita za munthu mahomoni kuti apereke njira yodziwika yolumikizira matupi a anthu odwala matenda ashuga.

Mankhwalawa amathandizira kuti athe kukwaniritsa bwino pakati pa zoopsa zodontha m'magazi amwazi ndikwaniritsa glycemia yomwe mukufuna.

Mitundu yamakono ya insulin malinga ndi nthawi yomwe ikuchitika nthawi zambiri imagawidwa m'magulu:

1. ultrashort (Humalog, Apidra, Novorapid Penfill);
2. yayitali (Lantus, Levemir Penfill).

Kuphatikiza apo, pali mankhwala osakanikirana omwe amalowa m'malo mwake, omwe ali osakanikirana ndi mahashoni a ultrashort komanso mahomoni ena muyeso inayake: Penfill, Humalog mix 25.

Humalog (lispro)

Mu kapangidwe ka insulin iyi, malo a proline ndi lysine adasinthidwa. Kusiyana pakati pa mankhwalawa ndi insulin yaumunthu yamunthu ndi kuchepa kocheperako kwa mayanjano apakati. Poona izi, lispro imatha kumizidwa mwachangu kulowa m'magazi a munthu wodwala matenda ashuga.

Ngati muzibayira mankhwala omwe ali mgulu lomwelo komanso nthawi yomweyo, Humalog iperekanso msanga kwambiri 2 times mwachangu. Hormone iyi imachotsedwa mwachangu kwambiri ndipo patatha maola 4 kuyika kwake kumafika pachimake. Kukumana kwa insulin yaumunthu yosavuta kudzasungidwa mkati mwa maola 6.

Poyerekeza lispro ndi insulin yochepa yochita, titha kunena kuti zakale zingalepheretse kupanga kwa chiwindi ndi chiwindi kwambiri.

Palinso mwayi wina wa mankhwala a Humalog - ndiwodziwikiratu ndipo ungathe kuyambitsa kusintha kwa mankhwalawa muzakudya zopatsa thanzi. Zimadziwika ndi kusowa kwa kusintha kwakanthawi kofikira kuchokera pakuwonjezeka kwa kuchuluka kwa zinthu.

Kugwiritsa ntchito insulin yosavuta yaumunthu, kutalika kwa ntchito yake kumasiyanasiyana kutengera mlingo. Ndi chifukwa ichi kuti nthawi yayitali maola 6 mpaka 12 imayamba.

Ndi kuwonjezeka kwa mulingo wa insulin Humalog, kutalika kwa ntchito yake kumakhalabe pafupifupi pamlingo umodzi ndipo kudzakhala maola 5.

Pambuyo pake ndikuwonjezeka kwa mlingo wa lispro, chiopsezo cha kuchepa kwa hypoglycemia sichikula.

Aspart (Novorapid Penfill)

Mafuta a insulin amenewa angayerekezere bwino mayankho okwanira a insulin pakudya. Kutalika kwake kumapangitsa kuti pakhale zovuta pakati pa chakudya, zomwe zimapangitsa kuti pakhale gawo lathunthu pakulamulira shuga.

Ngati tifanizira zotsatira za mankhwalawa ndi ma insulin omwe ali ndi insulin wamba yodziwika bwino ya anthu, kuwonjezeka kwakukulu kwa kuwongolera kwa misempha ya shuga yaposachedwa.

Kuphatikiza mankhwala ndi Detemir ndi Aspart kumapereka mwayi:

• pafupifupi 100% imasintha mawonekedwe a tsiku lonse la insulin;
• kusintha moyenera mulingo wa glycosylated hemoglobin;
• kuchepetsa kwambiri mwayi wokhala ndi mikhalidwe ya hypoglycemic;
• sinthani matalikidwe ndi nsonga ya shuga m'magazi a odwala matenda ashuga.

Ndizofunikira kudziwa kuti panthawi ya mankhwala omwe ali ndi mankhwala a basal-bolus insulin, kuwonjezeka kwapakati pa thupi kunachepa kwambiri kuposa nthawi yonse yowonera mwamphamvu.

Glulisin (Apidra)

Anulin ya insulin ya munthu ndi mankhwala owonetsa pang'onopang'ono. Malinga ndi pharmacokinetic yake, mawonekedwe a pharmacodynamic ndi bioavailability, Glulisin ndi wofanana ndi Humalog. Mu ntchito yake ya mitogenic ndi metabolic, timadzi tambiri timasiyana ndi insulin yosavuta ya munthu. Chifukwa cha izi, ndizotheka kugwiritsa ntchito nthawi yayitali, ndipo ndizotetezeka kwathunthu.

Monga lamulo, Apidra iyenera kugwiritsidwa ntchito kuphatikiza ndi:

1. kuchuluka kwa insulin ya anthu kwakanthawi;
2. basal insulin analogue.

Kuphatikiza apo, mankhwalawa amadziwika ndi kuyamba mwachangu pantchito komanso nthawi yofupikirapo kuposa mahomoni abwinobwino amunthu. Zimapangitsa odwala omwe ali ndi matenda ashuga kuwonetsa kusinthasintha kwakukulu pakugwiritsa ntchito ndi chakudya kuposa mahomoni amunthu. Insulin imayamba kugwira ntchito yake atangoyambika, ndipo magazi a shuga amatsika patadutsa mphindi 10 mpaka Apidra atabayidwa jakisoni.

Popewa hypoglycemia mwa okalamba odwala, madokotala amalimbikitsa kuyambitsidwa kwa mankhwalawo mukangodya kapena nthawi yomweyo. Kutalika kwa mahomoni kumathandiza kupewa zomwe zimadziwika kuti "overlay", zomwe zimapangitsa kupewa hypoglycemia.

Glulisin imatha kukhala yothandiza kwa iwo onenepa kwambiri, chifukwa kugwiritsa ntchito sikumayambitsa kulemera kowonjezereka. Mankhwala amadziwika ndi kuyambanso msanga kwa kuchuluka kwambiri poyerekeza ndi mitundu ina ya mahomoni, okhazikika komanso lispro.

Apidra ndi yoyenera madigiri osiyanasiyana onenepa kwambiri chifukwa chogwiritsa ntchito kwambiri. Mu kunenepa kwa mtundu wa visceral, kuchuluka kwa mankhwalawa kumatha kusintha, zimapangitsa kuti zikhale zovuta kwa prandial glycemic control.

Detemir (Levemir Penfill)

Levemir Penfill ndi analogue of insulin ya anthu. Ili ndi nthawi yogwira ntchito ndipo ilibe nsonga. Izi zimathandizira kuyang'anira basal glycemic masana, koma amagwiritsidwa ntchito kawiri.

Mothandizidwa ndi subcutaneally, Detemir amapanga zinthu zomwe zimalumikizana ndi serum albin mu madzi amkati. Pambuyo posamutsira kudzera khoma la capillary, insulin imamangirizanso ku albumin m'magazi.

Pokonzekera, ndi gawo laulere lokha lomwe likugwira ntchito mwachilengedwe. Chifukwa chake, kumangiriza albumin ndi kuwola kwake pang'onopang'ono kumapereka ntchito yayitali komanso yopanda pake.

Levemir Penfill insulin imagwira wodwala yemwe ali ndi matenda ashuga bwino ndikuwonjezera kufunikira kwake kwathunthu kwa insulin. Sipereka kugwedeza musanayambe makatani.

Glargin (Lantus)

M'malo mwa insulin ya Glargin ndiye kuti imakhala yothamanga kwambiri. Mankhwalawa amatha kukhala osalala komanso osungunuka pang'ono m'malo okhala acidic, ndipo m'malo osalowerera ndendende (pamafuta ochepa) samasungunuka bwino.

Atangokhala subcutaneous makonzedwe, Glargin amalowa mu kusayanjana ndi mapangidwe a microprecipitation, komwe ndikofunikira kuti amasulidwe enanso a mankhwalawa komanso kugawa kwawo kukhala ma cell a insulin komanso ma dimers.

Chifukwa cha kuyenda kosadukiza komanso kwapang'onopang'ono kwa Lantus kulowa m'magazi a wodwala yemwe ali ndi matenda ashuga, kufalikira kwake mu njira kumachitika mkati mwa maola 24. Izi zimapangitsa kuti jakisoni wa mankhwala a insulin azitha kamodzi kokha patsiku.

Tikapeza kuchuluka kwa zinc, insulin Lantus imalira m'matumba ochepetsa, omwe amawonjezera nthawi yake yoyamwa. Mtheradi zonse za mankhwalawa zimatsimikizira mawonekedwe ake osalala komanso opanda chiyembekezo.

Glargin amayamba kugwira ntchito mphindi 60 atabaya jekeseni wa subcutaneous. Kuthamanga kwa magazi m'magazi a wodwalayo kumatha kuchitika pambuyo pa maola 2-4 kuyambira nthawi yoyamba kumwa mankhwala.

Mosasamala nthawi yeniyeni ya jekeseni wa mankhwalawa (m'mawa kapena madzulo) ndi malo omwe jakisoni idzakhalire (m'mimba, mkono, mwendo), nthawi yowonekera kwa thupi idzakhala:

• pafupifupi - maola 24;
• pazambiri - maola 29.

Kusintha kwa insulin Glargin kumatha kufanana ndi mahomoni achilengedwe pakuyenda kwawo kwambiri, chifukwa mankhwalawa:

1. Moyenerera amathandizira kumwa kwa shuga ndi ma insulin omwe amadalira insulin (makamaka mafuta ndi minofu);
2. amalepheretsa gluconeogeneis (amachepetsa shuga).

Kuphatikiza apo, mankhwalawa amalepheretsa kuwonongeka kwa minofu ya adipose (lipolysis), kuwonongeka kwa mapuloteni (proteinolysis), pomwe amalimbikitsa kupanga minofu.

Kafukufuku wazamankhwala a Glargin's pharmacokinetics awonetsa kuti kugawa kosagwiritsa ntchito bwino kwa mankhwalawa kumapangitsa kuti pafupifupi 100% ikhale ndi fanizo loyambira la insulin ya insulin mkati mwa maola 24. Nthawi yomweyo, mwayi wokhala ndi machitidwe a hypoglycemic ndi kulumpha lakuthwa m'magazi a shuga amachepetsa kwambiri.

Kusakaniza kwa Humalog 25

Mankhwala awa ndi osakaniza omwe amakhala ndi:

• 75% yovala kuyimitsidwa kwa horpro ya mahomoni;
• 25% insulin Humalog.

Izi ndi mitundu ina ya insulin imaphatikizidwanso molingana ndi makina awo amasulidwe. Kutalika kwa mankhwalawa kumathandizidwa ndikuthokoza chifukwa cha kuyimitsidwa kwa mahomoni lyspro, zomwe zimapangitsa kubwereza kupanga kwapansi kwa mahomoni.

25% yotsalira ya inshuwaransi ya lispro ndi gawo limodzi lodziwonetsa nthawi yayifupi, yomwe imakhudza glycemia atatha kudya.

Ndizofunikira kudziwa kuti Humalog mu kapangidwe kazosakaniza zimakhudza thupi mwachangu kwambiri poyerekeza ndi mahomoni afupiafupi. Imapereka chiwongolero chomaliza cha glycemia ya postpradial chifukwa chake mbiri yake imakhala yolimba poyerekeza ndi insulin yochepa.

Ma insulini ophatikizika amalimbikitsidwa makamaka kwa anthu omwe ali ndi matenda ashuga a 2. Gululi limaphatikizapo odwala okalamba omwe, monga lamulo, amavutika ndi mavuto a kukumbukira. Ichi ndichifukwa chake kuyambitsa kwa mahomoni musanadye kapena atangomaliza kumene kumathandizira kwambiri kukonza moyo wa odwala otere.

Kafukufuku wokhudzana ndi thanzi la odwala matenda ashuga omwe ali pagulu la zaka 60 mpaka 80 pogwiritsa ntchito mankhwala osokoneza bongo a Humalog 25 adawonetsa kuti adakwanitsa kulipira zabwino za kagayidwe kazakudya. M'magulu a kuperekera kwa mahomoni musanadye komanso pambuyo chakudya, madokotala amatha kulemera pang'ono komanso kuchepa kwambiri kwa hypoglycemia.

Kodi insulin yabwino kwambiri ndi iti?

Ngati tingayerekeze ma pharmacokinetics a mankhwalawa omwe amawaganizira, ndiye kuti kupezeka kwawo ndi adotolo ndikulondola kwa matenda a shuga, onse oyamba ndi achiwiri. Kusiyana kwakukulu pakati pa ma insulin awa ndi kusowa kwa kuwonjezeka kwa thupi panthawi yamankhwala komanso kuchepa kwa chiwerengero cha kusintha kwa usiku m'magazi a glucose m'magazi.

Kuphatikiza apo, ndikofunikira kuzindikira kufunika kwa jakisoni imodzi masana, yomwe ili yabwino kwambiri kwa odwala. Mwapamwamba kwambiri ndizothandiza kwa insulin Glargin analogue yaumunthu kuphatikiza ndi metformin kwa odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga. Kafukufuku akuwonetsa kuchepa kwakukulu kwa ma spikes ausiku mu ndende ya shuga. Izi zimathandizira modabwitsa tsiku lililonse glycemia.

Kuphatikiza kwa Lantus ndi mankhwala amkamwa kuti achepetse shuga ya magazi kunaphunziridwa mwa odwala omwe sangathe kulipira shuga.

Afunika kupatsidwa Glargin posachedwa. Mankhwalawa atha kulimbikitsidwa kuti athandizidwe ndi dokotala endocrinologist ndi akatswiri onse.

Kulimbitsa kwambiri mankhwala ndi Lantus kumapangitsa kuti pakhale kusintha kwamtundu wa glycemic m'magulu onse a odwala matenda a shuga.