Insulin Apidra (Epidera): ndemanga, malangizo a glulisin

"Apidra", "Epidera", insulin-glulisin - chinthu chachikulu chomwe chimagwiritsa ntchito mankhwalawa ndi analogue ya insulle ya insulle yaumunthu, yomwe imapezeka ndi majini.

Ndi mphamvu ya ntchito yake, imakhala yofanana ndi sungunuka wa munthu. Koma Apidra amayamba kuchita zinthu mwachangu, ngakhale utali wa mankhwalawo umachepa pang'ono.

Makhalidwe a pharmacological

Mankhwala Chochita chachikulu cha insulini ndi mitundu yake yonse (insulin-glulisin sichili choncho) ndi kusintha kwa shuga m'magazi.

Chifukwa cha insulin gluzulin, kuchuluka kwa shuga m'magazi kumachepa ndipo mayamwidwe ake amalimbikitsidwa ndi zotumphukira zama minofu, makamaka mafuta, mafupa komanso minofu. Kuphatikiza apo, insulin:

• amalepheretsa kupanga shuga m'magazi;
• kumawonjezera kaphatikizidwe wa mapuloteni;
• amalepheretsa proteinolysis;
• amalepheretsa lipolysis mu adipocytes.

Kafukufuku wochitidwa pa odzipereka athanzi komanso odwala matenda a shuga amasonyezeratu kuti kulowetsedwa kwa insulin-glulisin sikuti kumangochepetsa nthawi yodikirira, komanso kumachepetsa nthawi yovutikira mankhwalawo. Izi zimasiyanitsa ndi insulin ya anthu osungunuka.

Ndi subcutaneous makonzedwe, kutsitsa-shuga kutsika kwa insulin-glulisin m'magazi kumayamba pakatha mphindi 15 mpaka 20. Ndi jakisoni wamkati, mphamvu ya insulin ya anthu sungunuka komanso zotsatira za insulin-glulisin pamagazi a shuga ndi ofanana.

Chipinda cha Apidra chilinso ndi zochitika zofanana za hypoglycemic monga gawo la insulin ya anthu sungunuka. M'mayesero azachipatala odwala omwe ali ndi matenda a shuga 1, zotsatira za hypoglycemic za insulle insulin ndi Apidra zimayesedwa.

Onsewa adawonetsedwa pa mlingo wa 0,15 U / kg mosasunthika mosiyanasiyana panthawi yokhudzana ndi chakudya champhindi 15, zomwe zimawerengedwa kuti ndi zofunikira.

Zotsatira za kafukufukuzi zidawonetsa kuti insulini-glulisin yomwe idaperekedwa mphindi ziwiri asanadye chakudya chimapereka chiwonetsero chofananira cha glycemic atatha kudya ngati insulin ya anthu osungunuka, yomwe idabayidwa mphindi 30 asanadye.

Ngati insulin-glulisin imayang'aniridwa 2 mphindi musanadye, mankhwalawa amapereka kuyang'aniridwa kwa glycemic pambuyo chakudya. Kuposa kupaka insulin ya anthu sungunuke pakadutsa mphindi ziwiri musanadye.

Insulin-glulisin, yomwe idapangidwira mphindi 15 chakumayambiriro kwa chakudyacho, idapereka kuwunika kwa glycemic pambuyo paphwando lofanana ndi lomwe limaperekedwa ndi insulin ya anthu osungunuka, kuyambitsa kwake komwe kumachitika pakadutsa mphindi 2 chakudya chisanayambe.

Kafukufuku wa gawo loyamba, wopangidwa ndi Apidra, insulin ya insulle ya munthu ndi insulin-lyspro pagulu la odwala omwe ali ndi kunenepa kwambiri komanso matenda ashuga, adawonetsa kuti mwa odwala insulin-glulisin sataya machitidwe ake othamangira.

Phunziroli, kuchuluka kwa 20% ya malo onse omwe amapezeka pansi pa insulin-glulisin anali maminiti 114, kwa insulin-lispro -121 mphindi ndi insulin ya anthu osungunuka - mphindi 150.

Ndipo AUC (maola 0-2), yowonetsanso ntchito yoyambirira ya hypoglycemic, inali 427 mg / kg ya insulin-glulisin, 354 mg / kg ya insulin-lyspro ndi 197 mg / kg ya insulin ya sungunuka ya anthu.

Mtundu woyamba wa shuga

Maphunziro azachipatala. Mtundu woyamba wa matenda a shuga 1 mellitus, insulin-lispro ndi insulin-glulisin amafananizidwa.

M'mayeso achipatala chachitatu omwe amakhala milungu 26, anthu odwala matenda a shuga 1 amapatsidwa insulin glulisin atatsala pang'ono kudya (insulin glargine imakhala ngati insulin insulin mwa odwalawa).

Mwa anthu awa, insulin-glulisin pokhudzana ndi kayendedwe ka glycemic adayerekeza ndi insulin-lyspro ndipo adayesedwa ndikusintha kuchuluka kwa glycosylated hemoglobin (L1L1c) kumapeto kwa phunziroli ndi poyambira.

Odwala, kuchuluka kwa shuga m'magazi, komwe kumatsimikiziridwa ndi kudziyang'anira pawokha, kunawonedwa. Kusiyana pakati pa insulin-glulisin ndi kukonzekera kwa insulin-lyspro ndikuti pomwe yoyamba idalembedwa, palibe chifukwa chowonjezera kuchuluka kwa insulin.

Kuyesedwa kwamankhwala kwa gawo lachitatu, masabata 12, (mtundu 1 wa shuga nthawi yomweyo musanadye (0-16 mphindi). Kapena mphindi 30-45 musanadye insulin yaumunthu.

Odwala omwe adachita mayeso adagawika m'magulu awiri:

1. Gulu loyamba lidamwa insulin apidra musanadye.
2. Gulu lachiwiri lidapatsidwa insulin ya anthu osungunuka.

Omwe adalandira gulu loyamba adawonetsa kuchepa kwakukulu mu HL1C kuposa odzipereka a gulu lachiwiri.

Type 2 shuga

Choyamba, zoyesa zamankhwala za gawo lachitatu zidachitika kupitilira masabata 26. Adatsatiridwa ndi maphunziro a chitetezo cha 26-sabata, zomwe zinali zofunikira kuyerekezera zochita za Apidra (mphindi 0-15 musanadye) ndi insulin yaumunthu (30-45 mphindi musanadye).

Mankhwalawa onse amaperekedwa kwa odwala omwe ali ndi matenda a shuga a 2 subcutaneally (anthuwa anagwiritsa ntchito insulin-isofan ngati insulin yayikulu). Mlozera wapakati wamagulu omasulira anali 34,55 kg / m².

Pokhudzana ndi kusintha kwa kuzama kwa HL1C, patatha miyezi isanu ndi umodzi ya chithandizo, insulini-glulisin adawonetsa kufananizidwa kwake ndi insulin yamadzimadzi poyerekeza ndi mtengo woyambirira motere:

• insulin yosungunuka ya anthu, 0,30%;
• kwa insulin-glulisin-0.46%.

Ndipo patatha chaka chimodzi cha chithandizo, chithunzicho chidasintha monga chonchi:

1. insulin ya anthu sungunuka - 0,13%;
2. kwa insulin-glulisin - 0,23%.

Ambiri mwa odwala omwe akuchita nawo phunziroli, atangolowa jakisoni, wosakanikirana wa insulin-isophan wokhala ndi insulin yochepa. Panthawi yodziwika, 58% ya odwala amagwiritsa ntchito mankhwala a hypoglycemic ndikupempha malangizo kuti apitilize kumwa nawo pa mlingo womwewo.

M'mayeso azachipatala olamulidwa mwa akulu, panalibe kusiyana pakukhazikika ndi chitetezo cha insulini-glulisin pofufuza magulu omwe adadziwika ndi jenda komanso mtundu.

Ku Apidra, kulowa kwa ampinogine wa amino acid pamalo a B3 a insulin yaumunthu, komanso, lysine pamalo a B29 ndi glutamic acid, amalimbikitsa kuyamwa mwachangu.

Magulu Opatsa Odwala

• Odwala aimpso kuwonongeka. Mu kafukufuku wazachipatala yemwe wachitika mwa anthu athanzi omwe ali ndi mitundu yayitali yogwira ntchito yaimpso (creatinine clearance (CC)> 80 ml / min, 30¬50 ml / min, <30 ml / min), kuchuluka kwa kuyamba kwa insulin-glulisin kunasungidwa. Komabe, pamaso pa kulephera kwa impso, kufunika kwa insulin kumatha kuchepetsedwa.
• Odwala omwe ali ndi matenda a chiwindi amagwira ntchito. Mu gululi la odwala, magawo a pharmacokinetic sanaphunzire.
• Anthu okalamba. Kwa gulu ili la odwala, zambiri za pharmacokinetic pazotsatira za insulin-glulisin ndizochepa.
• Ana ndi achinyamata. The pharmacodynamic ndi pharmacokinetic katundu wa insulin-glulisin mu achinyamata (wazaka 12-16) komanso mwa ana (wazaka 7 - 11) wokhala ndi matenda amtundu wa 1 amafufuzidwa. Mankhwala a insulin-glulisin amalowa msanga m'magulu onse a Stax ndi Tmax ofanana ndi omwe ali ndi odwala akuluakulu omwe ali ndi matenda a shuga 1 komanso odzipereka athanzi. Mukamapereka mankhwala musanayambe kuyesedwa ndi chakudya, insulin-glulisin, monga gulu la achikulire, imawongolera shuga la magazi mukatha kudya poyerekeza ndi insulin yaumunthu. Kuwonjezeka kwa ndende ya magazi nditadya (AUC 0-6 maola - dera lomwe limapindika "shuga wamagazi - nthawi" maola 0-6) linali 641 mg / (h'dl) kwa Apidra ndi 801 mg / (h ' d) kwa insulin yamadzimadzi ya anthu.

Zizindikiro ndi mlingo

Mtundu wa shuga wodalira insulin 1 mwa ana atatha zaka 6, achinyamata ndi akulu.

Insulin-glulisin iyenera kuperekedwa mwachangu kapena nthawi yomweyo ndi chakudya. Apidra iyenera kugwiritsidwa ntchito pazinthu zamankhwala zomwe zimaphatikizapo kuchitapo kanthu kwa nthawi yayitali, ma insulin kapena ma analogues awo.

Kuphatikiza apo, Apidra ikhoza kugwiritsidwa ntchito limodzi ndi mankhwala a pakamwa a hypoglycemic. Mlingo wa mankhwalawa nthawi zonse umasankhidwa payekha.

Njira Zoyang'anira

Mankhwala amathandizidwa ndi subcutaneous jakisoni kapena kulowetsedwa mosalekeza m'madzi amkati ogwiritsa ntchito insulin pump. Jekeseni wovomerezeka wa mankhwalawa amapangidwa m'mimba, ntchafu kapena phewa. Jekeseni wa pampu imachitidwanso pamimba.

Malo a kulowetsedwa ndi jakisoni ndi jakisoni watsopano aliyense wa insulin ayenera kusintha. Kukhazikika kwa zochita, nthawi yake komanso kuchuluka kwa adsorption imatha kutengera zochita zolimbitsa thupi komanso dera lotsogolera. Kukhazikitsidwa kwam'mimba kumimba kumapereka mofulumira adsorption kuposa jakisoni mbali zina za thupi.

Pofuna kuti mankhwalawo asalowe mwachindunji m'mitsempha yamagazi, muyenera kusamala kwambiri. Mukangomwa mankhwalawa, mankhwalawo sayenera kuzunzidwa.

Amaloledwa kusakaniza Apidra kokha ndi insulin-isophan yamunthu.

Pampu ya insulin yopitiliza kulowetsabe mosalekeza

Ngati Apidra amagwiritsidwa ntchito ndi dongosolo la pampu kuti apitilize kulowetsedwa kwa insulin, ndizoletsedwa kusakaniza ndi mankhwala ena.

Kuti mupeze zowonjezereka pakugwira ntchito kwa mankhwalawa, ndikofunikira kuti muphunzire malangizo omwe aphatikizidwe nawo. Pamodzi ndi izi, malingaliro onse okhudzana ndi zolembera zodzaza majakisoni ayenera kutsatiridwa.

Magulu apadera a odwala akuphatikizapo odwala omwe:

• impso yaimpso (ndi matenda otere, kufunika kwa jakisoni wa insulin kumatha kuchepa);
• ntchito ya chiwindi hepatic (monga momwe zinalili kale, kufunika kwa kukonzekera kwa insulin kumatha kuchepa chifukwa kuchepa kwa kuthekera kwa gluconeogeneis ndi kuchepa kwa insulin metabolism).

Zambiri zamaphunziro a pharmacokinetic a mankhwalawa okalamba sizokwanira. Kufunika kwa insulin kwa odwala okalamba kumatha kuchepa chifukwa cha vuto losakwanira la impso.

Mankhwalawa amatha kuperekedwa kwa ana atatha zaka 6 ndi achinyamata. Zambiri pazokhudza mankhwalawa kwa ana osakwana zaka 6 sizipezeka.

Zotsatira zoyipa

Zotsatira zoyipa zomwe zimachitika pakumwa mankhwala a insulin pamene mlingo wadutsa ndi hypoglycemia.

Pali zovuta zina zomwe zimagwirizanitsidwa ndikugwiritsa ntchito mankhwalawa ndipo zimawonedwa pakuyesedwa kwa chipatala, pafupipafupi momwe zimachitikira pagome.

Kusokonezeka kwa kagayidwe ndi khungu

Nthawi zambiri hypoglycemia imayamba. Zizindikiro za mkhalidwewu nthawi zambiri zimachitika mwadzidzidzi. Mawonetsero otsatirawa ndi amodzi mwa zizindikiro za neuropsychiatric:

1. Kutopa, kumva kuti watopa, kufooka.
2. Kuchepetsa mphamvu yoganizira.
3. Zosokoneza.
4. Kugona.
5. Mutu, nseru.
6. Kusokonezeka kwa chikumbumtima kapena kuwonongeka kwathunthu.
7. Matenda opatsirana.

Koma nthawi zambiri, zizindikiro za neuropsychiatric zimayambitsidwa ndi zizindikiro za adrenergic anti-regulation (kuyankha kwa hypoglycemia ya dongosolo la sympathoadrenal):

1. Mtsempha wodabwitsa, wosakwiya.
2. Kutopa, nkhawa.
3. Kumva njala.
4. Kukongola kwa khungu.
5. Tachycardia.
6. Thukuta lozizira.

Zofunika! Kubwerezabwereza kwambiri kwa hypoglycemia kumatha kuwononga dongosolo lamanjenje. Zolemba za hypoglycemia yayikulu komanso yayitali ingasokoneze moyo wa wodwalayo, chifukwa ngakhale zotsatira zakupha ndizotheka ndi boma lomwe likuwonjezeka.

Pamavuto a jakisoni wa mankhwala, mawonetseredwe am'deralo a hypersensitivity amapezeka nthawi zambiri:

• kuyabwa
• kutupa;
• Hyperemia.

Kwenikweni, izi zimachitika pang'onopang'ono ndipo nthawi zambiri zimazimiririka ndi mankhwala ena.

Kuyankha kotereku kuchokera ku minofu yaying'ono, monga lipodystrophy, ndikosowa kwambiri, koma kumatha kuwonekera chifukwa cha kuphwanya kusintha kwa malo a jekeseni (simungathe kulowa insulin m'dera lomwelo).

Mavuto ambiri

Mawonetsedwe achilengedwe a hypersensitivity ndi osowa, koma ngati akuwoneka, ndiye zotsatirazi:

1. urticaria;
2. kuthamangitsa;
3. chifuwa cholimba;
4. kuyabwa
5. matupa a ziwongo.

Milandu yapadera yokhudzana ndi chifuwa chachikulu (izi zimaphatikizapo mawonetseredwe a anaphylactic) amaopseza moyo wa wodwalayo.

Mimba

Zambiri pazakugwiritsira ntchito insulin-glulisin ndi amayi apakati sizipezeka. Kuyesa kwachilengedwe kwa nyama sikunawonetse kusiyana kulikonse pakati pa insulin ya insuble ya munthu ndi insulin-glulisin pokhudzana ndi pakati, kukula kwa fetus, kubereka mwana ndi chitukuko cha pambuyo pake.

Komabe, amayi apakati amayenera kupereka mankhwalawa mosamala kwambiri. Munthawi ya chithandizo, kuwunika shuga kumayang'aniridwa pafupipafupi.

Odwala omwe anali ndi matenda ashuga asanatenge pakati kapena omwe adayamba kudwala matenda ashuga azimayi apakati amayenera kuyang'anira glycemic nthawi yonse.

Munthawi yoyamba kubereka, kufunikira kwa wodwala insulin kumatha kuchepa. Koma, monga lamulo, mu trimesters wotsatira, zimawonjezeka.

Pambuyo pobereka, kufunika kwa insulin kumacheperanso. Amayi omwe akukonzekera kutenga pakati ayenera kudziwitsa woyang'anira wawo zaumoyo za izi.

Sizikudziwikabe ngati insulin-glulisin imatha kudutsa mkaka wa m'mawere. Amayi pa nthawi yoyamwitsa angafunikire kusintha kuchuluka kwa mankhwalawa ndi zakudya.

Ana ndi achinyamata

Insulin-glulisin itha kugwiritsidwa ntchito mwa ana atatha zaka 6 ndi achinyamata. Kwa ana ochepera zaka zisanu ndi chimodzi, mankhwalawa sanatchulidwe, popeza palibe chidziwitso chachipatala.