Insulin yochepa: momwe mungabayitsire anthu mankhwala

Insulin yaumunthu imanena za mahomoni omwe amapanga kapamba. Amagwiritsidwa ntchito pochiza matenda ashuga. Kuti muthane ndi chizolowezi cha kapamba, wodwalayo amapaka jakisoni:

• kukhudza kochepa;
• chikoka chosatha;
• nthawi yayitali yochita.

Mtundu wa mankhwalawa umatsimikizika potengera thanzi la wodwala komanso mtundu wa matenda.

Mitundu ya insulin

Insulin idapangidwa koyamba kuchokera ku zikondamoyo za agalu. Patatha chaka chimodzi, mahomoniwa adagwiritsidwa ntchito kale. Zaka zina 40 zidapita, ndipo zidatheka kupanga insulin mosiyanasiyana.

Pakapita kanthawi, zinthu zofunikira kwambiri zokhala oyeretsa. Pambuyo pazaka zochepa, akatswiri adayamba kupanga kapangidwe ka insulin ya anthu. Kuyambira 1983, insulini idayamba kupangidwa pamakampani ambiri.

Ngakhale zaka 15 zapitazo, matenda a shuga adathandizidwa ndi zinthu zopangidwa ndi nyama. Masiku ano, ndi oletsedwa. M'mafakitala, mutha kupeza zokonzekera zaumisiri, kupanga ndalamazi kumakhazikitsidwa ndikusintha kwa chinthu cha gene mu cell ya microorganism.

Pachifukwa ichi, yisiti kapena mtundu wa mabakiteriya osagwiritsa ntchito tizilombo ta Escherichia coli amagwiritsidwa ntchito. Zotsatira zake, tizilombo tating'onoting'ono timayamba kupanga insulin kwa anthu.

Kusiyana pakati pa zida zonse zamankhwala zomwe zilipo lero ndi:

• munthawi yowonekera, osachita kanthu kwakanthawi kochepa, ma insulin osakhalitsa pang'ono komanso insulin yochepa.
• mogwirizana ndi amino acid.

Palinso mankhwala ena omwe amaphatikizidwa kuti "zosakaniza", omwe ali ndi insulin yokhala ndi nthawi yayitali komanso yochepa. Mitundu yonse 5 ya insulin imagwiritsidwa ntchito pazolinga zawo.

Kuchita insulin mwachidule

Ma insulin achidule, nthawi zina a ultrashort, ndi mayankho a crystalline zinc-insulin ophatikizika ndi mtundu wa pH wosaloledwa. Ndalamazi zimagwira mwachangu, komabe, zotsatira zake za mankhwalawa ndizosakhalitsa.

Monga lamulo, ndalama zotere zimaperekedwa kwa mphindi 30-45 musanadye chakudya. Mankhwala ofanana amatha kuthandizidwa kudzera mu mnofu komanso m'mitsempha, komanso insulin.

Wothandizirana ndi ultrashort akamalowa m'mitsempha, shuga ya plasma imatsika kwambiri, zotsatira zake zimatha kuchitika pambuyo pa mphindi 20-30.

Posachedwa, magaziwo adzatsukidwa ndi mankhwalawo, ndipo mahomoni monga makatekolamaini, glucagon ndi STH zimakulitsa kuchuluka kwa glucose mpaka gawo loyambirira.

Ndi kuphwanya kwa kupanga mahomoni olimbana ndi mahomoni, mulingo wa shuga suwonjezeka kwa maora angapo pambuyo pobayira jakisoni wa mankhwala, chifukwa umakhudza thupi komanso mutachotsa magazi.

Mahomoni ochita kupanga mwachidule ayenera kubayidwa m'mitsempha:

1. pakutsitsimuka komanso chisamaliro chachikulu;
2. odwala matenda ashuga ketoacidosis;
3. ngati thupi likusintha mwachangu kufunika kwa insulin.

Odwala omwe ali ndi khola la matenda a shuga, mankhwalawa nthawi zambiri amatengedwa limodzi ndi zotsatira zazitali komanso nthawi yayitali.

Insulin yocheperako pang'onopang'ono ndi mankhwala apadera omwe wodwala amatha kukhala nawo mu kachipangizo kapadera kogwiritsa ntchito.

Kulipiritsa chotulutsira, zinthu zothandizidwazo zimagwiritsidwa ntchito. Izi sizimalola kuti insulini ikhale pansi pa khungu pakhungu pang'onopang'ono.

Masiku ano, timadzi tating'onoting'ono timayendetsedwa mu mawonekedwe a hexamers. Mamolekyu a chinthuchi ndi ma polima. Hexamers amatengeka pang'onopang'ono, zomwe sizimalola kufikira kuchuluka kwa insulin ndende ya plasma ya munthu wathanzi atatha kudya.

Izi zinali chiyambi cha kupanga zopangira zapakati zomwe zimayimira:

• masamba;
• monomola.

Mayesero ambiri azachipatala adachitidwa, chifukwa chake, zida zothandiza kwambiri, mayina a otchuka kwambiri

1. Aspart insulin;
2. Lizpro-insulin.

Mitundu ya insulin iyi imatengedwa kuchokera pansi pakhungu katatu katatu poyerekeza ndi insulin ya anthu. Izi zimabweretsa kuti gawo lalikulu kwambiri la insulini m'magazi limafikiridwa mwachangu, ndipo njira yochepetsera glucose imathamanga.

Ndi kuyambitsa kuphika kwa mphindi 15 musanadye, zotsatira zake zidzakhala zofanana ndi jakisoni wa insulin kwa munthu mphindi 30 asanadye.

Hormpro-insulin yotereyi imakhudzanso mphamvu kwambiri. Ndi zotumphukira za insulin ya anthu yomwe imapezeka ndikusinthana kwa proline ndi lysine m'matcheni a 28 ndi 29 B.

Monga insulin yaumunthu, m'makonzedwe opangidwa, lyspro-insulin ilipo mu mawonekedwe a hexamers, komabe, wothandizirayo akadzalowa m'thupi la munthu, amasintha kukhala ma monomers.

Pazifukwa izi, lipro-insulin imakhala ndi zotsatira zake, koma zotsatira zake zimakhala kwakanthawi. Lipro-insulin iwina poyerekeza ndi mankhwala ena amtunduwu pazinthu zotsatirazi:

• zimapangitsa kuchepetsa kuopseza kwa hypoglycemia ndi 20-30%;
• Kuchepetsa kuchuluka kwa A1c glycosylated hemoglobin, komwe kumawonetsa chithandizo chokwanira cha matenda ashuga.

Popanga insulin, gawo lofunikira limaperekedwa kuti likhale m'malo mwa proartic acid m'malo mwa Pro28 mu B. Monga lyspro-insulin, mankhwalawa, olowa m'thupi la munthu, posakhalitsa amagawanika kukhala opanga monoma.

Pharmacokinetic katundu wa insulin

Mu shuga mellitus, mankhwala a insulin amatha kukhala osiyana. Nthawi yapamwamba kwambiri ya kuchuluka kwa plasma insulin komanso zotsatira zazikulu zochepetsera shuga zimatha kusiyana ndi 50%. Kukula kwinanso kwa kusinthika koteroko kumadalira mulingo wosiyanasiyana wa mankhwala kuchokera kuzinthu zowononga. Komabe, nthawi ya insulin yayitali komanso yochepa ndiyosiyana.

Zotsatira zamphamvu kwambiri ndi mahomoni a nthawi yayitali komanso nthawi yayitali. Koma posachedwa, akatswiri apeza kuti mankhwala ochepetsa mphamvu ali ndi zinthu zofananira.

Kutengera insulin, ndikofunikira kubaya mahomoni nthawi zonse m'matumbo a subcutaneous. Izi zikugwiranso ntchito kwa odwala omwe sangathe kuchepetsa kuchuluka kwa shuga m'magazi chifukwa cha zakudya komanso mankhwala omwe amachepetsa shuga, komanso azimayi omwe ali ndi matenda osokoneza bongo panthawi yomwe ali ndi pakati, odwala omwe ali ndi matenda chifukwa cha pacreatectomy. Apa titha kunena kuti mapiritsi ochepetsa shuga a magazi samapereka mphamvu nthawi zonse.

Chithandizo cha insulin ndi chofunikira pa matenda monga:

1. hyperosmolar chikomokere;
2. matenda ashuga ketoacidosis;
3. pambuyo opaleshoni kwa odwala matenda a shuga,
4. pomwe chithandizo cha insulin chimathandizira kuti shuga akhale mu plasma,
5. Kuchotsa kwina kwa metabolic metabolologies.

Zotsatira zabwino zimatheka pogwiritsa ntchito njira zovuta zochizira:

• jakisoni;
• zolimbitsa thupi;
• chakudya.

Kufunika kwa insulin tsiku ndi tsiku

Munthu wokhala ndi thanzi labwino komanso wathanzi labwino amapanga magawo 18-40 patsiku, kapena mayunitsi 0,2-0,5 / kg wa insulin yayitali. Pafupifupi theka la bukuli ndi chimbudzi cha m'mimba, chotsalacho chimachotseredwa mutatha kudya.

Horm imapangidwa mayunitsi a 0.5-1 pa ola limodzi. Shuga atalowa m'magazi, kuchuluka kwa katulutsidwe ka timadzi timatulutsa mpaka magawo 6 pa ola limodzi.

Anthu onenepa kwambiri komanso omwe ali ndi insulin kukana omwe amadwala matenda ashuga amatha kupanga ma insulini mwachangu nthawi 4 akatha kudya. Pali kulumikizana kwa mahomoni omwe amapangidwa ndi portal system ya chiwindi, komwe gawo limodzi limawonongeka ndipo silimafikira magazi.

Odwala amtundu wa 1 wodwala matenda a shuga, kuvuta kwa mahomoni tsiku ndi tsiku ndi kosiyana:

1. Kwenikweni, chizindikirochi chimasiyana kuchokera pa 0,6 mpaka 0,7 mayunitsi / kg.
2. Ndi kulemera kambiri, kufunikira kwa insulin kumawonjezeka.
3. Munthu akamafuna mayunitsi 0,5 okha patsiku, amakhala ndi maholide okwanira kapena thupi labwino.

Kufunika kwa insulin ya mahomoni ndi amitundu iwiri:

• pambuyo-posachedwa;
• basal.

Pafupifupi theka la zosowa za tsiku ndi tsiku ndi za basal fomu. Hormone iyi imathandizira kupewa kufalikira kwa shuga mu chiwindi.

Mawonekedwe a posachedwa, zofunika tsiku lililonse zimaperekedwa ndi jakisoni musanadye. Timadzi timadzi timatenda timadzi timene timayamwa.

Kamodzi patsiku, wodwalayo amapatsidwa jakisoni wa insulin ndi nthawi yayitali, kapena wothandizira kuphatikiza amatumizidwa yemwe amaphatikiza insulin ndi nthawi yayitali komanso mahomoni apakati. Kusungitsa glycemia pamlingo wabwinobwino, izi sizingakhale zokwanira.

Kenako njira yothandizira mankhwalawo imagwiritsidwa ntchito kukhala yovuta kwambiri, pomwe insulini yokhala ndi nthawi yayitali kapena insulini yocheperako kapena yogwira insulin yokhala ndi yayifupi imagwiritsidwa ntchito limodzi.

Nthawi zambiri wodwala amathandizidwa molingana ndi mtundu wosakanikirana wa mankhwala, akaperekera jakisoni imodzi pakudya kadzutsa, ndi wina nthawi ya chakudya. Hormone pamilandu iyi imakhala ndi insulin ya nthawi yayifupi komanso nthawi yayitali.

Mukalandira mankhwalawa a mankhwalawa a mahomoni a NPH kapena insulin, tepiyo silipereka glycemia usiku, ndiye kuti jakisoni imagawidwa magawo awiri: asanadye chakudya chamadzulo, wodwalayo amapaka jekeseni wambiri ndi insulin, ndipo asanagone, amapatsidwa NPH insulin kapena tepi ya insulin.

Mtengo wa insulin umatsimikiziridwa payekhapayekha, kutengera mtundu wa shuga m'magazi. Chifukwa cha kuchuluka kwa glucometer, tsopano ndikosavuta kuyeza kuchuluka kwa hemoglobin m'magazi, ndipo kwakhala kosavuta kudziwa kukula kwa mahomoni, omwe amatengera zinthu izi:

• matenda ophatikizika;
• dera ndi kuya kwa jakisoni;
• minofu ntchito jekeseni zone;
• magazi;
• zakudya;
• zolimbitsa thupi;
• mtundu wa mankhwala;
• kuchuluka kwa mankhwalawa.