Chithandizo chamakono cha matenda ashuga chimaphatikizapo kugwiritsa ntchito mitundu iwiri ya insulin: kuphimba zofunikira zazikulu komanso kulipiritsa shuga mutatha kudya. Mwa mankhwala a sing'anga kapena apakatikati, mzere woyamba womwe umakhala ndi insulin Protafan, gawo lake la msika ndi pafupifupi 30%.
Wopanga, kampani Novo Nordisk, ndiwotchuka padziko lonse polimbana ndi matenda a shuga. Chifukwa cha kafukufuku wawo, insulini idawoneka chakumapeto kwa 1950 ndikuchita kwanthawi yayitali, zomwe zidapangitsa kuti moyo wawo ukhale wosavuta. Protafan ili ndi kuyeretsa kokwanira, kokhazikika komanso zodziwikiratu.
Malangizo achidule
Protafan imapangidwa mosiyanasiyana. DNA yofunikira pakuphatikizidwa kwa insulin imayambitsidwa mu tizilombo toyambitsa matenda, pambuyo pake amayamba kupanga proinsulin. Insulin yomwe imapezeka pambuyo pa chithandizo cha enzymatic imafanana kwathunthu ndi munthu. Kuti ichulukitse kuchitapo chake, timadzi timene timasakanikirana ndi protamine, ndipo timabisala pogwiritsa ntchito ukadaulo wapadera. Mankhwala opangidwa mwanjira iyi amadziwika ndi kuphatikizika kosalekeza, mutha kutsimikiza kuti kusintha kwa botolo sikukhudza shuga. Kwa odwala, izi ndizofunikira: zinthu zochepa zomwe zimakhudza kugwira ntchito kwa insulin, kubwezeredwa kwabwino kwa matenda ashuga kudzakhala.
| Kufotokozera | Protafan, monga ma insulin onse a NPH, amawatulutsa mosapumira. Pansi pali yoyera yoyera, pamwambapa - madzi owoneka bwino. Pambuyo posakaniza, yankho lonse limakhala loyera. Ndende ya yogwira ntchito ndi magawo zana pa millilita. |
| Kutulutsa Mafomu | Protafan NM imapezeka m'mbale zamagalasi ndi 10 ml ya yankho. Mwanjira imeneyi, mankhwalawa amalandiridwa ndi azachipatala komanso odwala matenda ashuga omwe amaba jakisoni ndi syringe. Mu katoni 1 ndi botolo ndi malangizo ogwiritsira ntchito. Protafan NM Penfill ndi ma cartridge atatu a 3 ml omwe amatha kuyikidwa mu NovoPen 4 syringe pens (gawo 1 unit) kapena NovoPen Echo (mayunitsi 0,5). Kuti mukhale ndi mwayi wosakanikirana mu cartridge iliyonse galasi. Phukusili limakhala ndi ma cartridge 5 ndi malangizo. |
| Kupanga | Chosakaniza chophatikizacho ndi insulin-isophan, wothandizira: madzi, protamine sulfate kuti ikhale nthawi yayitali yochita, phenol, metacresol ndi zinc ion ngati zoteteza, zinthu kuti zisinthe acidity yankho. |
| Machitidwe | Kuchepetsa shuga m'magazi ndikuwanyamula kupita nawo ku minofu, kukulitsa kapangidwe ka glycogen mu minofu ndi chiwindi. Zimapangitsa mapangidwe a mapuloteni ndi mafuta, chifukwa chake, zimathandizira kulemera. Amagwiritsidwa ntchito popanga shuga osala kudya: usiku komanso pakati pa chakudya. Protafan sangagwiritsidwe ntchito kukonza glycemia, ma insulin amafupikirako amapangidwira izi. |
| Zizindikiro | Matenda a shuga ndi odwala omwe amafuna insulin, ngakhale atakhala zaka zingati. Ndi matenda amtundu wa 1 - kuyambira kumayambiriro kwa zovuta za carbohydrate, ndi mtundu wachiwiri - pamene mapiritsi ochepetsa shuga ndi othandiza sizokwanira, ndipo hemoglobin wa glycated amaposa 9%. Matenda a shuga kwa amayi apakati. |
| Kusankha kwa Mlingo | Malangizowo alibe mulingo woyenera, chifukwa kuchuluka kwa insulin kwa odwala matenda ashuga osiyanasiyana ndi kosiyana kwambiri. Amawerengeredwa pamaziko a kusala kudya kwa glycemia. Mlingo wa insulin m'mawa ndi madzulo makonzedwe amasankhidwa mosiyanasiyana - kuwerengetsa kwa insulin mitundu yonse iwiri. |
| Kusintha kwa Mlingo | Kufunika kwa insulini kumawonjezeka ndi kupsinjika kwa minofu, kuvulala kwamthupi ndi m'maganizo, kutupa, ndi matenda opatsirana. Kuledzera kwa matenda ashuga sikwabwino, chifukwa kumathandizira kuwonongeka kwa matendawa ndipo kumayambitsa hypoglycemia. Kusintha kwa Mlingo kumafunika mukamamwa mankhwala ena. Kuchulukitsa - kugwiritsa ntchito okodzetsa ndi mankhwala ena a mahomoni. Kuchepetsa - munthawi ya makonzedwe apanthawi yomweyo okhala ndi mapiritsi ochepetsa shuga, tetracycline, aspirin, antihypertensive mankhwala ochokera m'magulu a AT1 receptor blockers ndi ACE inhibitors. |
| Zotsatira zoyipa | Zotsatira zoyipa kwambiri za insulin iliyonse ndi hypoglycemia. Mukamagwiritsa ntchito mankhwala a NPH, chiopsezo chobwera ndi shuga usiku ndichokwera, popeza ali ndi chiwopsezo chochita. Nocturnal hypoglycemia ndiowopsa kwambiri mu matenda osokoneza bongo, chifukwa wodwalayo sangathe kuzindikira okha ndikuwathetsa okha. Mchere wotsika usiku chifukwa cha mlingo wosankhidwa mosayenera kapena chinthu chama metabolic. Osakwana 1% ya anthu odwala matenda ashuga, insulin Protafan imayambitsa kukwiya komweko chifukwa cha zotupa, kuyabwa, kutupa m'malo a jakisoni. Kuthekera kwa mitundu yayikulu yolumikizana ndi kochepera 0.01%. Kusintha kwamafuta obisika, lipodystrophy, amathanso kuchitika. Chiwopsezo chawo chimakhala chachikulu ngati njira ya jakisoni satsatiridwa. |
| Contraindication | Protafan ndi oletsedwa kugwiritsa ntchito mwa odwala omwe ali ndi mbiri yakale kapena ya Quincke's edema ya insulin. Monga cholowa m'malo, ndibwino kuti musagwiritse ntchito ma NPH omwe ali ndi mawonekedwe ofanana, koma insulin analogues - Lantus kapena Levemir. Protafan sayenera kugwiritsidwa ntchito ndi anthu odwala matenda ashuga okhala ndi vuto la hypoglycemia, kapena ngati zizindikiro zake zachotsedwa. Zinapezeka kuti ma insulin analogu pamilandu imeneyi ndi otetezeka kwambiri. |
| Kusunga | Pamafunika kutetezedwa ndi kuwala, kuzizira kozizira komanso kutentha kwambiri (> 30 ° C). Mbale ziyenera kusungidwa m'bokosi, insulin m'malembera ayenera kutetezedwa ndi chipewa. Mu nyengo yotentha, zida zapadera zozizira zimagwiritsidwa ntchito kunyamula Protafan. Mikhalidwe yoyenera kwambiri yosungirako kwa nthawi yayitali (mpaka masabata 30) ndi alumali kapena khomo lafiriji. Potentha firiji, Protafan poyambira amatha sabata 6. |
Zambiri za Protafan
Pansipa pali zofunikira zonse zokhudza mankhwalawo.
Nthawi yogwira
Mlingo wa kulowa kwa Protafan kuchokera kuzinthu zowerengeka kulowa m'magazi mwa odwala omwe ali ndi matenda ashuga ndizosiyana, chifukwa chake ndizosatheka kuneneratu molondola nthawi yomwe insulin idzayamba kugwira ntchito. Zambiri:
Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale
- Matenda a shuga -95%
- Kuthetsa kwa mitsempha thrombosis - 70%
- Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
- Kuthana ndi kuthamanga kwa magazi - 92%
- Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%
- Kuchokera pa jakisoni mpaka pakuwoneka kwa timadzi m'magazi, pafupifupi maola 1.5 amapita.
- Protafan ili ndi chochita chapamwamba, mu odwala matenda ashuga ambiri amapezeka maola 4 kuyambira nthawi yoyendetsa.
- Kutalika konse kwa kuchitako kumafika maola 24. Pankhaniyi, kudalira kwa nthawi yayitali ya ntchito pamtengowo. Ndi kukhazikitsidwa kwa magawo khumi a Protafan insulin, kutsitsa kwa shuga kumawonedwa pafupifupi maola 14, magawo 20 kwa maola pafupifupi 18.
Malangizo a jekeseni
Nthawi zambiri wodwala matenda ashuga, kuyendetsa kawiri ka Protafan ndikokwanira: m'mawa komanso asanagone. Jakisoni wamadzulo azikhala okwanira kusunga glycemia usiku wonse.
Momwe mulingo woyenera:
- shuga m'mawa ndizofanana ndi nthawi yogona;
- palibe hypoglycemia usiku.
Nthawi zambiri, shuga m'magazi amakwera pambuyo pa 3 am, pamene kupanga kwa mahomoni otsutsana kumakhala kothandiza kwambiri, ndipo zotsatira za insulin zimafooka. Ngati nsonga ya Protafan imatha m'mbuyomu, chiwopsezo chaumoyo ndi chotheka: hypoglycemia usiku ndi shuga m'mawa kwambiri. Kuti mupewe, muyenera kuyang'ana kuchuluka kwa shuga pa 12 ndi maola atatu. Nthawi ya jakisoni wamadzulo imatha kusinthidwa, kusintha mawonekedwe a mankhwalawo.
Zomwe zikuchitika pazing'ono
Ndi matenda a shuga a 2, matenda ashuga azimayi oyembekezera, ana, achikulire pachakudya chochepa cha carb, kufunika kwa NPH insulin kungakhale kochepa. Ndi mtundu umodzi wochepa (mpaka maunitsi 7), nthawi yogwira Protafan ikhoza kuchepera maola 8. Izi zikutanthauza kuti jakisoni awiri omwe aperekedwa ndi malangizo sangakhale okwanira, ndipo pakati pa shuga magazi azikula.
Izi zitha kupewedwa pobaya jakisoni wa Protafan insulin katatu pakatha maola 8 aliwonse: jakisoni woyamba amaperekedwa akangodzuka, wachiwiri nthawi ya nkhomaliro ndi insulin yochepa, yachitatu, yayikulu kwambiri, asanagone.
Ndemanga za odwala matenda ashuga, sikuti aliyense amakwanitsa kubwezera zabwino za anthu odwala matenda ashuga motere. Nthawi zina mlingo wa usiku umaleka kugwira ntchito musanadzuke, ndipo shuga m'mawa amakhala okwera. Kuonjezera mlingo kumabweretsa bongo wa insulin ndi hypoglycemia. Njira yokhayo yochotsera izi ndikusinthira ma insulin omwe ali ndi nthawi yayitali.
Zakudya zotere
Anthu odwala matenda ashuga omwe amapezeka pa insulin amakhalapo nthawi zambiri amakhala ndi insulin. Mwachidule ndikofunikira kuti muchepetse shuga omwe amalowa m'magazi kuchokera ku chakudya. Amagwiritsidwanso ntchito kukonza glycemia. Pamodzi ndi Protafan, ndibwino kugwiritsa ntchito kukonzekera kwapafupi kwa wopanga yemweyo - Actrapid, yemwe amapezekanso mumbale ndi ma cartridgeges a syringe pens.
Nthawi yoyendetsera insulin Protafan sikudalira zakudya mwanjira iliyonse, kuphatikiza pakati pa jakisoni ndikokwanira. Mukasankha nthawi yabwino, muyenera kutsatira nthawi zonse. Ngati chikugwirizana ndi chakudya, Protafan ikhoza kudulidwa ndi insulin yochepa. Nthawi yomweyo kuzisakaniza mu syringe yomweyo ndikosayenera, popeza ndizotheka kulakwitsa ndi mlingo ndikuchepetsera kuchitapo kanthu kwa timadzi tating'onoting'ono.
Mulingo woyenera
Mu shuga mellitus, muyenera jakisoni insulin momwe angathere kuti shuga asamalowe. Malangizo ogwiritsira ntchito mlingo waukulu osakhazikitsidwa. Ngati mulingo woyenera wa Protafan insulin ukukula, izi zikuwonetsa kukana insulini. Ndi vutoli, muyenera kufunsa dokotala. Ngati ndi kotheka, adzalembera mapiritsi omwe amathandiza kusintha kwa mahomoni.
Kugwiritsa Ntchito Mimba
Ngati ndi gestational matenda a shuga sizingatheke kukwaniritsa glycemia kokha kudzera mu chakudya, odwala amadziwika ndi insulin. Mankhwala ndi mlingo wake amasankhidwa mosamala, popeza onse a hypo- ndi hyperglycemia amawonjezera chiopsezo cha kusokonezeka kwa mwana. Insulin Protafan imaloledwa kugwiritsidwa ntchito panthawi yomwe ali ndi pakati, koma nthawi zambiri, analogi yayitali imakhala yothandiza kwambiri.
Mimba ikapezeka ndi matenda amtundu woyamba 1, ndipo mayiyo amakwaniritsa bwino matenda a Protafan, kusintha kwa mankhwala sikofunikira.
Kuyamwitsa kumayenda bwino ndi insulin. Protafan sichingavulaze thanzi la mwana. Insulin imalowa mkaka wambiri, pambuyo pake imasweka m'matumbo a mwana, ngati protein ina iliyonse.
Protafan analogu, kusinthana ndi insulin ina
Zofanizira kwathunthu kwa Protafan NM zomwe zimagwira ntchito zomwezi komanso nthawi yayifupi yogwira ntchito ndi:
- Humulin NPH, USA - mpikisano wamkulu, ali ndi gawo la msika loposa 27%;
- Insuman Bazal, France;
- Biosulin N, RF;
- Rinsulin NPH, RF.
Kuchokera pakuwona kwa mankhwala, kusintha kwa Protafan kupita ku mankhwala ena a NPH sikusintha kwa insulin ina, ndipo ngakhale maphikidwe ndi chinthu chokhacho chokhacho chomwe chikuwonetsedwa, osati mtundu winawake. Pochita izi, kulowetsedwa koteroko sikungangowononga chiwopsezo cha glycemic kwakanthawi ndipo kumafunikira kusintha kwa mlingo, komanso kumayambitsa ziwengo. Ngati glycated hemoglobin ndi yachilendo komanso hypoglycemia sichachilendo, sibwino kukana insulin Protafan.
Kusiyana kwa insulin analogues
Ma aligineti a insulin ataliitali, monga Lantus ndi Tujeo, omwe alibe nsapato, amatha kuloledwa bwino ndipo samayambitsa matenda. Ngati munthu wodwala matenda ashuga ataya magazi popanda chifukwa chomveka, Protafan iyenera kusinthidwa ndi ma insulin amakono.
Zowonongeka zawo zazikulu ndizokwera mtengo kwawo. Mtengo wa Protafan ndi pafupifupi ruble 400. kwa botolo ndi 950 yonyamula ma cartridge a syringe pens. Ma insulin analogu ali pafupifupi 3 times okwera mtengo.
