Kugwiritsa ntchito insulin yayitali - mankhwala, momwe mungawerengere mlingo

Pofuna kuti glucose azikhala pamlingo wa matenda ashuga usiku wonse ndikuonetsetsa kuti m'mimba mulibe kanthu masana, insulini yowonjezera imagwiritsidwa ntchito. Cholinga chake ndikuti abweretse timadzi m'magazi pafupi ndizobisika zake zachilengedwe. Insulin yayitali nthawi zambiri imaphatikizidwa ndi yochepa, yomwe imalowetsedwa musanadye chilichonse.

Mlingo ndi munthu payekha, mutha kuwanyamula mwanjira zoyesera. Popewa hypoglycemia, kuchuluka koyamba kwa mahomoniwo kumapangidwa kwambiri, kenako kumachepetsedwa pang'onopang'ono mpaka magazi a m'magazi amayamba.

Kusankhidwa kwa Insulin Yowonjezera

Kutulutsa kwa insulin m'magazi sikuyima mozungulira wotchi, ngakhale kukhalapo kapena kusowa kwa chakudya. Usiku ndi masana, pomwe chakudya chimodzi chakhala chikugwiritsidwa kale ndipo chinacho sichinafike, mawonekedwe am'mbuyomu amakhala osungika. Ndikofunikira kuti shuga amasweke, omwe amalowa m'magazi kuchokera m'masitolo a glycogen. Kuti muwonetsetse maziko, ngakhale khola, kukhazikitsa insulin yayitali ndikofunikira. Kutengera zomwe tafotokozazi, zikuwonekeratu kuti mankhwala abwino ayenera khalani ndi yayitali, yofananira, simunatchulidwe nsonga zapamwamba ndi zopondera.

Pazifukwa izi:

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%

Kusankhidwa kwa insulin yayitali ndi udindo wa dokotala. Zimatengera kulanga kwa wodwalayo, kupezeka kwatsalira mwa mahomoni ake, chizolowezi cha hypoglycemia, kuuma kwa zovuta, kuchuluka kwa kusala kwa hyperglycemia.

Momwe mungasankhire insulin yayitali:

1. Nthawi zambiri, zokonda zimaperekedwa kwa ma insulin analogues, omwe ndi othandiza kwambiri komanso amaphunziridwa.
2. Ma Protamine othandizira amagwiritsidwa ntchito nthawi zambiri ngati njira ina ilibe. Ma insulin a NPH amatha kupereka chindapusa chokwanira cha mtundu wa 2 shuga kumayambiriro kwa insulin, pamene kufunika kwa mahomoni kumakhalabe kotsika.
3. Tresiba itha kugwiritsidwa ntchito bwino ndi mtundu woyamba wa anthu ashuga, omwe samakonda kutsika magazi ndikuyamba kumva zizindikiro za hypoglycemia koyambirira. Ndi matenda a shuga a mtundu 2, Tresib ndiye mtsogoleri wosagonjetseka pamsika wa insulin, chifukwa amaphatikiza bwino ndi othandizira pakamwa, amakhala ndi zotulukapo, ndipo amachepetsa pafupipafupi hypertlycemia yausiku ndi 36%.

Kuchuluka kwa insulin kwa nthawi yayitali kumagawidwa m'mawa ndi usiku makonzedwe, mlingo wawo nthawi zambiri umasiyana. Kufunika kwa mankhwalawa kumatengera kuopsa kwa matenda ashuga. Njira zingapo zapangidwa pakuwerengera kwake. Zonsezi zimafunikira magawo angapo a shuga. Kusankhidwa kwa mankhwalawa kumatenga nthawi, popeza kuchuluka kwa nthawi yayitali ya insulini kumasinthidwa kulingalira za mawonekedwe a mayamwidwe ndi kuwonongeka kwa mahomoni m'thupi la wodwala winawake. Kukhazikitsidwa kwa mlingo woyambira "ndi maso" kumabweretsa chiwopsezo chachikulu cha matenda ashuga, ndikukulitsa zovuta za matendawa.

Kukula kwa mlingo wosankhidwa bwino ndikubwino kwa kudya kwa glycemia, kuchepa kwamapapo komanso kusapezeka kwa hypoglycemia. Masana, kusinthasintha kwa shuga musanadye kumayenera kukhala ochepera 1.5 mmol / L - momwe mungawerengere moyenera muyezo wa insulin.

Kuwerengedwa kwa nthawi yamadzulo

Woyamba kusankha kuchuluka kwa insulin yochulukirapo, iyenera kupereka mulingo wa shuga usiku komanso m'mawa mutadzuka. Mu shuga mellitus, "mbandakucha chodabwitsa" zambiri zimawonedwa. Uku ndikuwonjezereka kwa glycemia m'mawa m'mawa, chifukwa cha kuwonjezeka kwa katulutsidwe ka mahomoni omwe amachepetsa mphamvu ya insulin. Mwa anthu athanzi, kutulutsidwa kwa insulin kumawonjezeka panthawiyi, motero shuga amakhazikika.

Mu shuga mellitus, kusinthasintha kumeneku kungathetsedwe kokha ndi kukonzekera kwa insulin. Kuphatikiza apo, kuchuluka kwa kuchuluka kwa mankhwalawa kumachepetsa shuga m'magazi kuti akhale abwinobwino, koma kumapangitsa kutsika kwambiri kwa glycemia koyambira komanso pakati pausiku. Zotsatira zake, wodwala matenda ashuga amadwala malodza, mtima wake ndi thukuta lake limakulirakulira, ndipo minyewa yake imamvanso.

Kuti muthane ndi vuto la hyperglycemia m'mawa, osachulukitsa mlingo wa mankhwalawa, mutha kugwiritsa ntchito chakudya cham'mbuyomu, moyenera - maola 5 musanayambitse insulin yayitali. Munthawi imeneyi, shuga onse azakudya azikhala ndi nthawi yoti adutse m'magazi, zochita za timadzi tambiri tating'onoting'ono timatha, ndipo insulin yayitali ingasowe glycogen pachiwindi.

Chiwerengero cha Algorithm:

1. Kuti mudziwe kuchuluka kwa mankhwalawa jakisoni wamadzulo, manambala a glycemic kwa masiku angapo amafunikira. Muyenera kudya chakudya cham'mawa kwambiri, kuyeza shuga musanagone, kenako m'mawa mutangodzuka. Ngati m'matumbo glycemia anali apamwamba, miyeso imapitilira masiku ena anayi. Masiku omwe chakudya chidayandikira sachotsedwa pamndandanda.
2. Kuti muchepetse chiopsezo cha hypoglycemia, kusiyana kocheperako pakati pa miyeso iwiriyi kumasankhidwa masiku onse.
3. Chidziwitso cha insulin chimawerengedwa. Ichi ndiye kuchuluka kwa kuchepetsedwa kwa glycemia pambuyo poyang'anira gawo limodzi la mahomoni. Mwa munthu wolemera makilogalamu 63, gawo limodzi la insulin yowonjezera limatsitsa shuga ndi 4.4 mmol / L pafupifupi. Kufunika kwa mankhwalawa kukukula molingana ndi kulemera. PSI = 63 * 4.4 / kulemera kwenikweni. Mwachitsanzo, ndi kulemera kwa 85 kg, PSI = 63 * 4.4 / 85 = 3.3.
4. Mlingo woyambira amawerengedwa, ndi wofanana ndi kusiyana kocheperako pakati pa miyezo isanayambe kugona ndi m'mawa, yogawidwa ndi PSI. Ngati kusiyana ndi 5, lowetsani nthawi yogona musanadye magawo 5 / 3.3 = 1.5.
5. Kwa masiku angapo, shuga amayeza pambuyo podzuka, kutengera deta iyi, kuchuluka kwa insulini kumasinthidwa. Ndikwabwino kuti musinthe mankhwalawa pakadutsa masiku atatu, kusintha kulikonse kuyenera kupitirira gawo limodzi.

Ndi mtundu 2 wa shuga, shuga m'mawa amatha kukhala otsika kuposa nthawi yogona. Pankhaniyi, insulin yotalikilapo sikuti imabayira madzulo. Ngati glycemia pambuyo chakudya chamadzulo chikwezedwa, kupangitsa kwa mahomoni othamanga kumapangidwa. Insulin yayitali pazolinga izi sizingagwiritsidwe ntchito, imayendetsedwa chimodzimodzi.

Ngati kusintha kwa mlingo kulephera

Hypoglycemia usiku ikhoza kubisika, ndiye kuti, wodwalayo m'maloto samva chilichonse ndipo sakudziwa za kukhalapo kwawo. Kuti mupeze kuchepa kobisika kwa shuga m'magazi, miyezo imachitika kangapo usiku: pa maola 12, 3 ndi 6. Ngati 3 koloko m'mawa glycemia ali pafupi ndi malire ochepa, tsiku lotsatira amayeza pa 1-00, 2-00, 3-00. Ngati chisonyezo chimodzi sichinachite bwino, zimawonetsa bongo

Anthu ena omwe ali ndi matenda ashuga omwe amafunikira insulin yaying'ono amakumana ndi zomwe zimachitika kuti timadzi tambiri timachepa m'mawa, ndipo sikokwanira kuthetsa vuto lodzuka m'mawa. Kuwonjezeka kwa mlingo pamenepa kumayambitsa nocturnal hypoglycemia. Izi zimatha kuchitika mukamagwiritsa ntchito NPH-insulin yokha, komanso Lantus, Tujeo ndi Levemira.

Ngati pali mwayi wazachuma, ndikotheka kukambirana za kufunikira kwa insulini yayitali. Zochita za Treshiba ndizokwanira usiku wonse, chifukwa chake shuga m'mawa amakhala abwinobwino popanda jakisoni wowonjezera. Munthawi ya kusintha, kuwongolera pafupipafupi kwa glycemia kumafunikira kuti muchepetse kuchepa kwake masana.

Ambiri a endocrinologists amalimbikitsa kusinthira ku Treshiba kokha kuti awonetsetse. Anthu omwe ali ndi matenda ashuga, omwe othandizira amatsimikizira kuti amapereka chindapusa cha matendawa, akulangizidwa kuti apewe insulin yatsopano mpaka wopanga atapeza maphunziro okwanira ndipo zamuchitikira ndi mankhwalawo.

Kusankhidwa kwa Mlingo wam'mawa

Insulin yayitali masana imafunikira kuti muchepetse shuga zakudya zikagayidwa kale. Zakudya zomanga thupi kuchokera ku chakudya zimalipitsidwa ndi mahomoni afupiafupi. Kuti mphamvu zake zisasokoneze kusankha kuchuluka kwa insulini yowonjezera, muyenera kufa ndi njala tsiku lina.

Kuwerengetsa kwamawonekedwe tsiku lililonse:

1. Sankhani tsiku laulere kwathunthu. Idyani chakudya cham'mawa. Pangani kuchuluka kwa shuga mutadzuka, pambuyo pa ola limodzi, kenako katatu pakatha maola anayi aliwonse. Nthawi yonseyi yomwe simutha kudya, madzi okha ndi omwe amaloledwa. Pambuyo muyeso wotsiriza mutha kudya.
2. Sankhani shuga wochepa kwambiri patsiku.
3. Kuwerengera kusiyana pakati pa mulingo uno ndi chandamale, chomwe 5 mmol / l amatengedwa.
4. Muwerenge insulin tsiku ndi tsiku: gawani kusiyana ndi PSI.
5. Pakatha sabata, bwerezani miyezo pamimba yopanda kanthu, ngati kuli kotheka, sinthani mlingo wake potengera deta

Ngati kusala kudya kwanthawi yayitali kuli koletsedwa kwa odwala matenda ashuga, muyeso ungachitike m'magawo angapo: kulumpha kadzutsa, tsiku lotsatira - nkhomaliro, tsiku lotsatira - chakudya chamadzulo. Kuchokera pakudya mpaka kuyeza shuga ayenera kutenga maola 5 ngati wodwalayo wavulala jakisoni wofupikiratu wa insulin asanadye, ndi pafupifupi maola 7 ngati insulin ya anthu yagwiritsidwa ntchito.

Kuwerengera Chiwerengero

Wodwala wodwala matenda a shuga a mtundu wachiwiri wolemera makilogalamu 99 samatsitsa shuga wokwanira, motero amamulembera insulin. Kuwerengera tsiku ndi tsiku insulin yayitali, timayeza:

Mtengo wocheperako ndi 7.2. Kusiyana kwake ndi gawo la chandamale: 7.2-5 = 2.2. PSI = 63 * 4.4 / 96 = 2.9. Mlingo wofunikira tsiku lililonse = 2.2 / 2.9 = 0,8 mayunitsi, kapena 1 unit. zokhala ndi zozungulira.

Kuyerekeza malamulo a kuwerengera zam'mawa ndi zamadzulo

Ndi matenda 2 a shuga, sikofunikira kuti mukhale ndi insulin yayifupi komanso yayitali. Zitha kuzindikirika kuti kapamba payekha imapilira kupereka maziko oyambira, ndipo mahomoni owonjezera safunika. Ngati wodwala amatsatira zakudya zamafuta ochepa, mwina sipangakhale chifukwa chochepa cha insulin musanadye. Ngati wodwala matenda ashuga amafuna insulin yayitali kwa onse usana ndi usiku, mlingo wa tsiku ndi tsiku umakhala wotsikirapo.

Pakadutsa matenda a shuga 1, mtundu ndi kuchuluka kwa mankhwalawo amafunikira nthawi zambiri amasankhidwa kuchipatala. Malamulo kuwerengera omwe ali pamwambapa angagwiritsidwe ntchito kusintha mlingo ngati woyambayo adasiya kupereka chipepeso chabwino.

Zoyipa za NPH-Insulin

Poyerekeza ndi Levemir ndi Lantus, ma NPH-insulins ali ndi zovuta zingapo zazikulu:

• sonyezani kuchuluka kwakukulu kwa zochita pambuyo pa maola 6, chifukwa chake, kusungidwa bwino kwakumbuyo kwakumbuyo, komwe kumakhala kokhazikika;
• kuwonongeka kosasinthika, kotero zotsatira zake zingakhale zosiyana pamasiku osiyana;
• Nthawi zambiri zomwe zingayambitse matenda ashuga. Chiwopsezo cha kusinthika kwa anaphylactic chimachulukitsidwa ndi maantibayotiki, ma radiopaque zinthu, NSAIDs;
• Ndiwo kuyimitsa, osati yankho, chifukwa chake zimatengera kusakanikirana kwathunthu kwa insulin ndikutsatira malamulo ake.

Zovuta zamakono zamtundu wamakono zilibe zoperewera, kotero kugwiritsa ntchito kwake pothandizira matenda a shuga kumakondedwa.