Momwe mungawerengere molondola kuchuluka kwa insulin kwa wodwala matenda a shuga (Algorithm)

Chithandizo cha insulin pano ndi njira yokhayo yotalikitsa moyo kwa anthu odwala matenda ashuga amtundu 1 komanso matenda oopsa a 2 shuga. Kuwerengera molondola kwa kuchuluka kwa insulini kumakupatsani mwayi wofanana ndi zachilengedwe za kupanga kwa mahomoni awa mwa anthu athanzi.

Mlingo wosankha algorithm zimatengera mtundu wa mankhwala omwe amagwiritsidwa ntchito, mankhwala osankhidwa a insulin, zakudya ndi physiology ya wodwala yemwe ali ndi matenda ashuga. Kuti mupeze kuchuluka koyamba kwa mankhwalawa, sinthani kuchuluka kwa mankhwalawo malinga ndi chakudya chamagulu pachakudya, chotsani episodic hyperglycemia ndiyofunikira kwa odwala onse omwe ali ndi matenda ashuga. Pomaliza, chidziwitso ichi chithandiza kupewa zovuta zingapo ndikupereka zaka zambiri zathanzi.

Mitundu ya insulin panthawi ya chochita

Ambiri a insulin padziko lapansi amapangidwa muzomera zamankhwala pogwiritsa ntchito matekinoloje amtundu wa genetic. Poyerekeza kukonzekera kwatha kwa nyama, zinthu zamakono zimadziwika ndi kuyeretsa kwambiri, zotsatira zoyipa zochepa, komanso kulimba. Tsopano, pochiza matenda a shuga, mitundu iwiri ya mahomoni imagwiritsidwa ntchito: analogi ya anthu ndi insulin.

Molekyulu ya insulin yaumunthu imabwereza molekyulu ya mahomoni opangidwa m'thupi. Awa ndimankhwala osakhalitsa; Kutalika kwapakatikati NPH zimaphatikizanso a m'gululi. Amakhala ndi nthawi yayitali, pafupifupi maola 12, chifukwa cha kuwonjezeka kwa protamine pamankhwala.

Kapangidwe ka insulin kamasiyana pakapangidwe ka insulin yaumunthu. Chifukwa cha mawonekedwe a molekyulu, mankhwalawa amatha kulipirira shuga. Izi zimaphatikizira othandizira a ultrashort omwe amayamba kuchepetsa shuga patatha mphindi 10 jakisoni, atakhala nthawi yayitali komanso yayitali, akugwira tsiku mpaka maola 42.

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%

Kuwerengeredwa kwa kuchuluka kwa insulin

Nthawi zambiri, kapamba amatulutsa insulin nthawi yonse, pafupifupi 1 unit pa ola limodzi. Izi ndizomwe zimatchedwa basal insulin. Ndi chithandizo chake, shuga yamagazi imasungidwa usiku ndi pamimba yopanda kanthu. Kutsanzira kusuntha kwa insulini, mahomoni apakati komanso omwe amakhala ndi nthawi yayitali amagwiritsidwa ntchito.

• >> Mndandanda wa insulin yayitali

Odwala omwe ali ndi matenda amtundu wa 1 alibe mafuta okwanira a insulin iyi, amafunika jakisoni wa mankhwala omwe amapangika mwachangu katatu patsiku, asanadye. Koma ndi matenda amtundu wa 2, jakisoni m'modzi kapena awiri a insulin yayitali nthawi zambiri amakhala okwanira, popeza kuchuluka kwa mahomoni kumabisidwa ndi kapamba.

Kuwerengera kwa kuchuluka kwa insulin yomwe imatenga nthawi yayitali kumachitika poyamba, chifukwa popanda kukwaniritsa zofunikira zonse za thupi, ndizosatheka kusankha mulingo woyenera wa kukonzekera kwakanthawi, ndipo mukatha kudya kumadumphira shuga kumachitika.

Algorithm yowerengera kuchuluka kwa insulin patsiku:

1. Timazindikira kulemera kwa wodwalayo.
2. Tachulukitsa kulemera ndi chinthu kuchokera pa 0,3 mpaka 0,5 mtundu wa matenda ashuga 2, ngati kapamba akhoza kubisalabe insulin.
3. Timagwiritsa ntchito ufa wofanana ndi 0,5 wa mtundu woyamba wa matenda ashuga kumayambiriro kwa matendawa, ndipo 0,7 - zitatha zaka 10-15 kuyambira kumayambiriro kwa matendawa.
4. Timatenga 30% ya mlingo womwe walandila (nthawi zambiri mpaka magawo 14) ndikugawa m'magulu a 2 - m'mawa ndi madzulo.
5. Timayesa kuchuluka kwa masiku atatu: koyamba timadumphira chakudya cham'mawa, mgonero wachiwiri, chachitatu - chakudya chamadzulo. Panthawi yaanjala, kuchuluka kwa glucose kumayenera kukhalabe kwapafupi.
6. Ngati tikugwiritsa ntchito NPH-insulin, timayang'ana glycemia tisanadye: nthawi ino, shuga amatha kuchepetsedwa chifukwa cha kuyambika kwa mphamvu ya mankhwalawa.
7. Kutengera ndi zomwe zapezedwa, timasintha kuwerengera kwa mlingo woyambirira: kuchepetsa kapena kuwonjezeka ndi magawo awiri, mpaka glycemia ikhale yofanana.

Mlingo woyenera wa mahomoni amawunikira malinga ndi izi:

• kuthandizira glycemia wabwinobwino patsiku, palibe jakisoni wopitilira 2;
• palibe usiku hypoglycemia (muyeso umachitika usiku 3 koloko);
• musanadye, kuchuluka kwa glucose kuyandikira pafupi ndi chandamale;
• Mlingo wa insulin yayitali simapitilira theka la mankhwalawo, nthawi zambiri kuchokera 30%.

Kufunika kwa insulin yayifupi

Kuwerengera insulin yayifupi, lingaliro lapadera limagwiritsidwa ntchito - gawo laz mkate. Ndi ofanana ndi magalamu 12 a chakudya. XE imodzi ili ndi kagawo ka buledi, theka la bun, theka la pasiti. Mutha kudziwa kuti ndi ma mkate angati omwe ali pagawo pogwiritsa ntchito masikelo ndi matebulo apadera a odwala matenda ashuga, omwe amawonetsa kuchuluka kwa XE mu 100 g yazinthu zosiyanasiyana.

• >> Otchuka oterewa okhazikika

Popita nthawi, odwala matenda ashuga amasiya kufuna kulemera chakudya nthawi zonse, ndikuphunzira kudziwa zomwe zili m'maso ndi iwo. Monga lamulo, kuchuluka kumeneku ndikokwanira kuwerengera kuchuluka kwa insulini ndikukwaniritsa Normoglycemia.

Mlingo waufupi wa insulin

1. Tikhazikitsa gawo lazakudya, zimalemera, kudziwa kuchuluka kwa XE mmenemo.
2. Timawerengera kuchuluka kwa insulin: timachulukitsa XE ndi kuchuluka kwa insulini yomwe imapangidwa ndi munthu wathanzi nthawi yayikulu patsiku (onani tebulo pansipa).
3. Timayambitsa mankhwalawa. Chochita chachifupi - theka la ola musanadye, ultrashort - musanadye kapena musanadye chakudya.
4. Pambuyo maola 2, timayeza shuga m'magazi, pofika nthawi imeneyi ziyenera kukhala zofanana.
5. Ngati ndi kotheka, sinthani mlingo: kuti muchepetse shuga ndi 2 mmol / l, gawo lina lowonjezera la insulin likufunika.

Kutsogolera kuwerengera kwa insulini, diary yodyetsa zakudya imathandizira, yomwe imawonetsa glycemia asanafike komanso chakudya, kuchuluka kwa XE komwe kumamwa, mlingo ndi mtundu wa mankhwala omwe amaperekedwa. Kukhala kosavuta kusankha kumwa mankhwalawa ngati mumadya koyamba nthawi yomweyo, kudya zakudya zama protein ndi mapuloteni nthawi imodzi. Mutha kuwerenga XE ndikusunga zolemba pa intaneti kapena mapulogalamu apadera pama foni.

Mankhwala a insulin

Pali mitundu iwiri ya insulin yothandizira: yachikhalidwe komanso yolimba. Yoyamba imaphatikizanso Mlingo wa insulin, womwe umawerengeredwa ndi dokotala. Lachiwiri limaphatikizapo jekeseni wa 1-2 wa kuchuluka kosankhidwa kwa timadzi tambiri tambiri - zingapo zazifupi, zomwe zimawerengeredwa nthawi iliyonse chakudya chisanachitike. Kusankha kwa regimen kumadalira kuopsa kwa matendawa komanso kufunitsitsa kwa wodwalayo kudziletsa pawokha magazi.

Makonda

Ubwino wazikhalidwe zachikhalidwe ndizosakhalapo pakufunika kogwiritsa ntchito mankhwalawa amawerengera masiku onse, masiku a 1-2. Itha kugwiritsidwa ntchito kwa odwala omwe akulephera kapena osafuna kuyang'anira shuga yawo pafupipafupi.

Chochepetsa chachikulu cha regimen yachikhalidwe ndichakuti kuchuluka ndi nthawi ya insulini yolumikizira jakisoni sikugwirizana ndi kapangidwe ka insulin mwa munthu wathanzi. Ngati mahomoni achilengedwe amabisidwa kuti adye shuga, ndiye kuti zonse zimachitika mwanjira ina: kukwaniritsa glycemia, muyenera kusintha zakudya zanu kufikira kuchuluka kwa insulin. Zotsatira zake, odwala akukumana ndi chakudya chokhwima, kupatuka kulikonse komwe kungayambitse vuto la hypoglycemic kapena hyperglycemic.

Makina owonera

Chithandizo chachikulu cha insulini chimadziwika padziko lonse lapansi ngati njira yolowera kwambiri kwambiri ya insulin. Amatchulidwanso kuti basal bolus, chifukwa amatha kutsata zonse, basal, secretion ya mahomoni, ndi bolus insulin, yomwe imatulutsidwa poyankha kuchuluka kwa shuga m'magazi.

Ubwino wosakayikira wa boma lino ndi kuperewera kwa chakudya. Ngati wodwala yemwe ali ndi matenda ashuga adziwa kuchuluka kwa kuchuluka kwa mankhwalawa komanso kuwongolera glycemia, amatha kudya ngati munthu aliyense wathanzi.

Njira yogwiritsira ntchito insulin:

Palibe mtundu wa insulini yatsiku ndi tsiku yamtunduwu, imasintha tsiku lililonse kutengera mawonekedwe a zakudya, kuchuluka kwa zolimbitsa thupi, kapena kufalikira kwamatenda a concomitant. Palibe malire mpaka kuchuluka kwa insulin, chofunikira kwambiri pakugwiritsa ntchito mankhwalawa ndi manambala a glycemia. Odwala odwala matenda ashuga kwambiri ayenera kugwiritsa ntchito mita nthawi yambiri masana (pafupifupi 7) ndipo, potengera kuchuluka kwa maselo, asinthe mlingo wotsatira wa insulin.

Hyperglycemia Correction

Pambuyo pakuyamba kugwiritsa ntchito insulin, ndikofunikira kusintha kuchuluka kwa mankhwalawa ndi 1 XE kutengera umunthu wake. Kuti muchite izi, tengani chakudya chamagulu angapo a chakudya chopatsa, insulin imayikidwa, shuga atatha kuyezedwa. Hyperglycemia ikuwonetsa kusowa kwa mahomoni, chokwanira chikuyenera kuwonjezeka pang'ono. Ndi shuga wotsika, chokwaniracho chimachepetsedwa. Ndi diary yosalekeza, pakatha milungu ingapo, mudzakhala ndi chidziwitso pakufunika kwanu kwa insulin panthawi zosiyanasiyana za tsiku.

Ngakhale ndi chiwerengero chosankhidwa bwino cha odwala matenda a shuga, hyperglycemia nthawi zina imatha kuchitika. Itha kuchitika chifukwa cha matenda, mavuto, zochita zolimbitsa thupi pang'ono, kusintha kwa mahomoni. Hyperglycemia ikapezeka, muyezo wokonza, wotchedwa poplite, umawonjezeredwa ndi bolus insulin.

Kuti muwerenge molondola mlingo wa poplite, mutha kugwiritsa ntchito kukonza. Kwa insulin yochepa, ndi insulin ya 83 / tsiku ndi tsiku, ya ultrashort - 100 / insulin tsiku lililonse. Mwachitsanzo, kuti muchepetse shuga ndi 4 mmol / l, wodwala wokhala ndi mlingo wa tsiku lililonse wamagulu 40, pogwiritsa ntchito Humalog monga kukonzekera kwa bolus, akuyenera kuwerengera izi: 4 / (100/40) = mayunitsi 1.6. Timalikiratu mtengo wake mpaka 1.5, ndikuwonjezeranso ku mtundu wina wa insulin ndikuwupereka musanadye, mwachizolowezi.

Zomwe zimayambitsa hyperglycemia zitha kukhalanso njira yolakwika yoperekera mahomoni:

• Insulin yochepa imalowetsedwa bwino m'mimba, yayitali - ntchafu kapena matako.
• Kutalika kwenikweni kwa jakisoni mpaka chakudya kumasonyezedwera malangizo a mankhwala.
• Syringe satengedwa masekondi 10 atabayidwa, nthawi yonseyi akugwira khola.

Ngati jakisoni wachitika molondola, palibe zomwe zikuwoneka za hyperglycemia, ndipo shuga akupitilirabe kukwera pafupipafupi, muyenera kukaonana ndi dokotala kuti muonjezere kuchuluka kwa insulin.

Zambiri pamutuwu: momwe mungabayire insulin molondola komanso mopweteka