Insulin Detemir yog qhov sib npaug ntawm tib neeg cov insulin. Cov tshuaj yog npaj rau kev kho hypoglycemic ntawm cov neeg mob ntshav qab zib mellitus. Nws yog qhov txawv txav los ntawm kev ua haujlwm ntev thiab txo qis kev pheej hmoo ntawm kev txhim kho hypoglycemia thaum tsaus ntuj.
Lub Npe Tsis Yog Neeg Tsis Muaj Npe
INN rau cov tshuaj no yog Insulin detemir. Cov npe lag luam yog Levemir Flekspan thiab Levemir Penfill.
ATX
Qhov no yog qhov tshuaj hypoglycemic rau cov pab pawg pharmacological ntawm cov kua dej. Nws ATX code yog A10AE05.
Tso cov ntawv thiab cov nyob ua ke
Cov tshuaj muaj nyob rau hauv daim ntawv ntawm cov tshuaj txhaj rau npaj rau kev tswj hwm hauv qab daim tawv nqaij. Lwm cov ntawv me, nrog rau cov ntsiav tshuaj, tsis yog tsim. Qhov no yog vim qhov tseeb tias nyob rau hauv cov hnyuv hauv cov plab zom mov yog tawg mus rau cov amino acids thiab tsis tuaj yeem ua tiav nws txoj haujlwm.
Insulin Detemir yog qhov sib npaug ntawm tib neeg cov insulin.
Qhov nquag ua haujlwm yog sawv cev los ntawm insulin detemir. Nws cov ntsiab lus hauv 1 ml ntawm kev daws yog 14,2 mg, lossis 100 units. Muaj pes tsawg leeg ntxiv xws li:
- sodium tshuaj dawb;
- glycerin;
- hydroxybenzene;
- metacresol;
- sodium hydrogen phosphate dihydrate;
- zinc acetate;
- dilute hydrochloric acid / sodium hydroxide;
- txhaj dej.
Nws zoo li kev daws teeb meem ntshiab, tsis ua haujlwm, homogeneous. Nws tau muab faib rau hauv 3 ml daim cartridges (Penfill) lossis cwj mem koob (Flekspen). Cov thawv ntim khoom. Cov kev qhia yog txuas.
Pharmacological kev txiav txim
Cov tshuaj yog cov khoom lag luam ntawm kev tsim hluav taws xob. Nws tau txais los ntawm kev tsim cov rDNA hauv baker lub poov xab. Rau qhov no, thooj ntawm plasmids raug hloov pauv los ntawm cov noob uas txiav txim siab biosynthesis ntawm insulin ua ntej. Cov hloov kho DNA plasmids no tau tso rau hauv Saccharomyces cerevisiae hlwb, thiab lawv pib tsim cov tshuaj insulin.
Thaum siv cov tshuaj no, qhov pheej hmoo ntawm nocturnal hypoglycemia yog txo los ntawm 65% (piv rau lwm txoj kev siv).
Tus neeg sawv cev hauv kev txiav txim siab yog ib qho tshuaj tiv thaiv ntawm cov tshuaj hormone zais los ntawm cov islets ntawm Langerhans hauv tib neeg lub cev. Nws yog tus cwj pwm los ntawm lub sijhawm ua haujlwm txuas ntxiv thiab txawm tias tso tawm yam tsis muaj lub suab nrov jumps hauv lub siab ntawm cov khoom nquag hauv cov ntshav.
Cov tshuaj insulin lwg me tsim cov koom haum ua ke ntawm qhov chaw txhaj tshuaj, thiab tseem khi rau albumin. Vim tias qhov no, cov tshuaj yuav nqus thiab nkag mus rau daim phiaj nqaij ntawm qhov sib nrug maj mam, uas ua rau nws ua hauj lwm zoo dua thiab nyab xeeb dua li lwm cov tshuaj insulin (Glargin, Isofan). Hauv kev sib piv nrog lawv, kev pheej hmoo ntawm hypoglycemia thaum tsaus ntuj yog txo mus rau 65%.
Los ntawm kev ua ntawm lub cev ua haujlwm rau tes, cov tshuaj tiv thaiv kev cuam tshuam ntawm cov tshuaj ua rau ntau cov txheej txheem intracellular, suav nrog cov synthesis ntawm cov enzymes tseem ceeb xws li glycogen synthetase, pyruvate thiab hexokinase. Qhov ua kom tsawg nyob hauv cov ntshav dej qab zib yog muab los ntawm:
- kev txwv nws cov khoom lag luam hauv lub siab;
- ntxiv dag zog rau kev thauj mus los rau sab hauv;
- kev ua kom haum ntawm cov khoom siv hauv cov ntaub so ntswg;
- stimulation ntawm kev ua tiav rau hauv glycogen thiab fatty acids.
Cov tshuaj muaj txiaj ntsig ntawm cov tshuaj yog ib qho sib npaug ntawm cov koob tshuaj uas tau muab. Lub sijhawm tiv thaiv nyob ntawm qhov chaw txhaj tshuaj, kev noj tshuaj, lub cev kub, ntshav ntws ceev, kev ua haujlwm ntawm lub cev. Nws tuaj yeem ncav cuag 24 teev, yog li kev txhaj tshuaj yog ua 1-2 zaug hauv ib hnub.
Qhov mob ntawm ob lub raum tsis cuam tshuam cov metabolism hauv cov tshuaj.
Hauv cov txheej txheem ntawm cov kev tshawb fawb, cov genotoxicity ntawm kev daws, cov teebmeem carcinogenic, thiab cov lus tshaj tawm rau kev loj hlob ntawm tes thiab kev ua me nyuam lub zog tsis tau qhia tawm.
Cov Tshuaj Pharmacokinetics
Yuav kom tau txais qhov siab tshaj plaws ntshav plasma, 6-8 teev yuav tsum elapse los ntawm lub sijhawm tswj hwm. Bioavailability yog li ntawm 60%. Qhov sib txuam ua ke nrog kev tswj hwm ntawm ob zaug yog txiav txim siab tom qab 2-3 hno. Qhov ntim ntawm kev faib tawm yog kwv yees li 0.1 l / kg. Feem ntau ntawm cov insulin txhaj ntxiv rau cov ntshav ntws. Cov tshuaj tsis cuam tshuam nrog cov roj ntsha thiab cov chaw muag tshuaj uas khi rau cov protein.
Kev zom zaub mov tsis txawv ntawm kev ua cov tshuaj insulin. Txoj kev tshem tawm ib nrab-lub neej ua los ntawm 5 txog 7 teev (raws li qhov siv koob tshuaj). Pharmacokinetics tsis nyob ntawm tus tub los ntxhais thiab hnub nyoog ntawm tus neeg mob. Qhov mob ntawm ob lub raum thiab mob siab kuj tsis cuam tshuam rau cov ntsuas no.
Kev ntsuas rau siv
Cov tshuaj yog npaj rau kev tawm tsam hyperglycemia nyob rau hauv qhov muaj ntawm hom 1 thiab ntshav qab zib hom 2.
Cov tshuaj Insulin yog tsim los tua hyperglycemia thaum muaj mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2.
Cov Yuav Tsum Muaj
Qhov cuab yeej no tsis yog kws kho rau qhov tsis haum siab rau qhov kev nqis tes ua ntawm cov tshuaj tiv thaiv insulin lossis thev tsis nkag siab rau cov neeg sab nraud. Lub hnub nyoog txwv yog 2 xyoos.
Yuav Ua Li Cas Noj Insulin
Kev daws yog siv rau kev tswj hwm subcutaneous, kev tso ntshav ntawm qhov ntshav tuaj yeem ua rau mob ntshav qab zib heev. Nws tsis raug txhaj tshuaj intramuscularly thiab tsis yog siv nyob rau hauv insulin twj. Txhaj tshuaj tuaj yeem muab rau hauv thaj chaw ntawm:
- xub pwg (deltoid leeg);
- lub duav
- phab ntsa sab pem hauv ntej ntawm peritoneum;
- pob tw.
Qhov chaw txhaj tshuaj yuav tsum tau hloov tas li txhawm rau txo qhov muaj feem ntawm cov cim ntawm lipodystrophy.
Kev noj tshuaj ntau dua yog xaiv ncaj qha. Cov koob tshuaj vam khom rau kev yoo plasma ntshav qabzib. Dosage kev kho kom haum yuav tsim nyog rau kev tawm dag zog lub cev, hloov pauv ntawm kev noj zaub mov, kab mob concomitant.
Cov tshuaj no tau muab coj los siv rau ntau qhov chaw, suav nrog phab ntsa ntawm sab xub ntiag ntawm peritoneum.
Kev siv ntawm cov tshuaj tso cai:
- nyob ywj pheej;
- hauv kev sib txuas nrog bolus insulin kev txhaj tshuaj;
- ntxiv rau liraglutide;
- nrog rau cov tshuaj tiv thaiv kab mob hauv qhov ncauj.
Nrog txoj kev kho ntshav qab zib kom tsis txhob mob, nws raug nquahu kom muab tshuaj rau 1 zaug nyob rau ib hnub. Koj yuav tsum xaiv txhua lub sijhawm uas yooj yim thiab lo rau nws thaum ua qhov kev txhaj tshuaj txhua hnub. Yog tias muaj qhov xav tau los siv cov tshuaj 2 zaug hauv ib hnub, thawj koob tau muab thaum sawv ntxov, thiab zaum thib ob nrog ncua sijhawm 12 teev, nrog noj hmo lossis ua ntej mus pw.
Tom qab txhaj tshuaj subcutaneous ntawm lub koob, lub khawm ntawm rab koob txhaj tshuaj yog tuav, thiab lub koob tau tawm hauv daim tawv nqaij kom ntev li 6 lij.
Thaum hloov los ntawm lwm cov tshuaj insulin npaj rau Detemir-insulin hauv thawj lub lis piam, kev tswj nruj ntawm glycemic index yog qhov tsim nyog. Nws yuav tsim nyog hloov pauv kev kho mob, kev noj tshuaj thiab lub sijhawm noj tshuaj tiv thaiv kab mob, nrog rau hauv lub qhov ncauj.
Nws yog ib qho tsim nyog yuav tsum tau ua tib zoo soj ntsuam kom tsis txhob muaj suab thaj thiab kho lub sij hawm tshuaj hauv cov neeg laus.
Nws yog ib qho tsim nyog yuav tsum tau ua tib zoo soj ntsuam kom tsis txhob muaj piam thaj ntau thiab kho lub sij hawm tshuaj rau cov neeg laus thiab cov neeg mob raum-mob siab.
Phiv los ntawm Insulin Detemir
Tus kws sawv cev rau tshuaj muag no tau pom zoo zoo. Cov teeb meem tsis haum yog cuam tshuam nrog qhov teebmeem pharmacological ntawm insulin.
Ntawm ib feem ntawm cov khoom hauv nruab nrog kev pom
Kev tsis pom qhov tseeb ntawm kev ua kom zoo dua qub (blurring ntawm daim duab, ua rau mob taub hau thiab ua kom qhuav tawm ntawm lub ntsej muag qhov muag) qee zaum sau tseg. Muaj peev xwm kho tau tus mob ntshav qab zib siab dua. Qhov kev pheej hmoo ntawm nws kev nce zuj zus ntxiv nrog kev siv tshuaj insulin ntau dua.
Los ntawm cov leeg nqaij thiab pob txha sib txuas
Thaum kho, lipodystrophy tuaj yeem tsim kho, qhia nyob rau hauv ob leeg atrophy thiab adipose nqaij hypertrophy.
Nruab nrab hauv lub paj hlwb
Qee zaum cov leeg hlwb muaj kev cia siab loj tuaj. Feem ntau, nws thim rov qab. Feem ntau, nws cov tsos mob tshwm sim nrog cov ntawv qhov tseeb ntawm glycemic index.
Los ntawm ib sab ntawm cov metabolism
Feem ntau muaj qhov txo qis cov piam thaj hauv cov ntshav. Kev mob ntshav qog ntshav siab nyob hauv tsuas yog 6% ntawm cov neeg mob. Nws tuaj yeem ua rau pom qhov tsis meej, tsaus muag, ua haujlwm tsis zoo ntawm lub hlwb, kev tuag.
Kev ua xua
Qee zaum muaj tshuaj tiv thaiv tshwm sim ntawm qhov chaw txhaj tshuaj. Hauv qhov no, khaus, liab ntawm daim tawv nqaij, tawm pob, o tuaj yeem tshwm sim. Hloov chaw txhaj tshuaj ntawm cov tshuaj insulin tuaj yeem txo lossis cais cov yeeb yam no; kev tsis kam ntawm cov tshuaj yog qhov tsim nyog. Kev phiv tshuaj dav dav yog ua tau (mob plab hnyuv, ua tsis taus pa, mob ntshav ncig hypotension, blanching ntawm lub integument, tawm hws, tachycardia, anaphylaxis).
Cuam tshuam rau lub peev xwm los tswj cov tshuab
Kev mloog zoo thiab nrawm ntawm cov lus teb yuav muaj kev cuam tshuam nrog hypo- lossis hyperglycemia. Nws yog ib qho tsim nyog los tiv thaiv cov tsos ntawm cov xwm txheej no thaum ua haujlwm txaus ntshai thiab tsav tsheb.
Cov lus qhia tshwj xeeb
Qhov ntxim nyiam ntawm kev poob qis hauv cov piam thaj thaum hmo ntuj raug txo qis hauv kev sib piv nrog cov tshuaj zoo sib xws, uas ua rau nws muaj peev xwm txhim kho cov txheej txheem ntawm normalizing glycemic indices ntawm cov neeg mob. Cov kev ntsuas no tsis ua rau muaj qhov nce hauv lub cev hnyav (tsis zoo li lwm cov kev daws teeb meem insulin), tab sis tuaj yeem hloov cov tsos mob thawj qhov hypoglycemic.
Kev tsis ua haujlwm ntawm kev siv tshuaj insulin lossis kev siv tshuaj tsis txaus yuav ua rau hyperglycemia.
Kev txiav tawm ntawm kev siv tshuaj insulin lossis kev siv tshuaj tsis txaus yuav ua rau hyperglycemia lossis ua rau ketoacidosis, suav nrog kev tuag. Qhov tshwj xeeb tshaj yog muaj kev pheej hmoo siab nrog hom tshuaj insulin-mob ntshav qab zib. Cov tsos mob ntawm cov piam thaj ntau ntxiv:
- kev nqhis dej
- tsis muaj qab los noj mov;
- nquag tso zis;
- bouts ntawm xeev siab;
- gag tsis kam;
- kev noj tshuaj ntawm qhov ncauj ntawm qhov ncauj;
- dryness thiab khaus ntawm lub integument;
- hyperemia;
- kev hnov mob ntawm acetone tsw;
- tsaug zog
Qhov xav tau ntawm insulin ntau ntxiv nrog kev ua tsis tiav ntawm lub cev, txawv ntawm lub sijhawm noj mov, kev kis mob, kub cev. Qhov yuav tsum tau hloov lub sijhawm caij nyoog xav tau kev sib tham ua ntej txog kev kho mob.
Cov tshuaj tsis tuaj yeem siv:
- Mob leeg, intramuscularly, nyob rau hauv infusion twj.
- Thaum cov xim thiab pob tshab ntawm cov kua hloov.
- Yog hais tias hnub tim tas sij hawm tau tas sij hawm, qhov kev daws teeb meem tau muab khaws cia hauv qhov tsis tsim nyog lossis cia kom khov.
- Tom qab poob los yog nyem daim cartridge / koob txhaj tshuaj.
Kev tshem tawm cov tshuaj insulin tsis raug tso cai muab tshuaj rau hauv qhov leeg ntshav.
Siv rau lub sijhawm qub
Hauv cov neeg mob neeg laus, yuav tsum tau saib xyuas ntshav qabzib nyob nrog kev saib xyuas tshwj xeeb. Yog tias tsim nyog, hloov kho thawj zaug.
Txiag tej menyuam
Tsis muaj kev sim kho mob nrog kev siv cov tshuaj rau cov menyuam yaus hnub nyoog yau (txog li 2 xyoos). Cov menyuam yaus thiab cov tub ntxhais hluas yuav tsum xaiv nrog kev saib xyuas tshwj xeeb.
Siv thaum cev xeeb tub thiab lactation
Thaum ua qhov kev tshawb fawb, qhov tshwm sim tsis zoo rau cov menyuam yaus uas nws niam siv cov tshuaj thaum cev xeeb tub tsis tau txheeb xyuas. Txawm li cas los xij, siv nws thaum coj menyuam yuav tsum siv nrog ceev faj. Hauv thawj lub sijhawm cev xeeb tub, tus poj niam xav tau cov tshuaj insulin tsawg dua, thiab tom qab tau nce ntxiv.
Tsis muaj ib qho pov thawj dab tsi qhia tau hais tias insulin xa mus rau niam mis. Nws lub qhov ncauj tawm hauv cov menyuam mos yuav tsum tsis txhob xav txog qhov tsis zoo, txij li nyob rau hauv txoj hnyuv cov tshuaj sai sai thiab tau nqus los ntawm lub cev hauv daim ntawv ntawm cov amino acids. Tus niam tsev saib xyuas me nyuam yuav xav noj tshuaj ntau dua thiab hloov pauv kev noj haus.
Daim ntawv thov rau lub raum khiav tsis zoo
Tsuas tshuaj yog txiav txim siab ib tus zuj zus. Qhov xav tau ntawm cov tshuaj tuaj yeem raug txo qis me ntsis yog tias tus neeg mob lub raum tsis ua haujlwm.
Siv rau lub siab ua haujlwm tsis zoo
Kev tswj nruj ntawm cov piam thaj thiab txoj kev hloov pauv hauv kev siv tshuaj yog yuav tsum tau ua.
Noj ntau dhau ntawm Insulin Detemir
Tsis muaj kev pom tseeb meej tau koob tshuaj uas tuaj yeem ua rau muaj kev noj tshuaj ntau dhau. Yog tias cov koob txhaj tshuaj pom ntau dhau qhov yuav tsum tau siv ntau npaum li cas, cov tsos mob hypoglycemic yuav tshwm sim maj mam. Cov tsos mob ntxhov siab vim:
- blanching ntawm lub integument;
- hws txias;
- mob taub hau
- kev tshaib kev nqhis
- tsis muaj zog, qaug zog, tsaug zog;
- bouts ntawm xeev siab;
- ntxhov siab, cuam tshuam;
- palpitations
- pom kev txawv txav.
Kev poob qis me ntsis hauv glycemic yog tshem tawm los ntawm kev siv cov piam thaj, piam thaj, thiab lwm yam.
Kev txo qis me me ntawm cov glycemic index yog tshem tawm los ntawm kev siv cov piam thaj, qab zib, cov khoom noj uas muaj carbohydrates lossis cov dej qab zib uas cov ntshav qab zib yuav tsum muaj ib txwm nrog nws (ncuav qab zib, khoom qab zib, ua kom qab zib, thiab lwm yam). Hauv cov ntshav qog ntshav hnyav, tus neeg mob tsis nco qab yog txhaj nrog cov leeg nqaij lossis hauv qab daim tawv nqaij glucagon lossis tso ntshav qabzib / dextrose. Yog hais tias tus neeg mob tsis tsaug zog 15 feeb tom qab kev txhaj tshuaj ntawm glucagon, nws xav tau kev qhia txog kev daws cov kua nplaum ntev.
Kev cuam tshuam nrog lwm yam tshuaj
Cov tshuaj sib xyaw tsis tuaj yeem tov nrog ntau cov kua tshuaj thiab haus dej ntawm txoj kev ua kua. Thiols thiab sulfites ua rau kev puas tsuaj ntawm tus qauv ntawm tus neeg saib xyuas hauv nqe lus nug.
Lub zog ntawm cov tshuaj nce ntxiv nrog rau kev siv thooj:
- Clofibrate;
- Fenfluramine;
- Pyridoxine;
- Bromocriptine;
- Cyclophosphamide;
- Mebendazole;
- Ketoconazole;
- Theophylline;
- tshuaj tiv thaiv kab mob rau hauv lub qhov ncauj;
- ACE inhibitors;
- cov tshuaj tiv thaiv IMOA pawg;
- tsis xaiv khoom beta-blockers;
- carbonic anhydrase kev ua si inhibitors;
- lithium npaj;
- sulfonamides;
- derivatives ntawm salicylic acid;
- tetracyclines;
- anabolics.
Hauv kev sib xyaw nrog Heparin, Somatotropin, Danazole, Phenytoin, Clonidine, Morphine, corticosteroids, cov thyroid hormones, sympathomimetics, calcium antagonists, thiazide diuretics, TCAs, tshuaj tiv thaiv qhov ncauj, nicotine, insulin nyhuv txo.
Nws raug nquahu kom tsis txhob haus cawv.
Hauv qab ntawm Lanreotide thiab Octreotide, cov tshuaj ntawm cov tshuaj tuaj yeem txo qis thiab nce ntxiv. Kev siv cov beta-blockers ua rau kev hloov kho qhov tseeb ntawm cov qog ntshav qab zib thiab inhibits qhov kev kho dua ntawm cov piam thaj.
Cawv tau zoo
Nws raug nquahu kom tsis txhob haus cawv. Kev ua ntawm ethyl cawv yog qhov nyuaj rau twv, vim nws muaj peev xwm ob leeg txhim kho thiab ua kom cov nyhuv hauv lub ntsej muag tsis zoo.
Analogs
Ua tiav analogues ntawm Detemir-insulin yog Levemir FlexPen thiab Penfill. Tom qab sab laj nrog tus kws kho mob, lwm yam tshuaj insulins (glargine, Insulin-isophan, thiab lwm yam) tuaj yeem siv los hloov cov tshuaj.
Cov ntsiab lus ntawm lub tsev muag tshuaj tawm
Kev siv rau cov tshuaj muaj txwv.
Kuv tuaj yeem yuav yam tsis tas yuav tshuaj
Ib qho tshuaj yog muab tawm los.
Nqi
Tus nqi ntawm cov tshuaj txhaj tshuaj Levemir Penfill - los ntawm 2154 rubles. rau 5 daim cartridges.
Cia rau cov neeg mob rau cov tshuaj
Cov tshuaj Insulin yog cia rau hauv ntim ntawm qhov kub ntawm + 2 ... + 8 ° C, tsis txhob tso kom txias. Kev siv cov kua xaum xaum nrog cov tshuaj yog tiv thaiv los ntawm kev ua dhau ntawm qhov kub tshaj (kub txog + 30 ° C) thiab lub teeb.
Hnub tas sij hawm
Cov tshuaj tuaj yeem khaws cia rau 30 lub hlis txij li hnub ntawm kev tsim khoom. Lub txee lub neej ntawm kev siv daws yog 4 lub lis piam.
Chaw tsim tshuaj paus
Cov tshuaj no yog tsim los ntawm lub tuam txhab Danish chaw muag tshuaj Novo Nordisk.
Xyuas
Nikolay, 52 xyoo, Nizhny Novgorod
Kuv tau siv cov insulin no rau xyoo thib peb. Nws ua tau zoo txo cov piam thaj, ua haujlwm ntev dua thiab zoo dua li kev txhaj tshuaj dhau los.
Galina, 31 xyoo, Ekaterinburg
Thaum kev noj zaub mov tsis pab, Kuv yuav tsum paub daws teebmeem ntshav qab zib thaum muaj menyuam hauv plab thaum siv nrog cov tshuaj no. Cov tshuaj yog qhov ua tau zoo, kev txhaj tshuaj, yog tias ua tiav zoo, yuav tsis muaj mob.
