Kev kho tshuaj Insulin muaj lub cim hloov, vim hais tias lub luag haujlwm tseem ceeb ntawm kev kho yog txhawm rau them nyiaj rau qhov ua tsis zoo ntawm cov metabolism hauv kev ua kom rog rog los ntawm kev qhia cov tshuaj tshwj xeeb hauv qab tawv nqaij. Cov tshuaj zoo li no cuam tshuam rau lub cev ib yam nkaus li lub cev insulin uas tsim los ntawm txiav txiav los. Hauv qhov no, kev kho yog tag nrho lossis ib nrab.
Ntawm cov tshuaj siv rau ntshav qab zib, ib qho zoo tshaj plaws yog insulin Isofan. Cov tshuaj muaj cov tib neeg lub cev ua cov tshuaj insulin ntawm lub sijhawm nruab nrab.
Cov cuab yeej muaj nyob hauv ntau hom. Nws raug tswj nyob rau hauv peb txoj kev - subcutaneously, intramuscularly thiab leeg. Qhov no tso cai rau tus neeg mob xaiv qhov kev xaiv zoo tshaj plaws rau kev tswj hwm theem ntawm glycemia.
Kev qhia rau kev siv thiab cov npe lag luam ntawm cov tshuaj
Kev siv cov tshuaj yog qhia rau cov tshuaj insulin-tiv thaiv mob ntshav qab zib. Ntxiv mus, txoj kev kho yuav tsum kav tag lub neej.
Cov tshuaj Insulin li Isofan yog tib neeg cov tshuaj tiv thaiv kab mob hauv cov tshuaj xws li:
- ntshav qab zib hom 2 (insulin-dependant);
- phais cov txheej txheem;
- tsis kam lees rau cov kab mob ntshav qog ntshav coj qhov ncauj ntawm txoj kev kho mob;
- mob ntshav qab zib hauv plab (tsis muaj kev ua tau zoo ntawm kev noj haus);
- intercurrent pathology.
Cov tuam txhab kws tsim khoom lag luam tsim cov tib neeg cov tshuab hluav taws xob ua kom insulin nyob rau hauv ntau lub npe. Cov neeg nyiam tshaj plaws yog Vozulim-N, Biosulin-N, Protafan-NM, Insuran-NPH, Gensulin-N.
Lwm yam ntawm Isofan insulin yog siv nrog cov npe lag luam nram qab no:
- Saib Tsis Txaus;
- Cov tshuaj Humulin (NPH);
- Pensulin;
- Isofan insulin NM (Protafan);
- Actrafan
- Ntsuas H;
- Biogulin N;
- Protafan-NM Penifill.
Nws yog tsim nyog sau cia tias kev siv ib qho lus siv rau Insulin Isofan yuav tsum pom zoo nrog kws kho mob.
Pharmacological kev txiav txim
Tib neeg cov insulin muaj cov nyhuv hypoglycemic. Cov tshuaj cuam tshuam nrog cov receptors ntawm cytoplasmic cell membrane, txoj kev ua ib qho insulin-receptor complex. Nws ua kom muaj txheej txheem uas tshwm sim hauv cov hlwb thiab coj los ua cov enzymes tseem ceeb (glycogen synthetase, pyruvate kinase, hexokinase, thiab lwm yam).
Txo cov concentration ntawm cov piam thaj yog ua tiav los ntawm kev nce ntxiv nws txoj kev thauj mus los hauv qis, txo qis tawm ntawm cov piam thaj ntau ntau los ntawm lub siab, ua kom muaj zog nqus thiab ntxiv nqus ntawm cov piam thaj los ntawm cov ntaub so ntswg. Tsis tas li, tib neeg cov kua dej ua kom cov protein ua ke, glycogenogenesis, lipogenesis.
Lub sijhawm ntawm kev ua ntawm cov tshuaj yog nyob ntawm qhov ceev ntawm kev nqus, thiab nws yog vim muaj ntau yam (thaj tsam ntawm kev tswj hwm, txoj kev thiab qhov koob tshuaj). Yog li, qhov ua tau zoo ntawm Isofan insulin tuaj yeem raug dej nyab hauv ob tus neeg mob thiab lwm tus mob ntshav qab zib.
Feem ntau tom qab txhaj tshuaj, cov nyhuv ntawm cov tshuaj tau sau tseg tom qab 1.5 teev. Qhov siab tshaj plaws siab hauv qhov ua tau zoo tshwm sim hauv 4-12 teev tom qab kev tswj hwm. Sij hawm ntawm ua - ib hnub.
Yog li, qhov ua tiav ntawm kev nqus thiab qhov pib ntawm kev ua ntawm tus neeg sawv cev yog nyob ntawm ntau yam xws li:
- thaj chaw txhaj tshuaj (pob tw, ncej puab, plab);
- nquag siv khoom ua ke;
- tsuas tshuaj.
Kev npaj kua tshuaj rau tib neeg yog faib tsis txaus ntseeg nyob rau hauv cov ntaub so ntswg. Lawv tsis nkag rau hauv lub tsho (placenta) thiab tsis nqus rau niam mis.
Lawv raug rhuav tshem los ntawm insulinase feem ntau yog nyob hauv lub raum thiab mob siab, muaj feem nrog lub raum hauv qhov ntau npaum li 30-80%.
Tsuas tshuaj thiab tswj hwm
Cov lus qhia rau kev siv nrog insulin Izofan hais tias feem ntau ua rau subcutaneously txog 2 zaug hauv ib hnub ua ntej noj tshais (30-45 feeb). Hauv qhov no, koj yuav tsum hloov thaj chaw txhaj tshuaj txhua hnub thiab khaws cov koob txhaj tshuaj uas siv rau hauv chav tsev, thiab ib qho tshiab hauv lub tub yees.
Qee zaum cov tshuaj tau muab tshuaj intramuscularly. Thiab txoj hauv kev siv qhov tseeb nruab nrab ntawm kev siv tshuaj insulin yog qhov siv tsis tau siv.
Qhov ntau npaum li cas tau muab xam ib qho zuj zus rau txhua tus neeg mob, raws li theem ntawm cov suab thaj hauv kev tso zis lom thiab qhov tshwj xeeb ntawm tus kab mob. Raws li txoj cai, qhov nruab nrab txhua hnub ntau npaum li cas los ntawm 8-24 IU.
Yog tias cov neeg mob tau ua kom tsis txhob mob insulin, ces kev noj tshuaj muaj txiaj ntsig txhua hnub yog 8 IU. Nrog lub cev tsis zoo ntawm lub cev, qhov ntau npaum ntau ntxiv - los ntawm 24 IU ib hnub.
Thaum lub ntim txhua hnub ntawm cov khoom yog ntau dua 0.6 IU rau 1 kg ntawm huab hwm coj, tom qab ntawd 2 qhov hno tau ua nyob rau ntau qhov chaw ntawm lub cev. Cov neeg mob uas noj tshuaj ib hnub ib zaug ntawm 100 IU lossis ntau dua yuav tsum tau mus pw hauv tsev kho mob yog tias pauv cov ntshav insulin.
Ntxiv mus, thaum hloov los ntawm ib hom khoom lag luam mus rau lwm tus, nws yog qhov yuav tsum tau soj ntsuam cov piam thaj hauv qab.
Kev phiv tshuaj thiab kev haus ntau dhau
Kev siv cov tshuaj insulin rau tib neeg tuaj yeem ua rau ua rau ua xua tuaj. Feem ntau, nws yog angioedema (hypotension, ua pa luv, kub cev) thiab urticaria.
Tsis tas li, ntau tshaj qhov ntau npaum li cas tuaj yeem ua rau lub qog ntshav qab zib, los ntawm cov tsos mob hauv qab no:
- insomnia
- blanching ntawm daim tawv nqaij;
- Kev Nyuaj Siab
- hyperhidrosis;
- ntshai
- zoo siab xeev;
- plawv dhia;
- mob taub hau
- tsis meej pem txog txoj kev nco qab;
- vestibular kev ntshawv siab;
- kev tshaib kev nqhis
- tshee hnyo thiab os.
Cov kev mob tshwm sim suav nrog cov ntshav qab zib acidosis thiab hyperglycemia, uas tau tshwm sim los ntawm lub ntsej muag yaug, kev tsaug zog, tsis qab los noj mov thiab nqhis dej. Feem ntau, cov xwm txheej zoo li no tiv thaiv keeb kwm ntawm kev kis tus kab mob thiab kub taub hau, thaum txhaj tsis dhau, qhov ntau npaum li cas tsis yog, thiab yog tias kev noj haus tsis ua raws.
Qee lub sij hawm ua txhaum ntawm nco qab tshwm sim. Nyob rau hauv qhov teeb meem nyuaj, ib qho tab tom zoo thiab xeev tsis xeev tau nce qib.
Thaum pib kho mob, kev hloov pauv tsis ua haujlwm nyob hauv qhov pom kev zoo yuav tshwm sim. Kuj tseem muaj qhov nce ntxiv ntawm titer ntawm anti-insulin lub cev nrog kev nce ntxiv ntawm glycemia thiab kev tiv thaiv kab mob sib kis nrog tib neeg cov insulin.
Feem ntau qhov chaw txhaj tshuaj swells thiab khaus. Hauv qhov no, subcutaneous fatty cov ntaub so ntswg hypertrophies lossis atrophies. Thiab nyob rau theem pib ntawm txoj kev kho, kev ua txhaum cai ib ntus ntawm kev thim rov qab thiab o tuaj yeem tshwm sim.
Yog tias muaj kev noj tshuaj ntau dhau ntawm cov tshuaj hormones, cov ntshav qab zib cov ntshav yuav poob qis. Qhov no ua rau cov ntshav qog ua kom qis, thiab qee zaum tus neeg mob poob rau hauv lub xeev tsis xeev.
Yog tias cov koob tshuaj tau nce siab dua me ntsis, koj yuav tsum noj cov zaub mov uas muaj cov carb ntau (chocolate, qhob cij dawb, ib yob, khaub noom) lossis haus dej qab zib. Thaum tsaus muag, qhov dextrose tov (40%) lossis glucagon (s / c, v / m) tau muab rau tus neeg mob hauv / hauv.
Thaum tus neeg mob rov qab nco qab, nws yog qhov tsim nyog los pub nws cov zaub mov nplua nuj hauv kev ua si carbohydrates.
Qhov no yuav tiv thaiv hypoglycemic rov mob dua thiab glycemic coma.
Kev cuam tshuam thiab cov lus qhia tseem ceeb
Ncua rau sc coj tsis siv nrog daws lwm yam tshuaj. Ib tug co-thawj coj nrog sulfonamides, ACE / Mao / carbonic anhydrase, narcotics yuav muab, ethanol inhibitors, anabolic steroids, chloroquine, androgens, quinine, bromocriptine, pirodoksin, tetracyclines, lithium npaj, clofibrate, fenfluramine, Ketonozolom, Tsiklofosvamidom, theophylline, mebendazole tej hypoglycemic nyhuv.
Lub cev tsis muaj zog ntawm hypoglycemic ua rau:
- H1-histamine receptor blockers;
- Glucagon;
- Somatropin;
- Epinephrine;
- GCS;
- Phenytoin;
- qhov ncauj tiv thaiv;
- Epinephrine;
- Estrogens;
- calcium antagonists.
Ntxiv rau, qhov kev txo qis hauv qab zib ua rau kev siv Isofan insulin nrog loop thiab thiazide diuretics, Klondin, BMKK, Diazoxide, Danazol, cov thyroid hormones, tricyclic antidepressants, sympathomimetics, Heparin thiab sulfinpyrazone. Nicotine, tshuaj maj thiab morphine kuj nce rau hauv cov ntshav siab.
Pentamidine, beta-blockers, Octreotide thiab Reserpine tuaj yeem txhim kho lossis tsis muaj zog glycemia.
Ceev faj txog kev siv Isofan insulin yog tias tus neeg muaj ntshav qab zib yuav tsum hloov tas mus li qhov chaw uas yuav txhaj tshuaj insulin. Tom qab tag nrho, tib txoj kev los tiv thaiv cov tsos ntawm lipodystrophy.
Tawm tsam tom qab ntawm cov tshuaj insulin, koj yuav tsum tau saib xyuas kom tsis txhob muaj cov kua nplaum ntev. Tom qab txhua tus, ntxiv rau kev sib koom tes nrog lwm cov tshuaj, lwm yam tuaj yeem ua rau cov ntshav qog ntshav qab zib:
- mob ntshav qab zib thiab ntuav;
- tshuaj hloov;
- txhawb nqa lub cev;
- cov kab mob uas txo qis qhov xav tau rau lub cev (lub raum thiab lub siab ua haujlwm tsis txaus, kev ua haujlwm ntawm cov thyroid caj pas, lub caj pas pituitary, thiab lwm yam);
- kev noj haus tsis tseeb;
- hloov chaw txhaj tshuaj.
Kev noj tshuaj tsis yog lossis ncua ntev ntev ntawm kev txhaj tshuaj insulin tuaj yeem pab txhawb kev txhim kho hyperglycemia, tshwj xeeb tshaj yog muaj ntshav qab zib hom 1. Yog tias kev kho tsis tuaj yeem hloov kho hauv lub sijhawm, tom qab ntawd tus neeg mob qee zaum pib txhim kho ketoacidotic tsis meej pem.
Ib qho ntxiv, kev hloov pauv yuav tsum yog tus neeg mob muaj hnub nyoog ntau dua 65, nws muaj qhov tsis zoo ntawm lub qog, lub raum lossis mob siab. Nws kuj tseem ceeb rau kev ua haujlwm hypopituitarism thiab Addison's kab mob.
Tsis tas li ntawd, cov neeg mob yuav tsum paub tias tib neeg cov tshuaj insulin npaj txo kev haus cawv kom ua tau. Hauv cov theem pib ntawm kev kho, thaum muaj kev hloov pauv ntawm cov tshuaj, kev ntxhov siab, kev tawm dag zog lub cev, nws tsis tas yuav tsav lub tsheb thiab lwm cov txheej txheem nyuaj lossis koom rau hauv cov haujlwm txaus ntshai uas xav tau nce siab thiab ceev ntawm cov kev tawm tsam.
Cov neeg mob cev xeeb tub yuav tsum xav txog tias nyob hauv thawj peb lub hlis xav tau cov tshuaj insulin tsawg dua, thiab hauv 2 thiab 3 nws nce ntxiv. Tsis tas li, ib qho me me ntawm cov hormone yuav xav tau thaum lub sijhawm ua haujlwm.
Cov yam ntxwv ntawm kws tshuaj ntawm Isofan yuav tham txog hauv kev yees duab hauv kab lus no.
