Mob ntshav qab zib mellitus yog ib yam kab mob txaus ntshai heev uas tuaj yeem ua tau cov insulin-hom (yam 1) lossis cov tsis muaj insulin-tiv thaiv (hom 2). Hauv rooj plaub tom kawg, tus kab mob tau ua tiav zoo nrog kev pab ntawm hypoglycemic agents thiab tshwj xeeb kev noj haus. Tab sis nrog thawj hom mob thiab muaj tus mob ntshav qab zib hom 2 pib, kev kho cov tshuaj insulin tsis tuaj yeem muaj peev xwm ua kom tiav.
Feem ntau, cov neeg mob uas muaj kev nce siab ntxiv ntawm cov piam thaj hauv cov ntshav yog cov tshuaj insulin Glulizin. Qhov no yog cov tshuaj dawb rau kev txhaj tshuaj, cov tshuaj yeeb dej tseem ceeb ntawm uas yog cov tshuaj analogue ntawm soluble tib neeg cov kua dej, tsim los siv cov kev tsim hluav taws xob.
Cov tshuaj muaj cov nyhuv luv luv txhawm rau qhov kev poob qis sai sai hauv kev xav ntawm cov piam thaj hauv cov ntshav. Apidra SoloStar thiab Apidra koom nrog txoj hauv kev, uas koom nrog insulin Glulisin.
Pharmacological nyhuv thiab pharmacokinetics
Kev daws tau luv luv hypoglycemic nyhuv. Tsis tas li ntawd, nws ua kom cov txheej txheem qabzib nqus los ntawm cov ntaub so ntswg (rog, cov leeg pob txha), inhibiting cov txheej txheem ntawm cov piam thaj hauv siab.
Tsis tas li, cov tshuaj stimulates protein synthesis, inhibits proteolysis thiab lipolysis hauv adipocytes. Tom qab tswj hwm subcutaneous, qhov txo qis hauv qab zib qib tshwm sim tom qab 10-20 feeb.
Kev tswj hwm ntawm iv kev tswj hwm, cov nyhuv hypoglycemic yog piv rau cov kev ua ntawm tib neeg cov insulin. Yog li, hais txog qhov ua tau zoo, 1 IU ntawm insulin Glulisin yog sib npaug rau 1 IU ntawm solulin tib neeg cov kua dej.
Piv rau tib neeg cov insulin, Glulisin yog nqus ob zaug kom nrawm dua. Qhov no yog vim muaj kev hloov ntawm asparagine amino acid (txoj haujlwm 3B) nrog lysine, ntxiv rau lysine (txoj haujlwm 29B) nrog glutamic acid.
Kev tsis haum tom qab saib xyuas sc:
- hauv tus ncej puab - nruab nrab;
- hauv phab ntsa plab - nrawm;
- nyob rau hauv lub xub pwg - nruab nrab.
Kev tsis raug cai ntawm bioavailability yog 70%. Thaum qhia rau hauv thaj chaw sib txawv, nws zoo sib xws thiab muaj qhov txawv txav ntawm cov neeg mob (qhov txawv txav ntawm 11%).
Thaum muab tshuaj subcutaneously nrog hom 1 mob ntshav qab zib, 0.15 U / kg TCmax yog 55 min., Thiab kg Cmax yog 80.7-83.3 μU / ml. Hauv hom ob, tom qab kev tswj hwm sc ntawm cov tshuaj ntawm ib koob ntawm 0.2 PIECES / kg, Cmax yog 91 mcU / ml.
Hauv cov kab ke ncig tag nrho, kev siv sij hawm kwv yees yog 98 min. Nrog rau / hauv cov lus qhia, qhov ntim ntawm kev faib tawm yog 13 litres, T1 / 2 - 13 feeb. AUC - 641 mg x h / dl.
Cov chaw muag tshuaj rau cov neeg mob ntshav qab zib qis dua 16 xyoo muaj thawj hom mob yog tib yam li cov neeg laus. Nrog sc tswj hwm T1 / 2 yog ntawm 37 txog 75 feeb.
Cov lus qhia rau kev siv tshuaj
Cov tshuaj Insulin Glulisin yog cov tshuaj subcutaneously, cov koob tshuaj yog xaiv ib tus zuj zus rau txhua tus neeg mob. Kev txhaj tshuaj yog ua tiav nyob rau hauv 0-15 feeb. ua ntej lossis tom qab noj mov.
Glulisin yog siv rau hauv kev siv tshuaj kho mob, suav nrog kev siv tshuaj insulin hauv nruab nrab lossis ntev ntev, lossis lawv cov analogues. Tsis tas li, cov tshuaj yeeb yaj kiab tuaj yeem siv ua ke nrog cov tshuaj uas muaj cov nyhuv hypoglycemic, uas tau siv los hais lus.
Kev daws yog muab rau hauv daim ntawv ntawm kev txhaj tshuaj subcutaneous los yog infusion siv lub twj tso kua mis. Kev txhaj tshuaj yog ua tiav thaj chaw ntawm lub xub pwg, ncej puab, sab hauv plab phab ntsa. Thiab kev qhia ntawm cov nyiaj los ntawm kev sib txuas ntxiv txuas ntxiv yog nqa tawm hauv peritoneum.
Cov cheeb tsam rau kev txhaj tshuaj thiab infusions yuav tsum tau hloov txhua zaus. Lub nrawm ntawm kev nqus, qhov pib thiab lub sijhawm ntawm cov nyhuv yog txiav txim siab los ntawm ntau yam (kev tawm dag zog, chaw tswj). Rau kev nqus sai, cov tshuaj yuav tsum tau txhaj rau hauv qhov chaw ntawm sab xub ntiag ntawm phab ntsa plab.
Nws yog ib qho tseem ceeb kom ceev faj tias insulin Glulisin tsis nkag rau cov hlab ntshav. Yog li, txhua tus neeg mob ntshav qab zib yuav tsum txawj ntse nyob rau hauv kev tswj hwm insulin. Tom qab txhaj, qhov chaw txhaj tshuaj txwv tsis pub zaws.
Glulisin raug tso cai muab sib xyaw nrog Isofan (tib neeg insulin), tab sis Glulisin yuav tsum tau kos rau hauv cov koob txhaj tshuaj ua ntej. SC cov thawj coj yuav tsum tau nqa tawm tam sim tom qab sib xyaw cov txhais tau tias. Hauv qhov no, kev sib xyaw ntawm Isofan thiab Glulisin yog txwv tsis pub muab cov tshuaj ua leeg ntshav.
Yog tias cov tshuaj insulin Glulisin raug siv siv lub twj tso kua mis, tom qab ntawd cov khoom siv yuav tsum tau hloov pauv txhua 4 teev, ua raws li cov kev cai tiv thaiv kev lag luam. Nrog rau txoj kev lis ntshav ntawm txoj kev tswj hwm, cov tshuaj yuav tsum tsis txhob sib xyaw nrog lwm cov kev daws teeb meem lossis insulins.
Kev siv tsis zoo ntawm lub twj tso kua mis los yog ua txhaum nws txoj haujlwm, ntshav qab zib ketoacidosis, hyperglycemia lossis ketosis tuaj yeem txhim kho. Txhawm rau tiv thaiv qhov tshwm sim ntawm cov xwm txheej zoo li no, ua ntej yuav ua tus txheej txheem, koj yuav tsum ua tib zoo kawm kev cai rau kev siv qhov system thiab ua tib zoo suav kev siv tshuaj noj.
Ua ntej siv txoj kev daws teeb meem, koj yuav tsum xyuas nws qhov xwm yeem, xim thiab paub tseeb tias tsis muaj cov khoom txawv teb chaws hauv nws. Yog tias cov khoom yog pos huab, xim lossis nrog nrog impurities, ces nws yog txwv tsis pub siv nws.
Cov kev txuam nrog, phiv ntau dhau, siv ntau dhau
Kev siv tshuaj Insulin Glulizin tsis yog siv los kho cov menyuam yaus hnub nyoog qis dua 6 xyoo, muaj kev mob ntshav qab zib thiab kev tiv thaiv tsis haum rau nws cov khoom sib xyaw. Cov kev mob tshwm sim feem ntau yog hypoglycemia. Cov tawv nqaij ua xua tshwm sim thiab cov teeb meem ntawm lub cev zom zaub mov kuj tseem ua tau.
Qee zaum cov tsos mob neuropsychiatric tshwm sim, xws li tsaug zog, nkees nkees, ua kom lub cev tsis muaj zog, cramps, thiab xeev siab. Mob taub hau, tsis muaj peev xwm siab, tsis meej pem meej pem thiab pom qhov kev ntshaus siab kuj tshwm sim.
Feem ntau, ua ntej neuropsychiatric ntshawv siab, cov tsos mob ntawm adrenergic counterregulation tshwm sim. Qhov no yog kev tshaib kev nqhis, txob taus, tachycardia, tshee tshee zoo, tawm hws txias, ntxhov siab, blanching ntawm daim tawv nqaij thiab tshee.
Nws tsim nyog sau cia tias muaj kev tawm tsam ntau ntawm cov ntshav qog ntshav, uas yog pheej tas li, ua rau muaj kev puas tsuaj rau NS. Ntxiv mus, hauv qee kis, qhov no yuav ua rau tuag.
Ntxiv nrog rau qhov poob qis hauv cov suab thaj, cov kev mob tshwm sim hauv zos tuaj yeem tshwm sim hauv cov cheeb tsam uas tau txhaj koob tshuaj. Cov no suav nrog hyperemia, o thiab khaus, feem ntau cov tsos mob ploj lawv tus kheej thaum kho ntxiv. Qee zaum, vim yog qhov tsis ua raws li kev hloov chaw ntawm kev tswj hwm ntawm thaj chaw ntawm cov tshuaj insulin, cov ntshav qab zib yuav mob lipodystrophy.
Cov cim qhia ntsig txog qhov tsis nco qab yog qhov ua tau:
- khaus
- urticaria;
- dermatitis kev tsis haum;
- hauv siab nruj;
- zawm caj pas.
Cov ua xua tsis haum yuav ua tau neeg tuag taus.
Yog tias dhau ntawm kev siv tshuaj ntau dhau, mob ntshav qab zib ntawm qhov sib txawv yuav tshwm sim. Nrog rau cov ntshav qab zib kom tsawg, tus neeg mob yuav tsum haus dej haus lossis cov khoom muaj suab thaj.
Hauv kev mob hnyav dua thiab tsis nco qab, s / c lossis nyob rau hauv / m raug tshuaj Dextrose lossis Glucagon. Thaum tus neeg mob rov qab nco qab, nws yuav tsum noj cov khoom noj carbohydrates, uas yuav zam kom tsis txhob mob huam ntxiv.
Sib cuam tshuam nrog lwm cov tshuaj thiab cov lus qhia tshwj xeeb
Nrog kev sib xyaw ntawm cov tshuaj insulin Glulisin nrog ACE / MAO inhibitors, Disopyramide, fibrates, sulfonamides, salicylates thiab Propoxyphene, cov nyhuv hypoglycemic yog kho kom zoo thiab muaj peev xwm ntawm kev txhim kho hypoglycemia nce.
Kev sib xyaw ua ke ntawm cov tshuaj insulin nrog cov tshuaj tiv thaiv protease inhibitors, Danazole, antipsychotics, Salbutamol, Terbutaline, isoniazids, Epinephrine, Diazoxide, diuretics, Somatropin thiab phenothiazine derivatives yuav ua rau cov nyhuv hypoglycemic tsawg dua. Clonidine, beta-blockers, ethanol thiab lithium ntsev tsis muaj zog cov kev ua haujlwm ntawm insulin Glulisin. Thiab kev siv tshuaj sib xyaw ua ke nrog Pentamidine tuaj yeem ua rau ob leeg mob ntshav qab zib thiab hyperglycemia.
Kev txheeb xyuas cov neeg mob ntshav qab zib tau hais tias thaum siv cov neeg sawv cev uas qhia kev ua haujlwm sympatholytic, cov tsos mob ntawm adrenergic reflex activation tuaj yeem npog ntsej muag. Cov tshuaj no suav nrog clonidine thiab guanethidine.
Yog tias tus neeg mob hloov mus rau lwm hom tshuaj insulin lossis tshuaj los ntawm qhov chaw tsim khoom tshiab, tom qab ntawd qhov no yuav tsum ua tiav nyob hauv kev saib xyuas mob. Nws yog tsim nyog kom nco ntsoov tias kev noj tshuaj tsis yog lossis tsis txuas ntxiv ntawm kev kho mob insulin tuaj yeem txhim kho ketoacidosis thiab mob ntshav qab zib.
Ntxiv mus, qee qhov xwm txheej tuaj yeem hloov lossis ua cov tsos mob ntawm hypoglycemia tsis hais tawm. Xws li cov kev tshwm sim suav nrog:
- mob ntev ntshav qab zib;
- nruj kev kho mob ntawm kev kho mob nrog cov tshuaj insulin;
- hloov chaw ntawm tus neeg mob los ntawm ib tus tsiaj mus rau tib neeg cov tshuaj hormones;
- noj lwm yam tshuaj;
- uas mob ntshav qab zib neuropathy.
Thaum hloov ntshav kev noj haus lossis kev tawm dag zog nws yog qhov tsim nyog yuav hloov pauv cov tshuaj ntawm cov tshuaj insulin. Txawm li cas los xij, yog tias cov tshuaj tau muab tshuaj tam sim ntawd tom qab kis las, ces qhov yuav ua rau muaj ntshav siab qis yog qhov siab.
Hais txog kev siv tshuaj insulin Glulisin thaum cev xeeb tub, cov txheej txheem kev kho mob yuav tsum tau mus kom ze nrog kev ceev faj, vim tias glycemia yuav pib mob ntshav qab zib hom 2 thiab thawj zaug. Ntxiv mus, hauv thawj 3 lub hlis uas cev xeeb tub thiab tom qab yug menyuam, qhov koob tshuaj insulin feem ntau raug txo qis. Thaum lub sijhawm pub niam mis, yuav tsum tau hloov kho ntau dua.
Tus nqi ntawm cov kev daws rau sc tswj hwm raws li insulin Glulisin thaj tsam li ntawm 1720 txog 2100 rubles.
Cov vis dis aus hauv tsab xov xwm no qhia txog yuav ua li cas txhaj tshuaj insulin subcutaneously.
