Feem ntau, cov tshuaj insulin yog tsim tawm los ntawm cov txiav ua ke tas li, nws nkag mus rau hauv cov ntshav hauv cov ntshav me - qib theem. Thaum noj cov khoom noj carbohydrates, qhov kev tso tawm tseem ceeb tshwm sim, thiab cov piam thaj hauv ntshav nrog nws cov kev pabcuam nkag mus rau hauv cov cell.
Mob ntshav qab zib mellitus tshwm sim yog tias cov tshuaj insulin tsis tsim los yog nws cov nyiaj qis dua li ib txwm muaj. Kev loj hlob ntawm cov tsos mob ntshav qab zib kuj tshwm sim thaum cov cell receptors tsis tuaj yeem teb rau qhov hormone no.
Ntawm hom 1 mob ntshav qab zib mellitus, vim tias tsis muaj cov tshuaj insulin, nws txoj kev tswj hwm nyob rau hauv hom kev txhaj tshuaj yog qhia. Cov neeg mob ntawm hom thib ob kuj tuaj yeem kho cov tshuaj insulin hloov cov ntsiav tshuaj. Rau kev kho tshuaj insulin, kev noj zaub mov noj thiab kev txhaj tshuaj tas li yog qhov tseem ceeb.
Hla kev txhaj tshuaj insulin
Txij li kev kho mob ntshav qab zib hom 1 tau ua tshwj xeeb hauv kev siv tshuaj kho mob hauv lub cev tsis tu ncua, kev tswj hwm tshuaj ntawm cov tshuaj yog tib txoj kev los tswj cov ntshav qab zib kom qis.
Kev siv tshuaj insulin kom zoo tuaj yeem tiv thaiv kom tsis txhob muaj pauv hauv cov piam thaj thiab yuav zam kom tsis txhob muaj ntshav qab zib:
- Kev tsim cov comatose uas ua rau muaj kev phom sij rau lub neej: ketoacidosis, lactactacidosis, hypoglycemia.
- Kev rhuav tshem cov phab ntsa vascular - micro- thiab macroangiopathy.
- Ntshav qab zib nephropathy.
- Tsis pom kev zoo - retinopathy.
- Txhab ntawm cov hlab ntsha hlwb - ntshav qab zib neuropathy.
Qhov kev xaiv zoo tshaj plaws rau kev siv tshuaj insulin yog kom rov ua dua nws lub cev kev sib luag ntawm kev nkag mus rau hauv cov ntshav. Rau qhov no, insulins ntawm durations sib txawv ntawm kev ua yog siv. Txhawm rau tsim cov ntshav theem tsis tu ncua, cov tshuaj insulin nyob ntev yog siv 2 zaug hauv ib hnub - Protafan NM, Humulin NPH, Insuman Bazal.
Kev siv tshuaj insulin luv luv yog siv los hloov qhov kev tso tawm ntawm insulin hauv kev teb rau kev noj zaub mov. Nws raug qhia ua ntej noj mov tsawg kawg 3 zaug hauv ib hnub - ua ntej noj tshais, noj su thiab ua ntej noj hmo. Tom qab txhaj tshuaj, koj yuav tsum noj cov zaub mov kom nyob nruab nrab ntawm 20 mus rau 40 feeb. Hauv qhov no, cov koob tshuaj ntawm cov tshuaj insulin yuav tsum tsim los siv tus nqi ntawm cov carbohydrates.
Kev siv cov tshuaj insulin tsuas yog ua rau subcutaneous. Rau qhov no, qhov chaw nyab xeeb thiab yooj yim tshaj plaws yog thaj chaw tom qab thiab tom qab ntawm lub xub pwg, sab pem hauv ntej ntawm tus ncej puab lossis lawv sab tom qab, plab, tshwj tsis yog thaj chaw hais txog thaj chaw mos. Tib lub sijhawm, cov kua dej los ntawm daim tawv nqaij ntawm lub plab nkag mus rau hauv cov ntshav sai dua li lwm qhov chaw.
Yog li, nws raug nquahu kom cov neeg mob thaum sawv ntxov, thiab tseem, yog tias nws yuav tsum tau txo qis sai sai (suav nrog thaum txhaj tshuaj tas), txhaj tshuaj insulin rau hauv phab ntsa plab.
Qhov kev daws teeb meem ntawm kev txiav txim siab ntawm tus mob ntshav qab zib, yog tias nws tsis nco qab txhaj tshuaj insulin, nyob ntawm hom kev ncua tsis tau txhaj tshuaj thiab qhov mob uas tus neeg mob ntshav qab zib siv. Yog tias tus neeg mob tsis tuaj yeem siv tshuaj insulin ntev ntev, ces yuav tsum ua cov ntsuas hauv qab no:
- Thaum txhaj 2 zaug hauv ib hnub - rau 12 teev, tsuas yog siv cov insulin luv luv raws li kev cai ib txwm ua ntej noj mov. Txhawm rau kom them nyiaj rau qhov tsis raug txhaj tshuaj, nce kev qoj ib ce kom txo tau ntshav qab zib. Nco ntsoov tias txoj kev txhaj tshuaj zaum ob.
- Yog tias tus neeg mob ntshav qab zib tau txhaj tshuaj insulin ib zaug, uas yog, cov koob tshuaj yog tsim rau 24 teev, tom qab ntawd cov ntawv txhaj tshuaj tuaj yeem ua 12 teev tom qab dhau, tab sis nws cov koob tshuaj yuav tsum tau halved. Lwm zaus koj yuav tsum nkag rau hauv cov tshuaj rau lub sijhawm tsis tu ncua.
Yog tias koj hla ib koob tshuaj tiv thaiv luv luv ua ntej noj mov, koj tuaj yeem nkag mus rau tom qab noj tas. Yog tias tus neeg mob nco qab txog txoj cai lig dhau, tom qab ntawd koj yuav tsum nce lub nra - mus rau hauv kev ua kis las, mus taug kev, thiab tom qab ntawd ntsuas cov ntshav qab zib kom qis. Yog tias hyperglycemia siab tshaj 13 mmol / L, nws raug nquahu kom txhaj li 1-2 pawg ntawm cov tshuaj insulin luv luv kom tsis txhob dhia hauv qab zib.
Yog tias tau muab cov tshuaj tsis raug - es tsis txhob siv cov tshuaj insulin luv luv, tus neeg mob ntshav qab zib tau siv sijhawm ntev, tom qab ntawd nws lub zog tsis txaus los ua cov khoom noj carbohydrates los ntawm cov khoom noj. Yog li, koj yuav tsum txhawm rau choo cov insulin luv luv, tab sis tib lub sijhawm ntsuas koj cov piam thaj nyob rau txhua ob teev thiab muaj ob peb lub qab zib lossis kua qab zib nrog koj kom tsis txhob txo cov ntshav qab zib kom qis.
Yog tias koj txhaj luv luv es tsis txhob siv tshuaj ntev ntev, ces koj tseem yuav tsum dhau txoj kev txhaj tshuaj tsis tiav, vim tias koj yuav tsum noj cov khoom noj carbohydrate kom tsawg rau cov tshuaj insulin, thiab nws qhov kev txiav txim yuav xaus ua ntej lub sijhawm tsim nyog.
Yog tias muaj insulin ntau dua qhov kev txhaj tshuaj tshaj qhov tsim nyog lossis kev txhaj tshuaj yog ua yuam kev ob zaug, tom qab ntawd koj yuav tsum ua qhov kev ntsuas no:
- Qab ntxiv cov piam thaj hauv cov zaub mov uas muaj roj tsawg nrog cov khoom noj carbohydrates ntau - cereals, zaub thiab txiv hmab txiv ntoo.
- Txhaj tshuaj glucagon, yog tshuaj tua kab mob insulin.
- Ntsuas cov piam thaj tsawg kawg ib zaug txhua ob teev
- Txo kev ntxhov siab ntawm lub cev thiab lub hlwb.
Dab tsi nruj tsis pom zoo rau cov neeg mob ntshav qab zib yog ua rau koob thib ob ntawm koob tshuaj insulin ntxiv, vim tias qhov no yuav ua rau muaj piam thaj kom tsawg. Qhov tseem ceeb tshaj plaws thaum es txhaj koob tshuaj yog saib xyuas qhov qib ntawm cov piam thaj hauv cov ntshav kom txog thaum nws hloov siab.
Hyperglycemia thaum hla kev txhaj tshuaj insulin
Thawj qhov tshwm sim ntawm kev nce ntshav hauv cov ntshav nrog qhov tsis nco txhaj tshuaj yog nce nqhis dej thiab qhov ncauj qhuav, mob taub hau, thiab tso zis heev. Xeev siab, tsis muaj zog nyob ntawm ntshav qab zib, thiab mob plab kuj yuav tshwm sim. Qib qab zib yuav tseem tuaj yeem nce nrog qhov tsis suav xam cov koob tshuaj tsis zoo los yog noj ntau ntawm carbohydrates, kev ntxhov siab thiab kis kab mob.
Yog tias koj tsis noj zaub mov carbohydrates hauv lub sijhawm rau kev tawm tsam kev mob ntshav qab zib, tom qab ntawd lub cev tuaj yeem them nyiaj rau tus mob no ntawm nws tus kheej, thaum lub sijhawm cuam tshuam los ntawm cov tshuaj hormones yuav tswj cov ntshav qab zib kom ntev.
Txhawm rau txo cov piam thaj, koj yuav tsum nce ntxiv cov koob tshuaj insulin yooj yim yog tias, thaum ntsuas, ntsuas qhov ntsuas siab tshaj 10 mmol / l. Nrog rau qhov nce no, rau txhua qhov ntxiv 3 mmol / l, 0.25 units raug muab rau cov menyuam yaus npaj kawm, 0.5 ib qho rau cov tub ntxhais kawm, 1 -2 chav rau cov tub ntxhais hluas thiab cov neeg laus.
Yog tias qhov kev tso cai ntawm insulin tiv thaiv keeb kwm yav dhau los ntawm tus kab mob kis, thaum kub lossis thaum tsis kam noj zaub mov vim tsis qab los noj, yog li tiv thaiv cov teeb meem hauv daim ntawv ntawm ketoacidosis nws pom zoo:
- Txhua 3 teev twg, ntsuas qib hauv qab ntawm cov piam thaj hauv ntshav, nrog rau lub cev ketone hauv cov zis.
- Tawm hauv cov theem ntawm cov insulin ntev tsis hloov pauv, thiab tswj hwm hyperglycemia nrog cov insulin luv luv.
- Yog tias cov piam thaj hauv ntshav siab dua 15 mmol / l, cov tshuaj acetone tshwm rau hauv cov zis, tom qab ntawd txhua qhov kev txhaj tshuaj ua ntej noj mov yuav tsum nce 10-20%.
- Ntawm qhov glycemia theem txog li 15 mmol / L thiab cov kab mob ntawm acetone, qhov koob tshuaj luv luv ntawm insulin yog nce li 5%, nrog qhov txo qis txog 10, kev txiav txim dhau los yuav tsum tau rov qab.
- Ntxiv rau kev txhaj tshuaj tseem ceeb rau kev kis kab mob, koj tuaj yeem tswj hwm cov tshuaj Humalog lossis NovoRapid insulin tsis pub dhau 2 teev, thiab insulin luv luv - 4 teev tom qab kev txhaj tshuaj zaum kawg.
- Haus dej li tsawg kawg ib ລິດ nyob rau ib hnub.
Thaum muaj mob, menyuam yaus tuaj yeem tsis kam noj zaub mov, tshwj xeeb tshaj yog thaum xeev siab thiab ntuav, yog li lawv tuaj yeem hloov mus rau cov txiv hmab txiv ntoo lossis kua txiv hmab txiv ntoo rau lub sijhawm luv luv, muab cov txiv tsaj, txiv tsawb.
Yuav ua li cas tsis hnov qab txog kev txhaj tshuaj ntawm cov tshuaj insulin?
Qhov xwm txheej ntawm kev txhaj tshuaj yuav tsis yog nyob ntawm tus neeg mob, yog li ntawd, rau kev kho mob ntshav qab zib mellitus nrog cov tshuaj insulin, txhua tus pom zoo cov neeg sawv cev uas pab txhawb kev txhaj tshuaj kom tsis tu ncua:
Daim ntawv foos lossis cov ntawv tshwj xeeb sau nrog kev ntsuas ntawm cov koob tshuaj, lub sijhawm txhaj tshuaj, nrog rau cov ntaub ntawv ntawm txhua qhov ntsuas ntawm ntshav qab zib.
Muab lub teeb liab tso rau hauv koj lub xov tooj ntawm tes, ceeb toom rau koj kom nkag mus rau cov tshuaj insulin.
Nruab daim ntawv thov rau ntawm koj lub xov tooj, ntsiav tshuaj lossis khoos phis tawm kom tswj tau cov piam thaj. Cov kev qhia tshwj xeeb no cia koj ib txhij khaws cia chaw cia zaub mov, qab zib qib thiab laij cov tshuaj insulin. Cov no suav nrog Norma Qab Zib, Cov Ntshav Qab Zib Cov Ntshav Qab Zib, Mob Ntshav Qab Zib.
Siv cov ntawv thov kho mob rau cov khoom siv uas taw qhia lub sijhawm ntawm kev siv tshuaj, tshwj xeeb tshaj yog thaum siv lwm yam tshaj li cov ntsiav tshuaj insulin rau kev kho kab mob concomitant: Kuv cov ntsiav tshuaj, Kuv txoj kev kho.
Sau cov ntawv txhaj tshuaj nrog lub thawv rau lub cev kom tsis txhob muaj kev ntxhov siab.
Yog tias qhov kev txhaj tshuaj tsis tiav vim qhov tsis muaj ib qho ntawm cov hom tshuaj insulin, thiab tsis tuaj yeem nqa tawm, vim tias nws tsis yog nyob hauv cov khw muag tshuaj lossis rau lwm qhov laj thawj, tom qab ntawd nws yog qhov kawg los hloov cov tshuaj insulin. Yog tias tsis muaj cov tshuaj insulin luv luv, tom qab ntawd cov tshuaj insulin ntev yuav tsum tau txhaj rau lub sijhawm no uas lub ncov ntawm nws qhov kev txiav txim sib xws nrog lub sijhawm noj mov.
Yog tias tsuas muaj cov tshuaj insulin luv luv, tom qab ntawd koj yuav tsum txhaj nws ntau dua, tsom mus rau theem ntawm cov piam thaj, suav nrog ua ntej mus pw.
Yog tias koj tsis tau noj tshuaj rau kev kho mob ntshav qab zib mellitus ntawm hom thib ob, tom qab ntawd lawv tuaj yeem nqa mus rau lwm lub sijhawm, txij li qhov them nyiaj rau kev tshwm sim ntawm glycemia nrog cov tshuaj tiv thaiv kab mob niaj hnub tsis khi rau sau cov tswv yim. Nws yog txwv tsis pub ua ob npaug koob tshuaj ntawm cov ntsiav tshuaj txawm tias ncua ob koob.
Rau cov neeg mob ntshav qab zib mellitus, nws yog qhov txaus ntshai los ntawm cov ntshav qab zib thaum lawv hla kev txhaj tshuaj lossis kev npaj noj tshuaj, tab sis kev txhim kho ntawm cov mob ntshav qab zib tsawg feem ntau, tshwj xeeb tshaj yog thaum menyuam yaus, tuaj yeem ua rau lub cev tsis zoo, nrog rau txoj kev loj hlob ntawm lub hlwb, yog li kev kho kom haum siab yog qhov tseem ceeb.
Yog tias muaj kev ua xyem xyav txog qhov tseeb ntawm kev rov suav dua ntawm cov koob tshuaj lossis hloov cov tshuaj, ces nws yog qhov zoo dua kom nrhiav kev pab kho mob tshwj xeeb los ntawm endocrinologist. Daim yeeb yaj kiab hauv tsab xov xwm no yuav qhia txog kev sib raug zoo ntawm insulin thiab ntshav qab zib.
