Cov tib neeg solulin insulin analogue muaj qhov ua kom ntev (ua rau muaj kev sib raug zoo ntawm tus kheej kev koom tes ntawm detemir insulin lwg me me nyob hauv thaj chaw ntawm kev tswj hwm thiab kev cuam tshuam ntawm cov tshuaj lev tshuaj nrog albumin los ntawm kev tiv tauj cov kua qaub-fatty acid sab saw) nrog lub tiaj tus ntawm kev ua (tsawg dua piv rau insulin glargine thiab isofan) Cov.
Piv nrog tshuaj insulin-isofan, insulin detemir tau maj mam tawg ntawm cov nqaij mos, uas ua kom cov khoom lag luam nqus tau thiab qhov tsim nyog siv tau ntawm tus neeg sawv cev. Kev sib tham zoo nrog cov receptor ntawm sab nraud cytoplasmic cell membrane yog sau tseg.
Cov tshuaj kuj tseem tsim cov insulin-receptor complex uas ua kom cov txheej txheem uas tshwm sim hauv cov hlwb, suav nrog nws ua rau cov synthesis ntawm qee cov enzymes tseem ceeb (piv txwv, glycogen synthetase).
Qhov kev txo qis hauv cov ntshav qab zib yog tshwm sim los ntawm:
- nce ntxiv hauv nws thauj hauv cov hlwb;
- kev ua haujlwm ntawm glycogenogenesis, lipogenesis;
- nce kev zom ntawm cov nqaij;
- qhov txo qis hauv cov nqi ntawm cov piam thaj tsim tawm los ntawm lub siab.
Tom qab txhaj tshuaj (0.2-0.4 units / kg 50%), qhov siab tshaj plaws ntawm kev ua tiav tau tiav tom qab 3-4 teev thiab kav ntev txog 14 teev. Lub sijhawm tiv thaiv ntawm cov nyhuv yog li 1 hnub.
TCmax - los ntawm 6 txog 8 teev. Css, muab tias nws tau tswj hwm ob zaug ib hnub, tuaj yeem ua tiav tom qab hno zaum ob. Kev faib khoom yog 0.1 l / kg.
Kev mob plab nyuv zoo ib yam li cov metabolism hauv tib neeg cov insulin, txhua yam roj ntsha ua kom muaj lub zog. T1 / 2 ntawm 5 txog 7 teev.
Sib cuam tshuam nrog lwm txoj kev
Ntxiv dag zog rau hypoglycemic kawg ua rau:
- Cov tshuaj uas muaj ethanol;
- cov tshuaj hypoglycemic (qhov ncauj);
- Li +;
- MAO inhibitors;
- fenfluramine,
- ACE inhibitors;
- cyclophosphamide;
- carbonic anhydrase inhibitors;
- theophylline;
- tsis xaiv khoom beta-blockers;
- pyridoxine;
- bromocriptine;
- mebendazole;
- sulfonamides;
- ketonazole;
- cov tshuaj anabolic;
- clofibrate;
- tetracyclines.
Kev siv tshuaj txo ntshav qab zib kom tsawg
Nicotine, tshuaj tiv thaiv (qhov ncauj), corticosteroids, phenytoin, cov thyroid hormones, morphine, thiazide diuretics, diazoxide, heparin, calcium channel blockers (qeeb), tricyclic antidepressants, clonidine, danazole thiab sympathomimets txo cov nyhuv hypoglycemic.
Salicylates thiab reserpine muaj peev xwm txhim kho lossis txo cov nyhuv uas detemir muaj ntawm insulin. Lanreotide thiab octreotide nce lossis txo qis cov tshuaj insulin.
Ua tib zoo mloog! Beta-blockers, vim yog lawv cov yam ntxwv tshwj xeeb, feem ntau npog cov tsos mob ntawm kev mob ntshav qab zib thiab ncua kev kho dua ntawm cov piam thaj hauv qab.
Cov tshuaj Ethanol uas muaj tshuaj txhim kho thiab nce cov nyhuv hypoglycemic ntawm insulin. Cov tshuaj tsis sib xws nrog cov tshuaj raws li sulfite lossis thiol (insulin detemir raug rhuav tshem). Ntxiv mus, cov tshuaj tsis tuaj yeem tov nrog infusion daws teeb meem.
Cov lus qhia tshwj xeeb
Koj tuaj yeem tsis nkag mus hauv qhov quav tshuaj txhaws ntswg, vim tias ib hom kev hnyav ntawm lub qog ntshav qab zib yuav tshwm sim. Kev kho hnyav nrog cov tshuaj tsis pab rau kev sau cov phaus ntxiv.
Piv nrog rau lwm cov insulins, insulin detemir txo cov kev pheej hmoo ntawm hypoglycemia thaum hmo ntuj thiab muaj feem rau qhov kev xaiv ntau tshaj plaws hauv kev tshuaj noj uas yog ua tiav lub hom phiaj ruaj khov ntawm cov piam thaj hauv cov ntshav.
Tseem Ceeb! Kev cheem tsis tu ncua lossis kev siv tshuaj tsis yog, tshwj xeeb tshaj yog rau ntshav qab zib hom I, ua rau pom tshwm sim ntawm hyperglycemia lossis ketoacidosis.
Cov cim tseem ceeb ntawm hyperglycemia feem ntau tshwm sim hauv theem. Lawv tshwm sim hauv ob peb teev lossis hnub. Cov tsos mob ntawm hyperglycemia suav nrog:
- hnov tsw ntawm acetone tom qab exhalation;
- kev nqhis dej
- tsis muaj qab los noj mov;
- polyuria;
- kev xav ntawm dryness hauv qhov ncauj kab noj hniav;
- xeev siab
- daim tawv nqaij qhuav
- gagging;
- hyperemia;
- kev pw tsaug zog tas li.
Kev tawm dag zog tam sim thiab nquag, thiab kev noj zaub mov tsis xwm yeem kuj ua rau lub ntsej muag ntshav qab zib.
Txawm li cas los xij, tom qab pib rov ua dua ntawm cov carbohydrate metabolism, cov yam ntxwv ntawm tus mob hypoglycemia yuav hloov, yog li tus neeg mob yuav tsum tau qhia los ntawm tus kws kho mob uas koom nrog. Cov tsos mob tshwm sim tuaj yeem npog thaum muaj ntshav qab zib ntev. Cov kab mob sib kis txuas ntxiv kuj tseem xav tau cov tshuaj insulin.
Hloov chaw ntawm tus neeg mob mus rau ib hom tshiab lossis insulin, tsim los ntawm lwm tus neeg tsim khoom, ib txwm ua raws li kev saib xyuas mob. Thaum lub sijhawm hloov pauv ntawm cov khw tsim khoom, ntau npaum li cas, hom, hom lossis hom kev tsim cov tshuaj insulin, kev hloov kho ntau zaus yuav tsum tau ua.
Cov neeg mob hloov mus rau kev kho mob uas siv tshuaj tua kab mob insulin ntau zaus yuav tsum tau txhaj tshuaj kom haum dua yog piv rau cov tshuaj insulin uas muab rau yav tas los. Qhov yuav tsum tau hloov cov koob tau tshwm sim tom qab kev qhia thawj zaug ntawm kev txhaj tshuaj lossis thaum ib asthiv lossis hli. Cov txheej txheem ntawm kev nqus ntawm cov tshuaj nyob rau hauv cov ntaub ntawv ntawm intramuscular thawj coj yog heev ceev nyob rau hauv kev sib piv nrog sc tswj hwm.
Detemir yuav pauv pauv qhov feem cuam ntawm kev ua yog tias nws tau sib xyaw nrog lwm hom insulin. Nws ua ke nrog insulin aspart yuav ua rau cov kev ua ntawm kev ua haujlwm nrog qis, ncua kev ua haujlwm siab tshaj plaws hauv kev sib piv nrog kev hloov chaw tswj hwm. Detemir insulin yuav tsum tsis txhob siv rau hauv cov tshuaj insulin.
Txog rau hnub tim, tsis muaj ntaub ntawv hais txog kev siv tshuaj kho mob thaum cev xeeb tub, lactation thiab menyuam yaus hnub nyoog qis dua rau xyoo.
Tus neeg mob yuav tsum ceeb toom rau kev muaj peev xwm ntawm kev mob ntshav qab zib thiab kev mob ntshav qab zib nyob hauv tus txheej txheem ntawm kev tsav tsheb thiab tswj cov twj. Hauv qee qhov tshwj xeeb, nws yog ib qho tseem ceeb rau cov neeg muaj mob me me lossis tsis tuaj ua ntej uas muaj ntshav qab zib tsawg.
Kev qhia rau siv thiab muab ntau npaum li cas
Ntshav qab zib mellitus yog yam kab mob tseem ceeb hauv cov tshuaj qhia tau.
Cov tswv yim yog nqa tawm hauv lub xub pwg, lub plab hauv plab lossis ncej puab. Cov chaw uas txhaj tshuaj insemir yuav tsum tau kho tas li. Kev noj tshuaj thiab ntau zaus ntawm kev txhaj tshuaj yog tsim muaj tus kheej.
Thaum txhaj ob zaug los ua kom cov ntshav qabzib ntau dua, nws raug nquahu kom noj qhov tshuaj thib ob tom qab 12 teev tom qab thawj zaug, thaum noj hmo lossis ua ntej mus pw.
Yuav tau hloov kho ntau npaum li cas thiab lub sijhawm yuav tsum ua li cas yog hais tias tus neeg mob hloov tawm los ntawm cov tshuaj insulin ntev thiab ib qho tshuaj nruab nrab rau insulin detemir.
Sab sij huam
Cov kev mob tshwm sim feem ntau (1 ntawm 100, qee zaum 1 tawm ntawm 10) suav nrog kev muaj ntshav qab zib thiab tag nrho nws cov kev mob tshwm sim: xeev siab, pallor ntawm daim tawv nqaij, nce qab los noj mov, tsis meej pem, mob hlwb thiab txawm tias lub hlwb muaj teeb meem uas ua rau tuag. Cov kev tawm tsam hauv zos (khaus, o, hyperemia ntawm qhov chaw txhaj tshuaj) kuj tseem tuaj yeem ua tau, tab sis lawv ib ntus thiab ploj thaum kho.
Tsis tshua muaj cov kev mob tshwm sim (1/1000, qee zaum 1/100) suav nrog:
- txhaj tshuaj lipodystrophy;
- o ib ntus uas tshwm sim thaum pib siv tshuaj insulin;
- kev tsis haum tshuaj (txo cov ntshav siab, urticaria, palpitations thiab ua pa nyuaj, khaus, ua haujlwm ntawm lub plab zom mov, hyperhidrosis, thiab lwm yam);
- ntawm cov theem pib ntawm kev kho tshuaj insulin, kev ua txhaum ib ntus ntawm kev tshem tawm tshwm sim;
- uas yog kuaj ntshav qab zib.
Hais txog retinopathy, kev tswj ntev glycemic txo qhov ntxim nyiam ntawm kev tsim pathology, tab sis kev kho mob insulin ntau dua nrog kev nce sai sai ntawm kev tswj cov metabolism hauv cov khoom noj tuaj yeem ua rau muaj kev cuam tshuam ib ntus ntawm lub xeev ntawm cov ntshav qab zib retinopathy.
Tsis tshua muaj tshwm sim (1/10000, qee zaum 1/1000) cov kev mob tshwm sim suav nrog neippathy mob hlwb los yog mob neuropathy mob, uas feem ntau yog qhov thim rov qab.
Noj ntau dhau
Cov tsos mob tseem ceeb ntawm kev siv tshuaj ntau dhau ntawm cov tshuaj yog hypoglycemia. Tus neeg mob tuaj yeem tshem ntawm kev muaj ntshav qab zib tsawg ntawm lawv tus kheej los ntawm kev noj zaub mov qabzib lossis zaub mov carbohydrate.
Nyob rau hauv cov ntaub ntawv ntawm loj s / c, i / m raug tswj hwm 0.5-1 mg ntawm glucagon los yog dextrose daws nyob rau hauv / hauv. Yog tias tom qab 15 feeb tom qab noj cov tshuaj glucagon, tus neeg mob tsis rov qab nco qab, tom qab ntawv dextrose yuav tsum tau muab tshuaj. Thaum ib tug neeg rov qab nco qab rau txoj kev tiv thaiv, nws yuav tsum noj zaub mov uas muaj cov carbohydrates.
