Txhawm rau kom tshem tawm cov ntshav qab zib hauv kev xyaum kho mob, nws yog kev coj los siv tshuaj insulin analogues.
Ntev sijhawm, cov tshuaj no tau nrov zuj zus los ntawm cov kws kho mob thiab lawv cov neeg mob.
Tus qauv zoo li tuaj yeem piav qhia:
- kev ua tau zoo txaus ntawm cov tshuaj insulin hauv kev tsim khoom lag luam;
- zoo siab muaj kev ruaj ntseg profile;
- yooj yim ntawm kev siv;
- lub peev xwm los synchronize kev txhaj tshuaj nrog nws tus kheej zais cia ntawm cov tshuaj hormones.
Tom qab ib ntus, cov neeg mob uas muaj ntshav qab zib hom 2 mellitus raug yuam kom hloov los ntawm cov ntshav qab zib-txo cov ntsiav tshuaj mus rau kev txhaj tshuaj ntawm cov tshuaj insulin. Yog li no, lo lus nug ntawm kev xaiv cov tshuaj noj kom zoo rau lawv yog qhov tseem ceeb.
Cov yam ntxwv ntawm insulin niaj hnub
Muaj qee qhov kev txwv ntawm kev siv cov tshuaj insulin ntawm tib neeg, piv txwv li, qhov pib qeeb ntawm qhov kis tus kab mob (tus mob ntshav qab zib yuav tsum tau txhaj tshuaj 30-40 feeb ua ntej noj mov) thiab lub sijhawm ua haujlwm ntev dhau lawm (txog 12 teev), uas tuaj yeem dhau los ua qhov yuav tsum tau ua rau ncua sij hawm hypoglycemia.
Thaum kawg ntawm lub xyoo pua xeem, qhov kev xav tau tshwm sim los tsim cov tshuaj insulin uas yuav tso tau tsis raug los ntawm cov kev tsis txaus ntseeg no. Cov yeeb yam luv luv pib tsim muaj qhov muaj qhov txo qis tshaj plaws nyob rau hauv ib nrab-lub neej.
Qhov no coj lawv los ze zog rau cov khoom ntawm insulin haiv neeg, uas tuaj yeem ua rau tsis muaj zog tom qab 4-5 feeb tom qab nkag rau hauv cov hlab ntshav.
Peakless cov kua dej tsis sib xws tuaj yeem sib txig sib luag thiab ntseeg tau los ntawm cov roj ntsha subcutaneous thiab tsis ua rau lub cev tsis muaj ntshav ntau.
Xyoo tsis ntev los no, tau muaj kev pom zoo tseem ceeb hauv chaw muag tshuaj, vim nws sau tseg:
- kev hloov ntawm acidic daws teeb meem rau nruab nrab;
- txais tib neeg cov tshuaj insulin siv cov thev naus laus zis DNA thev naus laus zis;
- kev tsim cov siab zoo hloov pauv insulin nrog cov yam ntxwv pharmacological tshiab.
Cov tshuaj insulin hloov pauv lub sijhawm ntawm cov kev ua ntawm tib neeg los ua tib neeg los muab cov kev xav ntawm lub cev los kho thiab qhov yooj yim tshaj plaws rau cov ntshav qab zib.
Cov tshuaj ua rau nws ua tiav kom ua tiav txoj kev sib txig sib luag ntawm kev pheej hmoo ntawm kev poob ntshav qab zib thiab kev ua tiav ntawm lub hom phiaj glycemia.
Cov tshuaj hnub tshiab ntawm cov tshuaj insulin raws li lub sijhawm ntawm nws qhov kev txiav txim siab feem ntau muab faib ua:
- ultrashort (Humalog, Apidra, Novorapid Penfill);
- lub sijhawm ntev (Lantus, Levemir Penfill).
Tsis tas li ntawd, muaj cov tshuaj sib xyaw ua ke ntawm kev hloov pauv, uas yog ib qho kev sib xyaw ntawm ultrashort thiab lub cev ntev nyob hauv ib qho kev sib piv: Penfill, Humalog sib tov 25.
Humalog (lispro)
Hauv cov qauv ntawm cov tshuaj insulin no, txoj haujlwm ntawm proline thiab lysine tau hloov pauv. Qhov sib txawv ntawm cov tshuaj thiab cov tib neeg kho cov tshuaj lom neeg tsis muaj zog yog qhov tsis muaj zog ntawm kev sib txuas ntawm cov koom haum sib quas ntus. Hauv kev pom ntawm qhov no, lispro tuaj yeem nqus tau sai rau hauv cov hlab ntshav ntawm cov ntshav qab zib.
Yog tias koj txhaj tshuaj rau tib lub tshuaj thiab tib lub sijhawm, Tom qab ntawd Humalog yuav muab qhov siab tshaj 2 zaug sai dua. Qhov no cov tshuaj hormones yog tshem tawm ntau nrawm dua thiab tom qab 4 teev nws qhov kev kub siab tuaj txog nws qib pib. Qhov kev cia siab ntawm cov tshuaj insulin rau tib neeg yuav raug tswj nyob hauv 6 teev.
Piv cov lispro nrog cov tshuaj insulin luv luv, peb tuaj yeem hais tias cov qub tuaj yeem txwv kev tsim cov piam thaj los ntawm daim siab ntau ntau.
Muaj lwm qhov zoo dua ntawm cov tshuaj Humalog - nws yog qhov kom paub tseeb tseeb dua ntxiv thiab tuaj yeem pab lub sijhawm muab tshuaj kho rau cov zaub mov ntsaws kom zoo dua. Nws yog tus yam ntxwv los ntawm qhov tsis muaj qhov hloov ntawm lub sijhawm ua haujlwm los ntawm kev nce hauv lub ntim ntawm cov tshuaj nkag.
Siv tib neeg cov tshuaj insulin, lub sijhawm ua haujlwm ntawm nws txoj haujlwm yuav txawv nyob ntawm koob tshuaj. Nws yog los ntawm qhov no hais tias qhov nruab nrab li ntawm 6 txog 12 teev tshwm sim.
Nrog rau kev nce ntxiv hauv cov tshuaj ntawm cov tshuaj insulin Humalog, lub sijhawm ua haujlwm nws tseem yuav luag nyob rau tib theem thiab yuav yog 5 teev.
Nws ua raws tias nrog kev nce ntxiv ntawm cov koob tshuaj lispro, qhov kev pheej hmoo ntawm hypoglycemia tsis nce.
Aspart (Novorapid Penfill)
Cov tshuaj insulin no tuaj yeem ua rau zoo tiav raws li cov tshuaj insulin txaus rau kev noj zaub mov. Nws lub sijhawm luv luv ua rau muaj kev cuam tshuam tsis tshua zoo rau ntawm kev noj mov, uas ua rau nws muaj peev xwm ua kom tiav kev tswj xyuas kom ua tiav cov ntshav qab zib.
Yog tias peb piv cov txiaj ntsig ntawm kev kho mob nrog insulin analogues nrog cov neeg ua yeeb yam luv luv rau tib neeg, nws qhov tseem ceeb hauv kev tswj hwm tau zoo ntawm cov ntshav qab zib tom qab qib siab yuav raug sau tseg.
Ua ke nrog kev kho mob nrog Detemir thiab Aspart muab lub sijhawm:
- yuav luag 100% normalize rau daim ntawv qhia txhua hnub ntawm cov tshuaj insulin;
- txhawm rau txhim kho qib ntawm glycosylated hemoglobin;
- txo txoj kev pheej hmoo ntawm kev txhim kho hypoglycemic;
- txo qhov ua kom dav thiab qhov siab tshaj plaws ntawm cov piam thaj hauv cov ntshav ntawm cov ntshav qab zib.
Nws yog qhov tsim nyog hais tias thaum lub sij hawm kho nrog basal-bolus insulin analogues, qhov nruab nrab ntawm lub cev qhov hnyav tau qis dua qis dua rau tag nrho lub sijhawm ntawm kev tshuaj xyuas zoo.
Glulisin (Apidra)
Tib neeg cov tshuaj insulin analog Apidra yog cov tshuaj tiv thaiv ultra-luv. Raws li nws cov pharmacokinetic, cov yam ntxwv pharmacodynamic thiab kev nyab xeeb ntawm cev, Glulisin yog qhov sib npaug nrog Humalog. Hauv nws qhov kev ua kom zoo thiab metabolic, yam tshuaj no tsis txawv ntawm tib neeg insulin. Ua tsaug rau qhov no, nws yog qhov tsim nyog siv nws rau lub sijhawm ntev, thiab nws muaj kev nyab xeeb kiag li.
Raws li txoj cai, Apidra yuav tsum tau siv nrog:
- ntev neeg insulin ntev ntev;
- basal insulin analogue.
Tsis tas li ntawd, cov tshuaj yeeb tshuaj yog tus cwj pwm los ntawm kev pib ua haujlwm sai thiab nws lub sijhawm luv dua li ib txwm muaj tib neeg lawm. Nws tso cai rau cov neeg mob ntshav qab zib kom pom qhov ua kom yooj yim siv nws nrog zaub mov ntau dua li neeg lub cev. Cov tshuaj Insulin pib nws cov nyhuv tam sim ntawd tom qab kev tswj hwm, thiab cov ntshav qab zib cov ntshav poob 10-20 feeb tom qab Apidra tau txhaj tshuaj subcutaneously.
Txhawm rau kom tsis txhob mob ntshav qab zib hauv cov neeg laus, cov kws kho mob pom zoo kom qhia cov tshuaj tam sim ntawd tom qab noj mov lossis hauv tib lub sijhawm. Lub sijhawm tsawg ntawm cov tshuaj hormones pab ua kom tsis txhob muaj qhov hu ua "overlay" effect, uas ua rau nws tiv thaiv kom tsis txhob mob ntshav qab zib.
Glulisin tuaj yeem siv tau rau cov neeg rog dhau los, vim tias nws qhov kev siv tsis ua rau nce phaus ntxiv. Cov tshuaj yog tus cwj pwm los ntawm kev pib sai ntawm qhov siab tshaj plaws piv nrog lwm hom tshuaj hormones, tsis tu ncua thiab lispro.
Apidra yog qhov zoo tsim rau ntau qib ntawm kev hnyav dhau vim nws txoj kev ua haujlwm siab ntawm kev siv. Hauv visceral hom kev rog, qhov nqus ntawm cov tshuaj tuaj yeem sib txawv, ua rau nws nyuaj rau kev tswj hwm ntawm glycemic.
Kev tshuaj xyuas (Levemir Penfill)
Levemir Penfill yog ib qho tshuaj tiv thaiv ntawm tib neeg cov tshuaj insulin. Nws muaj lub sijhawm ua haujlwm nruab nrab thiab tsis muaj peaks. Qhov no pab kom cov hauv paus tswj glycemic tswj thaum nruab hnub, tab sis raug siv ob npaug.
Thaum muab tshuaj subcutaneously, Detemir tsim cov tshuaj uas khi rau cov ntshiab albumin hauv cov kua dej interstitial. Tom qab hloov mus los ntawm phab ntsa capillary, insulin rov khi rau albumin hauv cov hlab ntshav.
Hauv kev npaj, tsuas yog cov seem dawb yog kev ua haujlwm biologically. Yog li no, khi rau albumin thiab nws cov hniav qeeb tau muab kev ua haujlwm ntev thiab siab kawg.
Levemir Penfill insulin ua rau tus neeg mob ntshav qab zib kom zoo thiab ua tiav nws txoj kev xav tau tag nrho cov tshuaj insulin basal. Nws tsis muab kev co ua ntej ua haujlwm subcutaneous.
Glargin (Lub Teeb)
Glargin insulin hloov pauv yog ultra-nrawm. Cov tshuaj no tuaj yeem ua tau zoo thiab ua kom tiav nyob hauv ib puag ncig acidic me ntsis, thiab hauv ib puag ncig nruab nrab (hauv qab rog muaj roj) nws tsis zoo soluble.
Tam sim ntawd tom qab kev tswj hwm subcutaneous, Glargin nkag mus rau hauv qhov kev tiv thaiv nruab nrab nrog kev tsim cov microprecipitation, uas yog qhov tsim nyog rau kev tso tawm ntxiv ntawm cov tshuaj hexamers thiab lawv cais ua rau insulin hormone monomers thiab dimers.
Vim tias txoj kev nqus thiab maj mam khiav ntawm Lantus rau hauv cov ntshav ntawm tus neeg mob ntshav qab zib, nws cov ntshav ncig hauv cov channel tshwm sim hauv 24 teev. Qhov no ua rau nws muaj peev xwm txhaj tshuaj insulin analogues ib zaug ib hnub.
Thaum cov hmoov av me me ntxiv rau, insulin Lantus crystallizes hauv cov nqaij mos uas ua haujlwm hauv qab, uas txuas ntxiv ua rau nws lub sijhawm nqus tau. Kiag li ntawm tag nrho cov kev zoo ntawm cov tshuaj no lav nws cov ntaub ntawv du thiab tsis muaj dab tsi.
Glargin pib ua haujlwm 60 feeb tom qab txhaj tshuaj subcutaneous. Nws qhov kev tsom mus rau hauv tus neeg mob cov ntshav tau tuaj yeem pom tom qab 2-4 teev txij thaum thawj koob tau muab tshuaj.
Tsis hais txog lub sijhawm txhaj ntawm cov tshuaj tiv thaiv ultrafast no thaum sawv ntxov (yav sawv ntxov lossis yav tsaus ntuj) thiab qhov chaw txhaj tshuaj (lub plab, caj npab, ceg), lub sijhawm uas raug rau lub cev yuav yog:
- nruab nrab - 24 teev;
- qhov siab tshaj plaws - 29 teev.
Hloov hloov cov tshuaj insulin Glargin tuaj yeem hloov kho lub cev ntawm lub cev hormone nyob rau hauv nws qhov kev ua haujlwm siab, vim hais tias cov tshuaj:
- kev ua haujlwm zoo txhawb kev noj qab zib los ntawm insulin-dependant peripheral cov ntaub so ntswg (tshwj xeeb tshaj yog cov rog thiab cov leeg);
- inhibits gluconeogenesis (txo qis ntshav qabzib).
Tsis tas li ntawd, cov tshuaj cuam tshuam rau qhov cuam tshuam ntawm cov ntaub so ntswg adipose (lipolysis), kev ua kom cov protein tsis zoo (tiv thaiv kab mob), thaum ua kom cov nqaij ntshiv txha qhuav.
Kev tshawb fawb txog kev kho mob ntawm Glargin's pharmacokinetics tau qhia tias qhov tsis muaj kev faib ntau tshaj plaws ntawm cov tshuaj no ua rau nws muaj peev xwm yuav luag 100% mimic qhov pib ntawm zus ntawm cov tshuaj endogenous hormone insulin hauv 24 teev. Nyob rau tib lub sijhawm, qhov ntxim nyiam ntawm kev txhim kho hypoglycemic tej yam kev mob thiab cov ntshav siab ntxiv hauv cov ntshav qab zib kom tsawg.
Neej Neeg tshaj 25
Cov tshuaj no yog kev sib xyaw uas muaj:
- 75% kev tiv thaiv kev ncua ntawm cov hormone lispro;
- 25% insulin Humalog.
Qhov no thiab lwm yam tshuaj insulin kuj tseem ua ke raws li lawv qhov kev tso tawm. Lub sijhawm zoo ntawm cov tshuaj yog tau ua tsaug rau cov txiaj ntsig ntawm kev tiv thaiv kev tiv thaiv kev cuam tshuam ntawm cov tshuaj lyspro, uas ua rau nws tuaj yeem rov ua lub hauv paus pib ntawm cov tshuaj hormone.
Qhov seem 25% ntawm lispro insulin yog ib qho kev tiv thaiv nrog lub sijhawm luv luv, uas muaj cov txiaj ntsig zoo ntawm glycemia tom qab noj mov.
Nws yog ib qho tseem ceeb tshaj plaws tias lub Humalog hauv cov lus sib xyaw ua tiav cuam tshuam rau lub cev tau nrawm dua piv nrog cov tshuaj hormones luv luv. Nws muab kev tswj siab tshaj plaws ntawm postpradial glycemia thiab vim li ntawd nws cov ntaub ntawv qhia tau ntau physiological thaum piv nrog luv luv ua yeeb yam insulin.
Cov tshuaj insulins tshwj xeeb yog pom zoo rau cov neeg muaj ntshav qab zib hom 2. Pab pawg no suav nrog cov neeg laus laus uas, raws li txoj cai, raug kev txom nyem los ntawm teeb meem nco. Tias yog vim li cas qhov kev qhia ntawm cov tshuaj hormones ua ntej noj mov lossis tam sim ntawd tom qab nws pab txhim kho kev ua neej zoo ntawm cov neeg mob ntawd.
Cov kev tshawb fawb txog kev noj qab haus huv ntawm cov neeg mob ntshav qab zib nyob rau hauv pawg hnub nyoog ntawm 60 txog 80 xyoo uas siv cov tshuaj Humalog sib xyaw 25 qhia tau hais tias lawv tswj tau txais cov nyiaj zoo heev rau cov metabolism hauv kev noj haus. Hauv hom kev ua haujlwm ntawm cov tshuaj hormones ua ntej thiab tom qab noj mov, cov kws kho mob tau tswj hwm kom maj mam nce thiab nce ntshav tsawg kawg.
Nws yog ib qho zoo insulin?
Yog tias peb sib piv cov tshuaj pharmacokinetics ntawm cov tshuaj nyob hauv kev txiav txim siab, ces lawv cov kev teem caij los ntawm tus kws kho mob tau koom yog qhov pom tau tias tus mob ntshav qab zib mellitus, ob hom tshuaj thawj thiab thib ob. Qhov sib txawv tseem ceeb ntawm cov insulins no yog qhov tsis muaj qhov nce ntawm lub cev qhov hnyav thaum kho thiab txo qis ntawm hmo ntuj hloov pauv nyob rau hauv cov concentration ntawm cov piam thaj hauv cov ntshav.
Tsis tas li ntawd, nws yog ib qho tseem ceeb kom pom tias yuav tsum tau txhaj tshuaj ib hnub xwb, uas yooj yim dua rau cov neeg mob. Qhov tshwj xeeb tshaj yog qhov tseem ceeb ntawm cov tshuaj insulin Glargin analogue ua ke nrog metformin rau cov neeg mob ntshav qab zib hom thib ob. Cov kev tshawb fawb tau pom tias tseem ceeb nyob rau hauv qhov tsaus ntuj zoo li cov piam thaj hauv qab zib. Qhov no yuav pab kom ntseeg siab tau normalize glycemia txhua hnub.
Kev sib xyaw ntawm Lantus nrog cov tshuaj noj hauv qhov ncauj kom txo qis ntshav qab zib tau kawm hauv cov neeg mob uas tsis tuaj yeem them nyiaj mob ntshav qab zib.
Lawv yuav tsum tau muab rau Glargin sai li sai tau. Cov tshuaj no tuaj yeem raug pom zoo rau kev kho mob nrog tus kws kho mob endocrinologist thiab cov kws kho mob zaws.
Kev kho hnyav nrog Lantus ua rau nws muaj peev xwm txhim kho glycemia tswj hwm hauv txhua pab pawg ntawm cov neeg mob ntshav qab zib.
