Insulin Apidra (Epidera): tshuaj xyuas, cov lus qhia rau kev siv glulisin

"Apidra", "Epidera", insulin-glulisin - cov khoom tseem ceeb ntawm cov tshuaj yog cov tshuaj tiv thaiv ntawm tib neeg cov tshuaj insulin, tau los ntawm kev tsim hluav taws xob.

Los ntawm lub zog ntawm nws cov kev txiav txim, nws yog sib npaug rau soluble tib neeg insulin. Tab sis Apidra pib ua kom nrawm dua, txawm tias lub sijhawm ntawm cov tshuaj yog tsawg dua.

Cov yam ntxwv ntawm Pharmacological

Cov Tshuaj Hauv Tshuaj Kev ua tseem ceeb ntawm cov tshuaj insulin thiab tag nrho nws cov tshuaj noj (insulin-glulisin tsis muaj kev zam) yog qhov ib txwm ua ntawm cov ntshav qab zib.

Ua tsaug rau cov tshuaj insulin gluzulin, cov concentration ntawm cov piam thaj hauv cov hlab ntshav poob qis thiab nws txoj kev nqus tau yog txhawb los ntawm cov ntaub so ntswg, tshwj xeeb tshaj yog cov rog, pob txha thiab nqaij. Ib qho ntxiv, insulin:

• inhibits kev tsim tawm ntawm cov piam thaj hauv lub siab;
• nce protein synthesis;
• inhibits proteolysis;
• inhibits lipolysis hauv adipocytes.

Cov kev tshawb fawb ua rau cov neeg ua haujlwm noj qab haus huv thiab cov neeg mob ntshav qab zib mellitus tau qhia meej meej tias kev tswj hwm subcutaneous ntawm insulin-glulisin tsis tsuas yog txo lub sijhawm tos kom raug rau, tabsis tseem txo lub sijhawm siv tshuaj. Qhov no txawv nws los ntawm tib neeg cov kua dej.

Nrog kev tswj hwm subcutaneous, cov piam thaj txo qis ntawm cov tshuaj insulin-glulisin hauv cov ntshav pib tom qab 15-20 feeb. Nrog kev txhaj tshuaj tiv thaiv kab mob, cov nyhuv ntawm tib neeg cov tshuaj insulin thiab cov cuam tshuam ntawm insulin-glulisin ntawm cov ntshav qab zib yog kwv yees li qub.

Chav tsev Apidra muaj tib qhov kev tiv thaiv hypoglycemic uas yog chav tsev ntawm tib neeg cov kua dej hauv lub cev. Hauv kev sim kho mob hauv cov neeg mob uas muaj ntshav qab zib hom 1, qhov cuam tshuam ntawm tib neeg lub cev insulin thiab Apidra tau raug soj ntsuam.

Ob qho ntawm lawv tau raug tswj ntawm ib koob tshuaj ntawm 0.15 U / kg subcutaneously ntawm cov sijhawm sib txawv hauv kev sib piv nrog 15 feeb ntawm pluas noj, uas pom tias yog tus qauv.

Cov txiaj ntsig ntawm kev tshawb fawb pom tias insulin-glulisin, siv 2 feeb ua ntej noj mov, tau muab tib txoj kev kuaj glycemic tom qab noj mov raws li tib neeg cov tshuaj insulin, uas tau txhaj 30 feeb ua ntej noj mov.

Yog tias cov tshuaj insulin-glulisin noj 2 feeb ua ntej noj mov, cov tshuaj muab glycemic zoo soj ntsuam tom qab ib pluas noj. Zoo tshaj qhov kev tswj hwm tib neeg cov kua dej ua si 2 feeb ua ntej noj mov.

Cov tshuaj insulin-glulisin, uas tau siv 15 feeb tom qab pib noj mov, tau muab tshuaj glycemic saib xyuas tom qab noj mov zoo ib yam li cov tib neeg los ntawm insulin insulin, kev qhia ntawm uas tshwm sim 2 feeb ua ntej pib noj mov.

Kev tshawb xyuas ntawm thawj theem, ua nrog Apidra, tib neeg soluble insulin thiab insulin-lyspro hauv ib pawg neeg mob rog thiab ntshav qab zib, tau qhia tias hauv cov neeg mob no insulin-glulisin tsis plam nws cov yeeb yam zoo sai.

Hauv qhov kev tshawb fawb no, tus nqi nce mus txog 20% ​​ntawm tag nrho thaj tsam hauv qib theem-nkhaus nkhaus (AUC) rau insulin-glulisin yog 114 feeb, rau insulin-lispro -121 feeb thiab rau tib neeg cov tshuaj insulin - 150 feeb.

Thiab AUC (0-2 teev), kuj tseem cuam tshuam txog thaum ntxov hypoglycemic kev ua si, tau ntsig txog 427 mg / kg rau insulin-glulisin, 354 mg / kg rau insulin-lyspro thiab 197 mg / kg rau tib neeg cov kua dej.

Yam 1 ntshav qab zib

Cov chaw tshawb fawb. Hauv hom 1 mob ntshav qab zib mellitus, insulin-lispro thiab insulin-glulisin piv rau.

Hauv kev kuaj mob thib peb ncua ntev li 26 lub lis piam, cov neeg mob ntshav qab zib hom 1 tau muab cov tshuaj insulin glulisin ua ntej noj mov (insulin glargine ua cov insulin basal insulin hauv cov neeg mob no).

Hauv cov neeg no, insulin-glulisin hauv kev sib piv nrog kev tswj glycemic tau muab piv nrog insulin-lyspro thiab raug soj ntsuam los ntawm kev hloov pauv ntawm glycosylated hemoglobin (L1L1c) thaum kawg ntawm kev tshawb fawb nrog pib pib.

Hauv cov neeg mob, cov txiaj ntsig sib piv ntawm cov piam thaj hauv cov ntshav, txiav txim siab los ntawm kev ntsuas tus kheej, tau pom. Qhov sib txawv ntawm insulin-glulisin thiab kev npaj tshuaj insulin-lyspro yog tias thaum siv thawj zaug, tsis tas yuav tsum muaj qhov nce ntxiv ntawm cov tshuaj insulin.

Cov kev sim tshuaj ntawm qib peb, kav ntev li 12 lub lis piam, (hom 1 ntshav qab zib mellitus siv tshuaj insulin-glargine ua cov kev kho mob tseem ceeb tau raug caw tuaj pab ua haujlwm pab dawb) pom tias kev cuam tshuam ntawm kev txhaj tshuaj insulin-glulisin tam sim ntawd tom qab noj mov tau muab piv rau qhov ntawm kev txhaj tshuaj insulin-glisin. tam sim ntawd ua ntej noj mov (0-15 feeb). Los yog 30-45 feeb ua ntej noj insulin tib neeg cov kua dej.

Cov neeg mob uas dhau qhov kev ntsuam xyuas tau muab faib ua ob pawg:

1. Thawj pab pawg tau siv cov tshuaj insulin apidra ua ntej noj mov.
2. Qhov thib ob pab pawg tau muab kev tswj hwm tib neeg cov kua dej.

Qhov kev kawm ntawm thawj pab pawg pom tau txo qis dua HL1C ntau dua li cov neeg ua haujlwm pab dawb ntawm pab pawg thib ob.

Mob ntshav qab zib Hom 2

Ua ntej, kev sim kho mob ntawm qib peb tau ua dhau los 26 lub lis piam. Lawv tom qab 26-lub lim tiam kev tshawb fawb txog kev nyab xeeb, uas yog qhov tsim nyog los sib piv kev ua ntawm Apidra (0-15 feeb ua ntej noj mov) nrog soluble tib neeg cov insulin (30-45 feeb ua ntej noj mov).

Ob qho tshuaj no tau muab rau cov neeg mob ntshav qab zib hom 2 subcutaneously (cov neeg no tau siv insulin-isofan ua cov tshuaj insulin tseem ceeb). Qhov ntsuas nruab nrab ntawm lub cev qhov hnyav ntawm cov ncauj lus yog 34.55 kg / m².

Nrog rau kev hloov pauv hauv HL1C cov ntsiab lus, tom qab rau lub hlis ntawm kev kho mob, insulin-glulisin qhia tias nws qhov kev sib piv nrog tib neeg cov tshuaj insulin piv nrog tus nqi pib ntawm txoj kev no:

• rau tib neeg cov roj ntsha insulin, 0.30%;
• rau cov tshuaj insulin-glulisin-0.46%.

Thiab tom qab 1 xyoos ntawm kev kho mob, daim duab hloov zoo li no:

1. rau tib neeg cov kua dej hauv tshuaj lom - 0.13%;
2. rau cov tshuaj insulin-glulisin - 0.23%.

Feem ntau ntawm cov neeg mob koom nrog txoj kev tshawb fawb no, tam sim ntawd ua ntej txhaj tshuaj, sib xyaw cov tshuaj insulin-isophan nrog cov tshuaj insulin luv luv. Thaum lub sijhawm ntawm randomization, 58% ntawm cov neeg mob siv cov tshuaj hypoglycemic thiab enlisted cov lus qhia los txuas ntxiv noj lawv ntawm kev noj tshuaj tib.

Hauv kev tswj xyuas cov kab mob hauv cov neeg laus, tsis muaj qhov sib txawv hauv kev ua tau zoo thiab kev nyab xeeb ntawm insulin-glulisin thaum soj ntsuam cov pawg me tau txheeb xyuas los ntawm poj niam txiv neej thiab haiv neeg.

Hauv Apidra hloov chaw ntawm cov amino acid asparagine ntawm txoj hauj lwm B3 ntawm tib neeg insulin nrog lysine, thiab ntxiv rau, lysine ntawm txoj hauj lwm B29 nrog glutamic acid, txhawb kev nqus sai.

Pab Pawg Neeg Tshwj Xeeb

• Cov neeg mob lub raum. Hauv qhov kev tshawb fawb soj ntsuam ua rau cov neeg muaj kev noj qab haus huv nrog rau ntau qhov kev ua haujlwm rov ua haujlwm (kev tsim lub peev xwm tshem tawm (CC)> 80 ml / min, 30¬50 ml / min, <30 ml / min), tus nqi ntawm qhov pib ntawm kev ua ntawm insulin-glulisin tau tswj hwm. Txawm li cas los xij, nyob rau ntawm qhov tsis zoo ntawm lub raum, qhov xav tau ntawm cov tshuaj insulin tuaj yeem txo.
• Cov neeg mob nrog pathologies ntawm lub siab ua haujlwm. Hauv pab pawg neeg ntawm cov neeg mob no, cov tsis muaj tshuaj pharmacokinetic tsis tau kawm.
• Qub neeg. Rau pawg no ntawm cov neeg mob, cov ntaub ntawv pharmacokinetic ntawm cov teebmeem ntawm insulin-glulisin muaj tsawg heev.
• Menyuam yaus thiab tub ntxhais hluas. Cov chaw muag tshuaj thiab cov tshuaj pharmacokinetic ntawm insulin-glulisin hauv cov hluas (12-16 xyoo) thiab hauv cov menyuam yaus (7-11 xyoo) uas muaj ntshav qab zib hom 1 tau tshawb xyuas. Cov tshuaj insulin-glulisin nrawm rau ob pawg hnub nyoog nrog Stax thiab Tmax zoo ib yam li cov neeg muaj mob ntshav qab zib hom 1 thiab cov neeg ua haujlwm pab dawb noj qab nyob zoo. Thaum muab tam sim ntawd ua ntej kev sim nrog cov zaub mov, insulin-glulisin, xws li hauv pawg neeg mob cov laus, pab tswj ntshav qab zib cov ntshav tom qab noj mov piv rau tib neeg cov kua dej. Qhov kev nce hauv cov ntshav qab zib ntau tom qab noj mov (AUC 0-6 teev - thaj chaw hauv qab nkhaus "ntshav qab zib - sijhawm" 0-6 teev) yog 641 mg / (h'dl) rau Apidra thiab 801 mg / (h ' d) rau tib neeg cov kua dej hauv lub cev.

Kev taw qhia thiab tsuas tshuaj

Ntshav qab zib Insulin-hom mob ntshav qab zib hom 1 hauv cov menyuam yaus tom qab muaj 6 xyoo, cov hluas thiab cov laus.

Insulin-glulisin yuav tsum ua kom sai sai lossis noj mov nrog noj mov. Apidra yuav tsum tau siv rau hauv kev kho mob uas suav nrog kev ua haujlwm ntev, nruab nrab lub cev lossis lawv cov duab zoo nkauj.

Tsis tas li ntawd, Apidra tuaj yeem siv ua ke nrog hypoglycemic tshuaj noj ntawm qhov ncauj. Cov tshuaj ntawm cov tshuaj yog ib txwm xaiv ib tus zuj zus.

Cov hau kev tswj hwm

Cov tshuaj yog muab los ntawm kev txhaj tshuaj subcutaneous los yog los ntawm kev ua kom tas mus li rau hauv cov rog subcutaneous siv lub twj tso kua mis. Kev txhaj tshuaj subcutaneous ntawm cov tshuaj yog tsim hauv plab, ncej puab lossis xub pwg. Kev hno tawm kuj yog ua rau hauv plab.

Cov chaw ntawm Txoj kev lis ntshav thiab txhaj tshuaj nrog txhua cov tshuaj insulin tshiab yuav tsum ua lwm txoj haujlwm. Qhov pib ntawm kev nqis tes ua, nws lub sijhawm thiab tus nqi ntawm adsorption tuaj yeem cuam tshuam los ntawm kev siv dag zog thiab thaj chaw tswj hwm. Kev tswj hwm tus neeg mob rau lub plab ua rau muaj kev tshaj tawm sai dua li kev txhaj tshuaj rau lwm qhov ntawm lub cev.

Txhawm rau tiv thaiv cov tshuaj ntawm cov ntshav ncaj qha rau hauv cov hlab ntshav, yuav tsum ceev faj qhov siab tshaj plaws. Sai li sai tau tom qab ua haujlwm ntawm cov tshuaj, lub vev xaib yuav tsum tsis txhob zaws.

Nws raug tso cai kom sib xyaw Apidra tsuas yog siv nrog tib neeg insulin-isophan.

Insulin twj tso kua mis rau kev nruam subcutaneous Txoj kev lis ntshav

Yog tias Apidra tau siv los ntawm lub twj tso kua mis lub zog rau kev txuas ntxiv mus ntawm insulin, nws yog txwv tsis pub nws xyaw nrog lwm cov tshuaj.

Txhawm rau tau txais cov ntaub ntawv ntxiv rau kev ua haujlwm ntawm cov tshuaj, nws yog ib qho tsim nyog yuav tsum kawm cov lus qhia nrog rau nws. Nrog rau qhov no, tag nrho cov lus pom zoo hais txog kev siv cov kua dej puv lub taub hau yuav tsum tau ua raws.

Cov pab pawg tshwj xeeb ntawm cov neeg mob suav nrog cov neeg mob uas muaj:

• Lub raum khiav tsis zoo (nrog rau cov kab mob zoo li no, xav tau cov tshuaj insulin tuaj yeem txo qis);
• lub cev tsis muaj zog ua haujlwm (zoo li yav dhau los, qhov kev xav tau los ntawm insulin yuav tuaj yeem txo vim muaj peev xwm txo qis gluconeogenesis thiab txo qis hauv cov tshuaj insulin metabolism.

Cov ntaub ntawv ntawm pharmacokinetic kev tshawb fawb ntawm cov tshuaj hauv cov neeg laus tseem tsis txaus. Txoj kev xav tau cov tshuaj insulin hauv cov neeg laus cov neeg laus tuaj yeem txo vim yog lub raum tsis ua haujlwm.

Cov tshuaj tuaj yeem muab rau cov menyuam yaus tom qab 6 xyoo thiab cov hluas. Cov ntaub ntawv qhia txog cov tshuaj ntawm cov menyuam yaus hnub nyoog qis dua 6 xyoo tsis muaj.

Kev phiv tshuaj

Feem ntau cov kev xav tsis zoo uas tshwm sim thaum kho cov tshuaj insulin thaum kev noj tshuaj ntau dua yog qhov ua kom tsis txhob mob ntshav qab zib.

Muaj lwm qhov kev phiv tshuaj uas cuam tshuam nrog kev siv tshuaj yeeb thiab tau pom hauv kev sim tshuaj, lawv cov ntau zaus muaj tshwm sim hauv lub rooj.

Kev cuam tshuam los ntawm cov metabolism thiab daim tawv nqaij

Heev feem ntau hypoglycemia tsim. Cov tsos mob ntawm tus mob no feem ntau tshwm sim sai. Cov qauv hauv qab no yog rau cov tsos mob neuropsychiatric:

1. Qaug zog, zoo li nkees, qaug zog.
2. Tsis tshua muaj peev xwm ua kom pom tseeb.
3. Pom kev tsis sib haum xeeb.
4. Kev nkees nkees.
5. Mob taub hau, xeev siab.
6. Tsis meej pem ntawm kev nco qab lossis nws qhov ua tiav tsis tiav.
7. Xaus cov leeg mob.

Tab sis feem ntau, cov cim neuropsychiatric yog ua ntej los ntawm cov cim ntawm adrenergic counter-regulation (teb rau hypoglycemia ntawm lub cev sympathoadrenal):

1. Tsaus arousal, chim siab.
2. Tsov siab, ntxhov siab.
3. Tsaus muag pom tsis zoo.
4. Pallor ntawm daim tawv nqaij.
5. Tachycardia.
6. Ua fws hws.

Tseem Ceeb! Rov ua dua ntawm cov ntshav qog ua kom ntshav qab zib tuaj yeem ua rau kev puas tsuaj rau cov hlab ntshav ntawm lub paj hlwb. Kev mob tshwm sim ntawm qhov mob ntshav qab zib thiab lub cev ntev mus ntev ua rau muaj kev hem thawj rau lub neej ntawm tus neeg mob, vim tias txawm tias txoj kev tuag yuav tshwm sim nrog lub xeev nce ntxiv.

Ntawm qhov chaw txhaj tshuaj ntawm cov tshuaj, hauv zos qhov pom ntawm tus mob siab tau zoo yog feem ntau pom:

• khaus
• o tuaj;
• kev hyperemia.

Yeej, cov kev cuam tshuam no yog hloov thiab feem ntau feem ntau ploj nrog kev kho ntxiv.

Xws li cov tshuaj tiv thaiv los ntawm cov nqaij mos subcutaneous, xws li lipodystrophy, yog qhov tsawg heev, tab sis nws tuaj yeem tshwm sim vim qhov kev ua txhaum ntawm qhov hloov ntawm qhov chaw txhaj tshuaj (koj tsis tuaj yeem nkag rau hauv insulin hauv tib thaj chaw).

Kev ntsawv siab dav

Cov kab ke ua rau lub cev tsis tshua nco qab muaj tsawg, tab sis yog tias lawv tshwm sim, tom qab ntawv cov tsos mob li no:

1. urticaria;
2. daig caj dab;
3. hauv siab nruj;
4. khaus
5. ua xua dermatitis.

Cov teeb meem tshwj xeeb ntawm kev tsis haum tshuaj (qhov no suav nrog kev nthuav qhia) ua rau muaj kev hem thawj rau tus neeg mob lub neej.

Cev xeeb tub

Cov ntaub ntawv hais txog kev siv cov insulin-glulisin los ntawm cov poj niam cev xeeb tub tsis muaj. Cov kev sim me nyuam hauv tsiaj tsis tau qhia txog qhov sib txawv ntawm tib neeg cov tshuaj lom neeg insulin thiab insulin-glulisin piv rau kev xeeb tub, kev loj hlob ntawm tus me nyuam hauv plab, kev yug menyuam thiab kev loj hlob tom qab yug menyuam tas.

Txawm li cas los xij, cov poj niam cev xeeb tub yuav tsum sau cov tshuaj kom zoo zoo. Lub sijhawm kho mob, kev saib xyuas cov ntshav qab zib yuav tsum tau saib xyuas tsis tu ncua.

Cov neeg mob uas muaj ntshav qab zib ua ntej cev xeeb tub lossis tus neeg uas muaj tus mob ntshav qab zib hauv poj niam cev xeeb tub yuav tsum tau tswj kev mob glycemic thoob plaws hauv lub sijhawm.

Hauv thawj peb lub hlis thaum cev xeeb tub, tus neeg mob xav tau cov tshuaj insulin yuav poob qis. Tab sis, raws li txoj cai, hauv kev txiav txim siab tom qab, nws nce.

Tom qab yug menyuam tas, xav tau cov tshuaj insulin tsawg dua. Cov poj niam npaj ua cev xeeb tub yuav tsum qhia lawv tus kws kho mob txog qhov no.

Tseem tsis tau paub meej tias insulin-glulisin tuaj yeem nkag mus rau hauv niam mis tau li cas. Cov poj niam thaum lub sij hawm pub mis niam yuav xav tau los kho qhov ntau npaum ntawm cov tshuaj thiab kev noj haus.

Menyuam yaus thiab tub ntxhais hluas

Insulin-glulisin tuaj yeem siv rau hauv menyuam yaus tom qab 6 xyoo thiab tub ntxhais hluas. Rau cov menyuam yaus hnub nyoog qis dua 6 xyoo, cov tshuaj tsis raug cai, vim tsis muaj ntaub ntawv tshuaj.