Lub luag haujlwm ntawm insulin hauv lub cev tsis tsim nyog rau kev ua haujlwm ntau dhau. Ib qib twg ntawm cov tshuaj insulin yog fraught nrog ib qho kab mob endocrine loj - ntshav qab zib. 40 xyoo dhau los, cov kab mob ntshav qab zib nyob tsis ntau dua 10-15 xyoos.
Cov tshuaj niaj hnub siv cov feem ntau haum soluble tib neeg cov kev sib xyaw ua ntej tsim cov tshuaj insulin los ua kom cov ntshav ntshav qabzib feem ntau. Ua tsaug rau cov tshuaj no, ntshav qab zib tau tas ib qho kab lus, muab txoj hauv kev rau cov neeg mob tau tag nrho thiab lub neej ntev.
Vim li cas cov tshuaj insulin hu ua "txhob kaw cov cav"
Qee tus neeg mob ntshai ntawm lub sijhawm "tsim kho txhob kaw," ua rau lawv nco txog "GMOs siab phem."
Qhov tseeb, nws yog qhov tsim muaj ntawm cov tshuaj no uas tau cawm ntau lab tus tib neeg cov mob ntshav qab zib.
Thaum pib, cov kws kho mob siv cov tshuaj insulin cais tawm ntawm cov tsiaj (feem ntau yog npua thiab nyuj). Txawm li cas los xij, qhov kev loj hlob no tsis tsuas yog txawv teb chaws rau tib neeg, tab sis kuj tseem nkag rau hauv cov hlab ntshav, ua rau cov ntshav qabzib hauv qab thiab ua kom muaj ntau yam teeb meem.
Cov tshuaj insulin tau tsim kho rau hauv txhua qhov kev xav tau ntawm tus neeg mob ntshav qab zib, tshem tawm cov kev tsis haum tshuaj. Tom qab qhov kawg ntawm nws qhov kev txiav txim, nws tawg cia rau hauv cov amino acids zoo tib yam thiab nws tau tawm ntawm lub cev.
Cov khoom tseem ceeb pharmacological
Solulin tib neeg cov kua dej yog hais txog luv luv ua yeeb yam insulin hloov yeeb tshuaj.
Ua ke nrog cov xovtooj ntawm phab ntsa receptor, cov tshuaj tsim cov tshuaj insulin receptor complex uas ua rau cov txheej txheem ua haujlwm:
- Kev rho tawm ntawm cov enzymes rau kev ua tiav thiab kev txau ntawm qabzib los ntawm cov ntaub so ntswg;
- Kev nce nyob rau hauv kev thauj thiab tso ntshav qab zib;
- Tsawg tus nqi ntawm glycogen tsim nyob rau hauv daim siab;
- Stimulating zus tau tej cov protein thiab cov rog.
Nrog rau kev tswj hwm subcutaneous, cov tshuaj pib ua tom qab 20-30 feeb, mus txog nws qhov siab tshaj plaws hauv 1-3 teev, kav ntev txog 5-8 teev.
Cov tshuaj no tau muab faib rau qhov sib txawv ntawm cov ntaub so ntswg: piv txwv li, nws tsis nkag rau hauv qhov chaw tiv thaiv kab mob thiab tsis kis mus rau niam mis. Tom qab qhov kawg ntawm nws txoj kev txiav txim, tib neeg cov kua dej tawm sab nraud los ntawm lub raum (li 80%) tom qab nws rhuav tshem los ntawm insulinase.
Kev ntsuas rau siv
Feem ntau, cov kws kho mob tshaj tawm cov tshuaj insulin thaum muaj:
- Kev kho tus kheej lossis kev sib koom ua ke ntawm hom 1 thiab hom 2 mob ntshav qab zib mellitus;
- Yuav tiv thaiv tag nrho lossis ib nrab ntawm qhov tawm tsam (tawm tsam) ntawm lub cev mus rau qhov ncauj (noj ntawm qhov ncauj) tshuaj tiv thaiv kab mob;
- Mob ntshav qab zib mellitus thaum cev xeeb tub (yog tias cov khoom noj tsis zoo);
- Teeb meem ntawm ntshav qab zib mellitus (ketoacidosis, hypersmolar lossis ketoacidotic coma);
- Lub chav kawm ntawm kev kho mob ntshav qab zib tiv thaiv keeb kwm ntawm ntau yam kab mob;
- Cov teeb meem kev hem thawj hauv cov neeg mob ntshav qab zib uas tau noj ntawm qhov ncauj noj cov tshuaj muaj suab thaj (lub sijhawm ua ntej, mob hnyav, nrog rau raug mob lossis frostbite, ua ntej yug menyuam, thiab lwm yam);
- Ntshav qab zib nephropathy lossis mob rau daim siab;
- Qhov txhab tawv nqaij tawv nqaij (tawv nqaij daj, mob carbuncles, mob rwj);
- Hloov mus rau cov tshuaj insulin nrog qhov ua kom ntev (ntev ntev).
Cov Yuav Tsum Muaj
Contraindicated rau kev siv cov tshuaj insulin hauv:
- Txo cov ntshav qabzib (hypoglycemia);
- Ua kom lub cev nkag mus rau cov tshuaj insulin.
Kev phiv tshuaj
Txawm hais tias nws ua tau zoo mob siab, insulin tuaj yeem muaj cov kev mob tshwm sim thaum siv:
- Kev txhim kho ntawm cov ntshav qog nqaij hlav vim qhov tsis lees txais ntawm cov tshuaj los ntawm lub cev lossis cov tshuaj tiv thaiv kab mob nrog nws tus kheej insulin;
- Kev ua xua tsis haum (urticaria, khaus lossis ntau dua Quincke edema nrog qhov ntsej muag nrawm thiab hnoos qeev, pallor thiab ua tsis taus pa);
- Qog ntshav txias hypoglycemic;
- Kev tsis nco qab qhov tsis nco qab (qee zaus ncav cuag qhov tsis nco qab);
- Hyperglycemia lossis ntshav qab zib acidosis (tawm tsam keeb kwm ntawm kub ib ce lossis mob kis, noj zaub mov tsis zoo, tom qab kev txhaj tshuaj tsis raws cai lossis tsis raws cai);
- Deterioration ntawm kev zoo nyob rau hauv daim ntawv ntawm nqhis dej, tsaug zog, tsis qab los, liab puas ntsej muag;
- Cov kev tawm tsam hauv zos hauv cov lus qhia ua ke (hlawv, khaus, liab, liab nyob ze lossis atrophy ntawm adipose nqaij).
Ua ke nrog lwm cov tshuaj
Thaum siv tib neeg cov tshuaj insulin nrog qee yam tshuaj, nws cov nyhuv hypoglycemic yog lub zog lossis tsis muaj zog.
Qhov ua kom cov piam thaj txo qis tuaj yeem nce ntxiv thaum noj insulin nrog:
- Sulfonamides (sulfonamide lossis hypoglycemic agents);
- MAO inhibitors (furazolidone, thiab lwm yam);
- ACE inhibitors (captopril, enalapril, thiab lwm yam);
- NSAIDs inhibitors (tshuaj aspirin, diclofenac, thiab lwm yam);
- Androgens thiab anabolic steroids (Anavar, Androxon, thiab lwm yam);
- Cov tshuaj tiv thaiv kab mob (quinoline, quinidine, thiab lwm yam);
- Tetracyclines (tetracycline, doxycycline);
- Lwm yam tshuaj (theophylline, pyridoxine, morphine, thiab lwm yam)
Txhawm rau kom txo cov nyhuv hypoglycemic ntawm cov tshuaj, nws cuam tshuam nrog:
- Glucocorticoids;
- Amphetamines;
- Estrogens (suav nrog hauv daim ntawv tshuaj noj hauv qhov ncauj);
- Tshuaj kho mob;
- Sympathomimetics;
- Cov thyroid hormones;
- Cov tshuaj sib cais (triamterone, phenytoin, glucagon).
Tsis tas li ntawd, ua ke nrog cov tshuaj insulin, cov tshuaj tuaj yeem txo lossis txhim kho cov nyhuv hypoglycemic:
- Beta-blockers;
- Reserpine;
- Morphine;
- Octreotide.
Kev xaiv thiab ntau npaum cov kev xaiv
Cov koob tshuaj thiab cov txheej txheem ntawm kev tswj hwm ntawm tib neeg cov tshuaj insulin yog ib txwm txiav txim siab ntawm tus neeg endocrinologist, coj mus rau hauv tus lej ntsuas yuav tsum muaj ntawm cov ntshav qabzib thiab zis ntawm tus neeg mob.
Cov tshuaj no muab rau hauv ntshav qab zib ua ntau txoj hauv kev: subcutaneously (s / c), intramuscularly (i / m) lossis tso ntshav (i / v). Ntau zaus, cov insulin raug tswj xyuas subcutaneously. Ua qhov no, siv thaj chaw:
- Lub plab;
- Lub xub pwg;
- Daim tawv nqaij khoov rau hauv lub pob tw.
Cov tshuaj feem ntau yog tso rau dej khov rau hauv cov mob uas muaj tus kab mob ntshav qab zib: ketoacidosis, mob ntshav qab zib coma.
Nws raug nquahu kom siv cov tshuaj insulin 15-30 feeb ua ntej noj mov, 3 zaug hauv ib hnub. Qee zaum 5-6 ib zaug kev tswj hwm ntawm cov tshuaj raug tso cai.
Cov tshuaj insulin feem ntau yog xam raws li ib feem ntawm 0.5-1 units ib 1 kg ntawm qhov hnyav. Yog tias cov tshuaj insulin raug tshuaj ntau dua 0.6 mg rau ib kg ntawm lub cev qhov hnyav, ces cov tshuaj yuav tsum raug noj tsawg kawg 2 zaug hauv ib hnub. Qhov nruab nrab, cov tshuaj txhua hnub yog li 30-40 units (hauv cov menyuam yaus, 8 units).
Cov poj niam cev xeeb tub feem ntau yog tshuaj rau 0.6 units ib kg ntawm qhov hnyav. Kev txhaj tshuaj feem ntau tsim tawm 3-5 zaug hauv ib hnub, raws li tus naj npawb ntawm cov zaub mov.
Feem ntau, cov tshuaj insulin sai ua ke nrog cov insulin ntev dua.
Cov kev cai tswj hwm insulin
Txawm tias cov ntshav qab zib ua rau ua yuam kev thaum tswj cov tshuaj insulin.
Txoj cai tseem ceeb tshaj plaws rau kev kho tshuaj insulin yog:
- Txheeb xyuas cov txee lub neej thiab chaw cia khoom ntawm cov tshuaj: nws yuav tsum tsis txhob nphav mus rau qhov kub ntxhov lossis nce ntshav.
- Muab tshuaj rau hauv cov tub yees tso. Nws yog txaus kom khaws lub raj mis pib hauv qhov chaw tsaus thaum chav sov.
- Rov ua kom zoo ntawm cov ntau npaum ntawm cov tshuaj nrog cov lus qhia thiab kws kho mob pom zoo.
- Tso cov cua ntawm lub koob txhaj tshuaj ua ntej kev txhaj tshuaj. Nws tsis yog yuav tsum so cov tawv nqaij nrog cawv. Kev kis mob nrog cov tshuaj insulin yog qhov tsis tshua muaj, thiab haus dej cawv txo cov nyhuv ntawm cov tshuaj.
- Xaiv qhov chaw zoo coj los qhia. Rau kev ua yeeb yam luv luv, qhov no yog lub plab. Thaum txhaj rau hauv lub xub pwg lossis lub ntsej muag gluteal, cov tshuaj ua haujlwm tau qeeb dua.
- Kev tiv thaiv kev cuam tshuam ntawm qhov chaw txhaj tshuaj nyob rau hauv daim ntawv ntawm kev siv tag nrho thaj chaw saum npoo. Rau kev qhia ntawm cov insulin luv luv, tag nrho lub plab hauv plab yog siv: los ntawm sab saum toj ntawm cov npoo nqi mus rau qhov quav, nrog rau thaj chaw tom qab ntawm lub cev. Nws yog ib qho tseem ceeb kom rov qab li 2 cm ntawm qhov chaw txhaj tshuaj qub, qhia cov koob txhaj tshuaj ntawm kaum ntawm 45-60 degrees, kom cov tshuaj tsis xau.
- Ua ntej muab cov tshuaj, Nws yog qhov zoo dua los muab daim tawv nqaij hauv pob tawv nqaij nrog tus ntiv tes xoo thiab ntiv tes. Yog tias nws nkag mus rau hauv cov leeg nqaij, cov tshuaj yuav txo nws cov haujlwm. Tom qab tso cov koob, tuav cov koob txhaj tshuaj rau li 5-10 feeb.
- Hauv plab, tso tshuaj insulin luv luv yog qhov zoo tshaj 20 feeb ua ntej noj mov. Hauv lwm qhov chaw, cov tshuaj tau muab tshuaj rau ib nrab ib teev ua ntej noj mov.
Lub npe kev lag luam ntawm cov tshuaj
Qhov tshuaj insulin yog tsim nyob rau hauv daim ntawv ntawm cov tshuaj rau kev txhaj tshuaj thiab yog muag hauv khw muag tshuaj.
Txhob kaw cov neeg muaj peev xwm tsim cov tshuaj insulin tuaj yeem tsim nyob hauv cov npe lag luam:
- Biosulin;
- Actrapid;
- Actrapid NM;
- Gensulin;
- Peb yuav coj nws;
- Penfill.
Ua tsaug rau niaj hnub kev ua thev naus laus zis, tsim ua kom muaj zog (rov ua dua tshiab) tib neeg cov kua dej yog tsim. Nws yog nws leej twg yog tus nquag tshuaj ntawm qhov kev npaj: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Cov tshuaj no txawv ntawm thawj zaug hauv qhov rov ua dua ntawm cov amino acids, uas ntxiv cov khoom tshiab rau lawv (piv txwv li, cov txiaj ntsig tau ob-ntu ntev dua), uas yog qhov tseem ceeb heev rau cov neeg mob ntshav qab zib.
Kev phiv tshuaj
Txawm hais tias nws ua siab zoo, cov tshuaj no yuav muaj kev mob tshwm sim hauv daim ntawv ntawm:
- Kev siv tshuaj tiv thaiv tsis haum nrog tus neeg mob tus kheej insulin;
- Kev tsis haum tshuaj (urticaria, khaus khaus) lossis Quincke's edema (nrog rau qhov ntsej muag nrawm thiab hnoos qeev, pallor,
- Nyuaj ua pa, tawv nqaij xiav, lossis tsis nco qab);
- Qog ntshav txias hypoglycemic;
- Kev puas siab puas ntsws uas tsis nco qab zoo (qee zaus tsis nco qab nco ntsoov);
- Hyperglycemia lossis ntshav qab zib acidosis (tawm tsam keeb kwm ntawm kub ib ce lossis mob kis, noj zaub mov tsis zoo, tom qab kev txhaj tshuaj tsis raws cai lossis tsis raws cai);
- Nqhis dej, nkees nkees, tsis qab noj, liab ntsej muag;
- Mob tshwm sim hauv cov lus qhia ua ke (hlawv, khaus, loj hlob lossis atrophy ntawm adipose nqaij).
Qee lub sij hawm thaum pib noj cov tshuaj muaj cov kev ua kom pom kev nyob rau hauv daim ntawv ntawm ntau lub zeem muag tsis pom kev (ob lub zeem muag, qhov muag plooj, thiab lwm yam) lossis cov tsos ntawm edema. Tab sis lawv yog cov kev hloov pauv ntawm lub cev thiab dhau tom qab ntau lub lim tiam ntawm kev kho mob.
Noj ntau dhau
Nws tshwm sim tias kev tswj hwm ntawm insulin hauv qee kis ua rau hyperglycemia.
Cov tsos mob tseem ceeb ntawm hyperglycemia yog cov kev qhia hauv daim ntawv ntawm:
- Tsis muaj zog;
- Pallor;
- Cov hws txias txias;
- Cov lus cuav
- Mob taub hau;
- Kev xav ntawm kev tshaib kev nqhis;
- Cov kabmob hauv lub cev;
- Loog ntawm tus nplaig, daim di ncauj, nqua.
Thaum cov tsos mob zoo sib xws pib, tus neeg mob yuav tsum noj tam sim ntawd ib qho yooj yim zom cov zaub mov carbohydrate (feem ntau yog khoom qab zib, ib qho qab zib lossis tshuaj yej qab zib).
Teeb meem
Kev kho mob ntev ntev nrog cov tshuaj insulin tuaj yeem ua rau ntau yam mob. Lub ntsiab yog:
- Qhov tshwm sim ntawm cov ntshav qog ntshav qab zib. Qhov no tuaj yeem ua kom yooj yim los ntawm kev noj zaub mov tsis zoo, kev haus tshuaj ntau dhau, kev tawm dag zog ntau dhau, lub raum thiab mob siab.
- Kev tshaj xo lipodystrophy. Kev tiv thaiv kab mob yog hloov thaj chaw txhaj tshuaj, ntxiv cov tshuaj novocaine (0.5-1.5 ml) rau cov tshuaj insulin, thiab txhaj cov koob txhaj tshuaj rau hauv Ѕ ntawm cov tuab ntawm daim ntaub adipose.
- Tshuaj tsis lees paub. Lwm yam (feem ntau ua ke) hom tshuaj muaj suab thaj nyob qis tau xaiv.
- Kev ua xua tsis haum. Siv txoj hau kev kho mob (antihistamines, glucocorticoids) thiab kev hloov tshuaj txaus.
Solulin tib neeg lub cev yog qhov cawm txoj sia rau ntau tus neeg mob ntshav qab zib. Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tau siv cov tshuaj no kom muaj txiaj ntsig, coj mus rau hauv txhua tus cai rau nws txoj kev tswj hwm. Nws yog ib qho tsim nyog uas tus kws kho mob sau ntawv rau cov tshuaj no, laij nws cov koob tshuaj thiab saib xyuas tus neeg mob lub sijhawm thaum kho tag nrho.
