Kev tsim kho tshuab hauv tshuab hlwb hlau insulin-isophan (Insulin-isophan tib neeg kev lom neeg lub cev)

Cov tshuaj yeeb yaj kiab tau tsim tawm los ntawm cov tsiaj txhu DNA biotechnology siv ib hom kab mob ntawm Saccharomyces cerevisiae. Cov tshuaj, sib cuam tshuam nrog cov receptors tshwj xeeb ntawm sab nraud cytoplasmic ntawm lub cell, ua ib qho insulin receptor complex uas txhawb cov txheej txheem sab hauv lub cell, suav nrog kev tsim tawm ntawm qee cov enzymes tseem ceeb (pyruvate kinase, hexokinase, glycogen synthetase thiab lwm tus). Kev poob qis hauv cov concentration ntawm cov piam thaj hauv cov ntshav tshwm sim vim yog qhov nce hauv nws txoj kev thauj hauv cov hlwb, kev nce siab thiab nqus los ntawm cov ntaub so ntswg, thiab qhov poob qis hauv cov ntshav qabzib nyob hauv lub siab. Cov tshuaj stimulates glycogenogenesis, lipogenesis, synthesis protein.
Lub sijhawm tiv thaiv ntawm cov tshuaj yog feem ntau vim nws qhov nqus tus nqi, uas nyob ntawm qhov koob tshuaj, qhov chaw thiab kev coj noj coj ua thiab lwm yam, yog li, cov yeeb yaj kiab kev txiav txim siab sib txawv ntawm cov neeg mob sib txawv, tab sis kuj nyob hauv tib neeg. Qhov nruab nrab, nrog kev tswj hwm ntawm subcutaneous ntawm cov tshuaj, qhov pib ntawm kev ua yog pom tom qab 1.5 teev, qhov siab tshaj plaws ua tiav tau tiav tom qab 4 txog 12 teev, lub sijhawm ua haujlwm tau mus txog ib hnub. Qhov pib ntawm cov nyhuv thiab ua tiav ntawm kev nqus ntawm cov tshuaj yog nyob ntawm lub koob tshuaj (ntim ntawm cov tshuaj tau muab tshuaj), qhov chaw txhaj tshuaj (ncej puab, plab, pob tw), cov concentration ntawm insulin hauv tshuaj, thiab lwm yam. Qhov siab tshaj plaws ntawm cov tshuaj insulin hauv cov ntshav ntshav tau mus txog hauv 2 txog 18 teev tom qab kev tswj hwm subcutaneous. Tsis muaj kev tshaj tawm hais txog cov ntshav plasma tiv thaiv kab mob ntshav tsuas yog sau tseg, tshwj tsis yog rau lub cev sib kis rau cov insulin (yog tias muaj). Cov tshuaj tsis txaus ntseeg faib thoob plaws cov ntaub so ntswg, tsis txeem mus rau hauv niam mis thiab los ntawm qhov chaw tiv thaiv. Feem ntau nyob rau hauv ob lub raum thiab mob siab, cov tshuaj tau muab pov tseg los ntawm insulinase, thiab ntxiv, tejzaum nws, protein disulfide isomerase. Cov tshuaj insulin tsis ua haujlwm. Ib nrab-lub neej ntawm insulin los ntawm cov ntshav yog tsuas yog ob peb feeb. Kev tshem tawm ib nrab-lub neej los ntawm kev muaj sia ua rau txog 5 - 10 teev. Nws yog tawm los ntawm lub raum (30 - 80%).
Tsis muaj ib qho kev pheej hmoo ntawm cov tshuaj rau tib neeg tau raug qhia thaum lub sijhawm kev tshawb fawb, uas suav nrog kev tshawb fawb tshuaj lom nrog kev rov ua dua, kev tshawb nrhiav kev nyab xeeb ntawm tus kheej, kev tshawb fawb carcinogenic muaj peev xwm, genotoxicity, thiab tshuaj lom cuam tshuam rau ntawm tus kheej deev.

Hom 1 mob ntshav qab zib mellitus, hom 2 mob ntshav qab zib mellitus: ib nrab tawm tsam cov tshuaj hypoglycemic (thaum kho mob sib xyaw), theem ntawm tsis kam rau cov tshuaj tiv thaiv kab mob ntshav qab zib, cuam tshuam sib kis, hom 2 mob ntshav qab zib mellitus hauv cov poj niam cev xeeb tub.

Txoj kev siv tshuaj yeeb dej caw rau tib neeg cov tshuaj insulin-isophan genetic engineering thiab koob tshuaj

Cov tshuaj raug muab tsuas yog subcutaneously. Cov koob tshuaj hauv txhua kis tau txiav txim los ntawm tus kws kho mob ib leeg zuj zus raws li kev saib xyuas cov kua nplaum hauv cov ntshav, feem ntau cov tshuaj txhua hnub los ntawm 0.5 mus rau 1 IU / kg (nyob ntawm theem ntawm cov ntshav qabzib thiab tus yam ntxwv ntawm tus neeg mob). Feem ntau, cov tshuaj raug txhaj rau hauv qab ncej puab. Tsis tas li, cov tshuaj muaj peev xwm muab tshuaj subcutaneously nyob rau hauv lub pob tw, anterior plab phab ntsa, thiab lub cheeb tsam ntawm deltoid leeg ntawm lub xub pwg. Qhov ntsuas kub ntawm cov tshuaj tso cai yuav tsum nyob ntawm chav sov.
Tsis txhob tswj hwm txoj leeg.
Cov kev xav tau rau insulin txhua hnub yuav qis dua rau cov neeg mob uas muaj cov tshuaj insulin ntau dua thiab ntau dua nyob hauv cov neeg mob uas muaj cov tshuaj tiv thaiv insulin (piv txwv, hauv cov neeg mob rog lub sijhawm pub dawb).
Txhawm rau tiv thaiv kev txhim kho ntawm lipodystrophy, nws yog qhov tsim nyog los hloov chaw txhaj tshuaj nyob rau hauv thaj av anatomical.
Thaum siv cov tshuaj insulin, nws yog ib qho tsim nyog yuav tsum tau soj ntsuam tas li cov kev ntsuas ntawm cov piam thaj hauv cov ntshav. Ntxiv nrog rau kev siv tshuaj ntau dhau, qhov ua rau cov ntshav qab zib tsis tuaj yeem tuaj yeem yog: hla zaub mov noj, hloov cov tshuaj, raws plab, ntuav, ua kom lub cev muaj zog, hloov chaw txhaj tshuaj, kab mob uas txo qis qhov xav tau ntawm insulin (tsis hnov ​​mob raum thiab / lossis lub siab ua haujlwm, pituitary pituitary, adrenal cortex, cov thyroid caj pas), sib cuam tshuam nrog lwm yam tshuaj.
Kev so hauv insulin tswj hwm lossis kev noj tshuaj tsis raug, tshwj xeeb tshaj yog nyob rau cov neeg mob ntshav qab zib hom 1, tuaj yeem ua rau mob hyperglycemia. Raws li txoj cai, thawj cov cim ntawm hyperglycemia pib maj mam dhau los, dhau ob peb teev lossis hnub. Lawv suav nrog tso zis nce ntxiv, nqhis dej, xeev siab, kiv taub hau, ntuav, qhuav thiab liab ntawm daim tawv, tsis qab los noj mov, lub qhov ncauj qhuav, tsis hnov ​​ntxhiab ntawm cov acetone hauv cov pa ua pa. Yog tias tsis muaj kev kho mob tshwj xeeb, hyperglycemia tuaj yeem ua tus kab mob ntshav qab zib ketoacidosis, uas yog kev pheej hmoo tuag taus.
Cov koob tshuaj insulin yuav tsum tau kho rau Addison's disease, ua rau lub qog ua haujlwm tsis zoo, ua haujlwm lub raum thiab / lossis lub siab ua haujlwm, kev ua haujlwm hypopituitarism, kab mob thiab mob uas ua nrog kub taub hau, dhau lub hnub nyoog 65 xyoos. Tsis tas li, kev hloov pauv ntawm cov tshuaj yuav raug yog tias tus neeg mob hloov cov zaub mov ib txwm los yog nce qhov kev ua haujlwm ntawm lub cev.
Cov tshuaj txo cov cawv rau lub txim.
Ua ntej taug kev, uas cuam tshuam nrog kev hloov chaw hauv lub sijhawm, tus neeg mob yuav tsum tau sab laj nrog tus kws kho mob uas tuaj koom, vim tias thaum hloov chaw sijhawm nws txhais tau hais tias tus neeg mob yuav txhaj tshuaj insulin thiab noj zaub mov rau lwm lub sijhawm.
Nws yog ib qho tsim nyog yuav tau ua tiav kev hloov pauv los ntawm ib hom tshuaj insulin mus rau lwm qhov nyob hauv kev tswj hwm qhov kev tswj hwm ntawm cov piam thaj hauv cov ntshav.
Lub sijhawm siv cov tshuaj (tshwj xeeb rau lub hom phiaj thaum pib, hloov ib hom tshuaj insulin mus rau lwm qhov, kev ntxhov siab lossis kev tawm dag zog lub cev), lub peev xwm tswj tau ntau yam txheej txheem, tsav lub tsheb thiab koom nrog lwm yam kev phom sij uas xav tau ceev ntawm lub cev muaj zog thiab lub hlwb kev xav tuaj yeem txo qis. thiab nce mloog ntxiv.

Cev xeeb tub thiab lactation

Tsis muaj kev txwv txog kev siv cov tshuaj insulin thaum cev xeeb tub thiab thaum pub niam mis, txij li thaum insulin tsis nkag rau hauv tus me nyuam thiab mis niam. Kev mob ntshav qab zib thiab hyperglycemia, tuaj yeem tsim kho nrog kev kho tsis tau zoo, ua rau muaj kev pheej hmoo ntawm tus me nyuam hauv plab tuag thiab qhov tshwm sim ntawm cov me nyuam hauv plab tsis zoo. Cov poj niam cev xeeb tub uas muaj ntshav qab zib yuav tsum muaj kev saib xyuas mob thoob plaws hauv lawv cev xeeb tub, lawv yuav tsum saib xyuas lawv cov ntshav qabzib kom qis, thiab cov lus qhia zoo ib yam rau cov poj niam npaj xeeb menyuam. Nyob rau thawj peb lub hlis thaum cev xeeb tub, insulin thov feem ntau poob qis thiab maj mam nce qib thib ob thiab thib peb theem. Tom qab yug menyuam tas, xav tau cov tshuaj insulin feem ntau sai sai rau qib uas tau pom ua ntej muaj menyuam hauv plab. Thaum lub sijhawm pub niam mis, cov pojniam muaj ntshav qab zib yuav tau kho lawv kev noj haus thiab / lossis noj tshuaj ntxiv.

Kev phiv los ntawm cov tshuaj insulin-isophan tib neeg cov tshuaj muaj yees

Vim muaj cov ntxim rau cov metabolism hauv carbohydrate: lub ntsej muag ntshav qog ntshav (tawm hws, tawm hws, nkees, daj ntseg, tawv nqaij tsis pom kev, tsis pom kev, tsis pom kev, tsis hnov ​​qab, nkees, nkees nkees lossis tsis muaj zog, tshee tshee, tshee tshee, mob taub hau, ntxhov siab, ntxhov siab, mob plab hauv lub qhov ncauj, ua rau lub siab poob qis) saib xyuas, tsis meej pem, tsaug zog, tsis nco qab, cramps, ib ntus lossis tsis tuaj yeem ua haujlwm ntawm lub hlwb kev ua haujlwm, kev tuag), suav nrog kev tsis nco qab.
Kev tsis haum tshuaj: cov tawv nqaij ua pob, urticaria, Quincke's edema, anaphylactic ceeb, anaphylactic kev ua xua (suav nrog rau daim tawv nqaij sawv cev dav dav, nce tawm hws, ntshav nce qis, khaus, mob plab, chim siab, mob taub hau, ua pa nyuaj, dhia ceev ceev, tsaus muag / tsaus muag).
Lwm yam: transient refractive errors (feem ntau thaum pib kho), mob neuropathy mob (mob hlab ntsha hlwb), mob ntshav qab zib retinopathy, edema.
Cov tshuaj tiv thaiv hauv zos: o, mob, o, hyperemia, mob, khaus, hematoma, lipodystrophy ntawm thaj chaw txhaj tshuaj.

Kev sib cuam tshuam ntawm cov tshuaj insulin-isophan tib neeg kev tshawb fawb caj nrog lwm yam tshuaj

: glucocorticoids, qhov ncauj tawm tsam, cov thyroid hormones, heparin, thiazide diuretics, tricyclic antidepressants, danazole, clonidine, sympathomimetics, calcium channel blockers, phenytoin, morphine, diazoxide, nicotine.
: Monoamine oxidase inhibitors, qhov ncauj hypoglycemic tshuaj, angiotensin converting enzyme inhibitors, xim beta-blockers, carbonic anhydrase inhibitors, octreotide, bromocriptine, sulfonamides, tetracyclines, anabolic steroids, clofibrate, mebendazole, ketoconazole, pyridoxine, cyclophosphamide, theophylline, tshuaj lithium fenfluramine.
Hauv qab ntawm salicylates, reserpine, kev npaj muaj ethanol, ob qho tib si qaug zog thiab txhim kho kev ua ntawm insulin yog ua tau.
Octreotide, lanreotide tuaj yeem nce lossis txo qis hauv lub cev xav tau cov tshuaj insulin.
Beta-blockers tuaj yeem npog cov tsos mob ntawm kev ua qog ntshav qab zib thiab kev ua kom rov qab qeeb tom qab kev mob hypoglycemia.
Nrog rau kev siv cov tshuaj insulin thiab thiazolidinedione, nws muaj peev xwm txhim kho kev mob plawv tsis ua hauj lwm, tshwj xeeb tshaj yog nyob rau cov neeg mob uas muaj kev pheej hmoo rau nws txoj kev loj hlob. Thaum cov kev kho mob ua ke no tau tsim nyog, nws yog ib qho tsim nyog los soj ntsuam cov neeg mob kom paub txog lub plawv tsis ua haujlwm ntev, muaj qhov nyob ntawm edema, thiab qhov hnyav nce. Yog hais tias cov tsos mob ntawm lub plawv tsis zoo nyob rau hauv cov neeg mob, thiazolidinedione kev kho yuav tsum tau tsum tsis ua hauj lwm.

Noj ntau dhau

Nrog kev siv tshuaj ntau dhau ntawm cov tshuaj, hypoglycemia tshwm sim.
Kev Kho Mob: tus neeg mob tuaj yeem tshem tawm cov ntshav qab zib tsawg ntawm nws tus kheej, rau qhov no nws yog ib qho tsim nyog yuav tau noj zaub mov ntau hauv carbohydrates lossis qab zib sab hauv, yog li nws tau pom zoo rau cov neeg mob ntshav qab zib mellitus tas li nqa cov suab thaj, ncuav qab zib, khoom qab zib, kua txiv qab zib. Hauv kev mob ntshav qis (nrog rau kev tsis nco qab), 40% kev daws teeb meem yog muab tshuaj rau txoj leeg, intramuscularly, subcutaneously lossis tso ntshav qab zib - glucagon. Tom qab nws rov qab nco qab, tus neeg mob yuav tsum noj cov khoom noj uas muaj cov khoom noj carbohydrate kom tiv thaiv kev rov qab txhim kho ntshav qab zib.

Kws Tshuaj

Nws cuam tshuam nrog cov kis tshwj xeeb ntawm cov sab nraud cytoplasmic ntawm lub xovtooj ntawm thiab tsim cov txheej txheem insulin-receptor complex uas txhawb cov txheej txheem intracellular, suav nrog synthesis ntawm cov lej ntawm cov enzymes tseem ceeb (hexokinase, pyruvate kinase, glycogen synthetase, thiab lwm yam). Qhov ua kom tsis muaj piam thaj hauv cov ntshav yog vim muaj qhov nce ntxiv hauv nws txoj kev thauj mus los hauv lub cev, qhov ntau ntxiv thiab nqus tau los ntawm cov nqaij mos, thiab qhov txo qis hauv cov piam thaj los ntawm lub siab ua rau lub siab. Stimulates lipogenesis, glycogenogenesis, synthesis protein.

Lub sijhawm ntawm kev ua ntawm insulin npaj yog txiav txim siab los ntawm tus nqi ntawm kev nqus, uas nyob ntawm ntau yam (nrog rau cov koob tshuaj, txoj kev thiab qhov chaw ntawm kev tswj hwm), thiab yog li ntawd cov ntaub ntawv ntawm kev ua ntawm insulin yog raug hloov pauv tseem ceeb hauv cov neeg sib txawv, thiab hauv ib qho tib neeg. Qhov nruab nrab, tom qab kev tswj hwm sc, qhov pib ntawm kev ua yog tom qab 1.5 teev, cov txiaj ntsig siab tshaj plaws tsim tawm ntawm 4 thiab 12 teev, lub sijhawm ua haujlwm tau ntev txog 24 teev.

Kev ua tiav ntawm kev nqus thiab pib ntawm cov nyhuv ntawm cov tshuaj insulin nyob ntawm qhov chaw txhaj tshuaj (plab, ncej, pob tw), qhov koob tshuaj (ntim ntawm cov tshuaj insulin), cov tshuaj insulin nyob rau hauv cov tshuaj, thiab lwm yam Nws muab faib tsis ncaj ntawm cov ntaub so ntswg, thiab tsis nkag rau hauv qhov chaw tiv thaiv thiab nkag mus rau niam mis. Nws yog rhuav tshem los ntawm insulinase feem ntau hauv daim siab thiab lub raum. Nws yog tawm los ntawm ob lub raum (30-80%).

Qhov tshwm sim phiv los ntawm cov tshuaj Insulin-isophan tib neeg cov tshuaj muaj tshuab

Vim muaj cov ntxim rau cov metabolism hauv carbohydrate: hypoglycemic tej yam kev mob (pallor ntawm daim tawv nqaij, nce tawm hws, palpitations, tshee tshee, tshaib plab, ntxhov siab, kab mob plab hauv lub qhov ncauj, mob taub hau). Kev mob ntshav qog ntshav qis tuaj yeem ua rau txhim kho kev mob hypoglycemic coma.

Kev tsis haum tshuaj: tsis tshua muaj - tawv nqaij ua pob, Quincke's edema, tsis tshua muaj tshwm sim - anaphylactic kev poob siab.

Lwm yam: o, kev hloov pauv hloov pauv sai (feem ntau thaum pib kho).

Cov tshuaj tiv thaiv hauv zos: hyperemia, o thiab khaus ntawm qhov chaw txhaj tshuaj, nrog rau siv sijhawm ntev - lipodystrophy ntawm thaj chaw txhaj tshuaj.

Ceev faj txog cov tshuaj Insulin-isophan tib neeg kev tshawb fawb caj

Nws yog ib qho tsim nyog yuav tsum hloov chaw txhaj tshuaj nyob rau thaj tsam anatomical thiaj li tiv thaiv kev txhim kho ntawm lipodystrophy.

Tawm tsam keeb kwm yav dhau los ntawm kev kho mob insulin, kev tshuaj xyuas cov ntshav qabzib ntau yog tsim nyog. Cov ua rau cov ntshav qog ntshav, ntxiv rau kev noj tshuaj insulin ntau dhau, tuaj yeem yog: hloov tshuaj, hla zaub mov, ntuav, raws plab, ua kom lub cev qoj ib ce, cov kab mob uas txo qis qhov xav tau ntawm insulin (kev mob siab rau lub siab thiab lub raum kev ua haujlwm, kev ua haujlwm ntawm adrenal cortex, pituitary lossis thyroid caj pas), hloov chaw txhaj tshuaj, nrog rau kev sib cuam tshuam nrog lwm yam tshuaj.

Kev noj tshuaj tsis zoo los yog cuam tshuam hauv kev tswj hwm insulin, tshwj xeeb tshaj yog nyob rau cov neeg mob ntshav qab zib hom 1, tuaj yeem ua rau mob hyperglycemia. Feem ntau, thawj cov tsos mob ntawm hyperglycemia pib maj mam dhau ob peb teev lossis hnub. Cov no suav nrog kev nqhis dej, ntxiv tso zis, xeev ntuav, ntuav, kiv taub hau, liab thiab ntawm daim tawv nqaij, qhov ncauj qhuav, tsis qab los, tsis hnov ​​tsw ntawm Acetone hauv cov pa ua pa. Yog tias tsis kho, hyperglycemia hauv ntshav qab zib hom 1 tuaj yeem ua rau muaj kev tiv thaiv cov mob ntshav qab zib ketoacidosis.

Cov koob tshuaj insulin yuav tsum tau hloov kho thaum muaj mob qog ua haujlwm, Addison's disease, hypopituitarism, ua rau lub siab thiab lub raum ua haujlwm thiab mob ntshav qab zib mellitus hauv cov neeg mob hnub nyoog 65 xyoos. Hloov cov koob tshuaj ntawm cov tshuaj insulin kuj tseem xav tau yog tias tus neeg mob ua kom lub cev txav ntau ntxiv lossis hloov cov zaub mov ib txwm muaj.

Cov kab mob sib xyaw tshwj xeeb, tshwj xeeb tshaj yog kis mob thiab cov kab mob nrog kub taub hau, nce ntxiv qhov xav tau ntawm insulin.

Kev hloov pauv ntawm ib hom tshuaj insulin mus rau lwm qhov yuav tsum tau ua nyob ntawm kev tswjhwm ntawm cov ntshav nyob rau qib.

Cov tshuaj txo qis cawv rau cov neeg haus cawv.

Hauv kev sib txuas nrog lub hom phiaj tseem ceeb ntawm insulin, qhov kev hloov pauv ntawm nws hom lossis nyob ntawm qhov tseem ceeb ntawm lub cev lossis lub hlwb kev ntxhov siab, nws muaj peev xwm txo qis kev muaj peev xwm tsav lub tsheb lossis tswj ntau cov txheej txheem, nrog rau koom nrog lwm yam kev phom sij uas xav tau kev nce siab thiab ceev ntawm lub hlwb thiab lub cev kev xav.

Cov yam ntxwv ntawm lub zog Insulin-isophan tib neeg kev tshawb fawb engineering

Nruab nrab-insulin. Tib neeg cov kua dej tau txais los ntawm siv DNA thev naus laus zis thev naus laus zis.

Nws cuam tshuam nrog cov receptors tshwj xeeb sab nraud ntawm cytoplasmic membrane ntawm lub xovtooj ntawm thiab tsim cov txheej txheem insulin-receptor complex uas txhawb cov txheej txheem intracellular, suav nrog synthesis ntawm cov lej ntawm cov enzymes tseem ceeb (hexokinase, pyruvate kinase, glycogen synthetase, thiab lwm yam).Qhov ua kom tsis muaj piam thaj hauv cov ntshav yog vim muaj qhov nce ntxiv hauv nws txoj kev thauj mus los hauv lub cev, qhov ntau ntxiv thiab nqus tau los ntawm cov nqaij mos, thiab qhov txo qis hauv cov piam thaj los ntawm lub siab ua rau lub siab. Stimulates lipogenesis, glycogenogenesis, synthesis protein.

Lub sijhawm ntawm kev ua ntawm insulin npaj yog txiav txim siab los ntawm tus nqi ntawm kev nqus, uas nyob ntawm ntau yam (nrog rau cov koob tshuaj, txoj kev thiab qhov chaw ntawm kev tswj hwm), thiab yog li ntawd cov ntaub ntawv ntawm kev ua ntawm insulin yog raug hloov pauv tseem ceeb hauv cov neeg sib txawv, thiab hauv ib qho tib neeg. Qhov nruab nrab, tom qab kev tswj hwm sc, qhov pib ntawm kev ua yog tom qab 1.5 teev, cov txiaj ntsig siab tshaj plaws tsim tawm ntawm 4 thiab 12 teev, lub sijhawm ua haujlwm tau ntev txog 24 teev.

Kev ua tiav ntawm kev nqus thiab pib ntawm cov nyhuv ntawm cov tshuaj insulin nyob ntawm qhov chaw txhaj tshuaj (plab, ncej, pob tw), qhov koob tshuaj (ntim ntawm cov tshuaj insulin), cov tshuaj insulin nyob rau hauv cov tshuaj, thiab lwm yam Nws muab faib tsis ncaj ntawm cov ntaub so ntswg, thiab tsis nkag rau hauv qhov chaw tiv thaiv thiab nkag mus rau niam mis. Nws yog rhuav tshem los ntawm insulinase feem ntau hauv daim siab thiab lub raum. Nws yog tawm los ntawm ob lub raum (30-80%).

Kev piav qhia ntawm cov tshuaj nquag nquag Insulin-isophan tib neeg kev tshawb fawb engineering / Insulinum isophanum humanum biosyntheticum.

Cov mis, tshuaj lub npe: tsis muaj ntaub ntawv.
Pharmacological pawg: cov tshuaj hormones thiab lawv cov antagonists / insulins.
Pharmacological kev txiav txim: tshuaj qog ntshav.

Hom 1 mob ntshav qab zib mellitus, hom 2 mob ntshav qab zib mellitus: ib nrab tawm tsam cov tshuaj hypoglycemic (thaum kho mob sib xyaw), theem ntawm tsis kam rau cov tshuaj tiv thaiv kab mob ntshav qab zib, cuam tshuam sib kis, hom 2 mob ntshav qab zib mellitus hauv cov poj niam cev xeeb tub.

Isofan insulin: cov lus qhia rau kev siv thiab tus nqi ntawm cov tshuaj

Kev kho tshuaj Insulin muaj lub cim hloov, vim hais tias lub luag haujlwm tseem ceeb ntawm kev kho yog txhawm rau them nyiaj rau qhov ua tsis zoo ntawm cov metabolism hauv kev ua kom rog rog los ntawm kev qhia cov tshuaj tshwj xeeb hauv qab tawv nqaij. Cov tshuaj zoo li no cuam tshuam rau lub cev ib yam nkaus li lub cev insulin tsim tawm los ntawm lub txiav. Hauv qhov no, kev kho yog tag nrho lossis ib nrab.

Ntawm cov tshuaj siv rau ntshav qab zib, ib qho zoo tshaj plaws yog insulin Isofan. Cov tshuaj muaj cov tib neeg lub cev ua cov tshuaj insulin ntawm lub sijhawm ntev.

Cov cuab yeej muaj nyob hauv ntau hom. Nws raug tswj nyob rau hauv peb txoj kev - subcutaneously, intramuscularly thiab leeg. Qhov no tso cai rau tus neeg mob xaiv qhov kev xaiv zoo tshaj plaws rau kev tswj hwm theem ntawm glycemia.

Kev qhia rau kev siv thiab cov npe lag luam ntawm cov tshuaj

Kev siv cov tshuaj yog qhia rau cov tshuaj insulin-tiv thaiv mob ntshav qab zib. Ntxiv mus, txoj kev kho yuav tsum kav tag lub neej.

Cov tshuaj insulin li Isofan yog tib neeg cov tshuaj tiv thaiv ua tsis taus pa hauv cov tshuaj xws li:

1. ntshav qab zib hom 2 (insulin-dependant),
2. kev phais mob
3. tsis kam tiv thaiv cov kab mob ntshav qab zib ua qhov ncauj ntawm txoj kev kho mob,
4. mob ntshav qab zib hauv plab (tsis muaj kev ua tau zoo ntawm kev noj zaub mov),
5. intercurrent pathology.

Cov tuam txhab kws tsim khoom lag luam tsim cov tib neeg cov tshuab hluav taws xob ua kom insulin nyob rau hauv ntau lub npe. Cov neeg nyiam tshaj plaws yog Vozulim-N, Biosulin-N, Protafan-NM, Insuran-NPH, Gensulin-N.

Lwm hom isofan insulin kuj tseem siv nrog cov npe lag luam nram qab no:

• Ntsuas Yuam Kev
• Humulin (NPH),
• Pensulin,
• Isofan insulin NM (Protafan),
• Actrafan
• Saib tsis muaj N,
• Biogulin N,
• Protafan-NM Penifill.

Nws yog tsim nyog sau cia tias kev siv ib qho lus siv rau Insulin Isofan yuav tsum pom zoo nrog kws kho mob.

Tib neeg cov insulin muaj cov nyhuv hypoglycemic. Cov tshuaj cuam tshuam nrog cov receptors ntawm cytoplasmic cell membrane, txoj kev ua ib qho insulin-receptor complex. Nws ua kom muaj txheej txheem uas tshwm sim sab hauv cov hlwb thiab coj los ua cov enzymes tseem ceeb (glycogen synthetase, pyruvate kinase, hexokinase, thiab lwm yam).

Txo cov concentration ntawm cov piam thaj yog ua tiav los ntawm kev nce ntxiv hauv kev thauj mus los hauv qis dua, txo qis tawm ntawm cov piam thaj ntau ntau los ntawm lub siab, ua kom muaj zog nqus thiab ntxiv nqus ntawm cov piam thaj los ntawm cov ntaub so ntswg. Tsis tas li, tib neeg cov kua dej ua kom cov protein ua ke, glycogenogenesis, lipogenesis.

Lub sijhawm ntawm kev ua ntawm cov tshuaj yog nyob ntawm qhov ceev ntawm kev nqus, thiab nws yog vim muaj ntau yam (thaj tsam ntawm kev tswj hwm, txoj kev thiab qhov koob tshuaj). Yog li, qhov ua tau zoo ntawm Isofan insulin tuaj yeem ua dej nyab rau ob tus neeg mob thiab lwm tus mob ntshav qab zib.

Feem ntau tom qab txhaj tshuaj, cov nyhuv ntawm cov tshuaj tau sau tseg tom qab 1.5 teev. Qhov siab tshaj plaws hauv kev ua tau zoo tshwm sim hauv 4-12 teev tom qab kev tswj hwm. Sij hawm ntawm ua - ib hnub.

Yog li, qhov ua tiav ntawm kev nqus thiab qhov pib ntawm kev ua ntawm tus neeg sawv cev yog nyob ntawm ntau yam xws li:

1. thaj chaw txhaj tshuaj (pob tw, ncej puab, plab),
2. nquag siv tshuaj mloog
3. tsuas tshuaj.

Kev npaj tshuaj insulin rau tib neeg yog faib tsis txaus ntseeg nyob rau hauv cov ntaub so ntswg. Lawv tsis nkag rau hauv lub tsho (placenta) thiab tsis nqus rau niam mis.

Lawv raug rhuav tshem los ntawm insulinase feem ntau nyob hauv lub raum thiab mob siab, nyob hauv tus nqi 30-80% nrog lub raum.

Cov lus qhia rau kev siv nrog insulin Isofan hais tias nws feem ntau ua rau subcutaneously txog 2 zaug hauv ib hnub ua ntej noj tshais (30-45 feeb). Hauv qhov no, koj yuav tsum hloov thaj chaw txhaj tshuaj txhua hnub thiab khaws cov koob txhaj tshuaj uas siv los ntawm chav kub, thiab ib qho tshiab hauv lub tub yees.

Qee zaum cov tshuaj tau muab tshuaj intramuscularly. Thiab txoj hauv kev siv qhov tseeb nruab nrab ntawm kev siv tshuaj insulin yog qhov siv tsis tau siv.

Qhov ntau npaum li cas tau muab xam ib qho zuj zus rau txhua tus neeg mob, raws li theem ntawm cov suab thaj hauv kev tso zis lom thiab qhov tshwj xeeb ntawm tus kab mob. Raws li txoj cai, qhov nruab nrab txhua hnub ntau npaum li cas los ntawm 8-24 IU.

Yog tias cov neeg mob tau mob siab tsis txaus rau cov tshuaj insulin, ces qhov niaj hnub noj tshuaj ntau yog 8 IU. Nrog kev ua tsis tau zoo ntawm cov tshuaj hormones, qhov tshuaj ntau ntau ntxiv - los ntawm 24 IU ib hnub.

Thaum lub ntim txhua hnub ntawm cov tshuaj ntau dua 0.6 IU rau 1 kg ntawm huab hwm coj, tom qab ntawd 2 hno yog tsim nyob rau hauv qhov sib txawv ntawm lub cev. Cov neeg mob uas noj tshuaj ib hnub ib zaug ntawm 100 IU lossis ntau dua yuav tsum tau mus pw hauv tsev kho mob yog tias hloov cov kua dej.

Ntxiv mus, thaum hloov los ntawm ib hom khoom lag luam mus rau lwm tus, nws yog qhov yuav tsum tau soj ntsuam cov piam thaj hauv qab.

Kev siv cov tshuaj insulin rau tib neeg tuaj yeem ua rau ua xua tuaj. Feem ntau, nws yog angioedema (hypotension, ua pa luv, kub cev) thiab urticaria.

Tsis tas li, ntau tshaj qhov ntau npaum li cas tuaj yeem ua rau lub qog ntshav qab zib, los ntawm cov tsos mob hauv qab no:

• insomnia
• daim tawv nqaij blanching,
• kev nyuaj siab
• hyperhidrosis
• ntshai
• zoo siab lub xeev
• palpitations
• mob taub hau
• tsis meej pem,
• vestibular kev ntshawv siab
• kev tshaib kev nqhis
• tshee hnyo thiab os.

Cov kev mob tshwm sim suav nrog cov ntshav qab zib acidosis thiab hyperglycemia, uas tau tshwm sim los ntawm lub ntsej muag yaug, kev tsaug zog, tsis qab los noj mov thiab nqhis dej. Feem ntau, cov xwm txheej zoo li no tiv thaiv keeb kwm ntawm kev kis tus kab mob thiab kub taub hau, thaum txhaj tshuaj tsis dhau, qhov tsuas tshuaj tsis yog, thiab yog tias kev noj haus tsis ua raws.

Qee lub sij hawm ua txhaum ntawm nco qab tshwm sim. Nyob rau hauv qhov teeb meem nyuaj, ib qho tab tom zoo thiab xeev tsis xeev tau nce qib.

Thaum pib ntawm kev kho, kev hloov pauv tsis ua haujlwm nyob rau hauv kev ua haujlwm pom tau. Ib qho kev nce ntxiv ntawm lub titer ntawm anti-insulin lub cev tseem tseem sau tseg nrog kev nruam ntej ntawm glycemia thiab cov tshuaj tiv thaiv kab mob ntawm cov xwm txheej hla nrog tib neeg insulin.

Feem ntau qhov chaw txhaj tshuaj swells thiab khaus. Hauv qhov no, subcutaneous fatty cov ntaub so ntswg hypertrophies lossis atrophies. Thiab nyob rau theem pib ntawm txoj kev kho, kev ua yuam kev tsis txaus ntseeg ib ntus thiab mob edema yuav tshwm sim.

Yog tias muaj kev noj tshuaj ntau dhau ntawm cov tshuaj hormones, cov ntshav qab zib cov ntshav yuav poob qis. Qhov no ua rau cov ntshav qog ua kom qis, thiab qee zaum tus neeg mob poob rau hauv lub xeev tsis xeev.

Yog tias cov koob tshuaj tau nce siab dua me ntsis, koj yuav tsum noj cov zaub mov uas muaj cov carb ntau (chocolate, qhob cij dawb, ib yob, khaub noom) lossis haus dej qab zib. Thaum tsaus muag, qhov dextrose tov (40%) lossis glucagon (s / c, v / m) tau muab rau tus neeg mob hauv / hauv.

Thaum tus neeg mob rov qab nco qab, nws yog qhov tsim nyog los pub nws cov zaub mov nplua nuj hauv kev ua si carbohydrates.

Qhov no yuav tiv thaiv hypoglycemic rov mob dua thiab glycemic coma.

Kev ncua kev kawm rau sc tswj hwm tsis yog siv nrog kev daws teeb meem ntawm lwm cov tshuaj. Ib tug co-thawj coj nrog sulfonamides, ACE / Mao / carbonic anhydrase, narcotics yuav muab, ethanol inhibitors, anabolic steroids, chloroquine, androgens, quinine, bromocriptine, pirodoksin, tetracyclines, lithium npaj, clofibrate, fenfluramine, Ketonozolom, Tsiklofosvamidom, theophylline, mebendazole tej hypoglycemic nyhuv.

Lub cev tsis muaj zog ntawm hypoglycemic ua rau:

1. H1 histamine receptor blockers,
2. Glucagon
3. Somatropin
4. Epinephrine
5. GKS,
6. Phenytoin
7. tshuaj tiv thaiv qhov ncauj
8. Epinephrine
9. Estrogens
10. calcium antagonists.

Ntxiv rau, qhov kev txo qis hauv qab zib ua rau kev sib koom tes siv Isofan insulin nrog loop thiab thiazide diuretics, Klondin, BMKK, Diazoxide, Danazol, cov thyroid hormones, tricyclic antidepressants, sympathomimetics, Heparin thiab sulfinpyrazone. Nicotine, tshuaj maj thiab morphine kuj nce rau hauv cov ntshav siab.

Pentamidine, beta-blockers, Octreotide thiab Reserpine tuaj yeem txhim kho lossis tsis muaj zog glycemia.

Kev ceeb toom rau kev siv Isofan insulin yog tias tus neeg muaj ntshav qab zib yuav tsum hloov tas mus li qhov chaw uas yuav txhaj tshuaj insulin. Tom qab tag nrho, tib txoj kev los tiv thaiv cov tsos ntawm lipodystrophy.

Tawm tsam tom qab ntawm cov tshuaj insulin, koj yuav tsum tau saib xyuas kom tsis txhob muaj cov kua nplaum ntev. Tseeb, ntxiv rau kev sib koom tes nrog lwm cov tshuaj, lwm yam tuaj yeem ua rau cov ntshav qog ntshav qab zib:

• mob ntshav qab zib thiab ntuav,
• tshuaj hloov
• ntxiv dag zog lub cev
• cov kab mob uas txo qis qhov xav tau rau lub cev (lub raum thiab lub siab ua haujlwm tsis txaus, kev ua haujlwm ntawm cov thyroid caj pas, lub caj pas pituitary, thiab lwm yam),
• nrhiav tsis tau noj,
• hloov chaw txhaj tshuaj.

Kev noj tshuaj tsis yog lossis ncua ntev ntev ntawm kev txhaj tshuaj insulin tuaj yeem pab txhawb kev txhim kho hyperglycemia, tshwj xeeb tshaj yog muaj ntshav qab zib hom 1. Yog hais tias kev kho mob tsis tuaj yeem hloov kho hauv lub sijhawm, tom qab ntawd tus neeg mob qee zaum pib txhim kho ketoacidotic tsis meej pem.

Ib qho ntxiv, kev hloov pauv yuav tsum yog tus neeg mob siab dua 65, nws muaj qhov tsis zoo ntawm lub qog, lub raum lossis mob siab. Nws kuj tseem ceeb rau kev ua haujlwm hypopituitarism thiab Addison's kab mob.

Tsis tas li ntawd, cov neeg mob yuav tsum paub tias tib neeg cov tshuaj insulin npaj txo kev haus cawv kom ua tau. Hauv cov theem pib ntawm kev kho, thaum muaj kev hloov pauv ntawm cov tshuaj, kev ntxhov siab, kev tawm dag zog lub cev, nws tsis tas yuav tsav lub tsheb thiab lwm cov txheej txheem nyuaj lossis koom rau hauv cov haujlwm txaus ntshai uas xav tau nce siab thiab ceev ntawm cov kev tawm tsam.

Cov neeg mob cev xeeb tub yuav tsum xav txog tias nyob hauv thawj peb lub hlis xav tau cov tshuaj insulin tsawg dua, thiab hauv 2 thiab 3 nws nce ntxiv. Tsis tas li, ib qho me me ntawm cov hormone yuav xav tau thaum lub sijhawm ua haujlwm.

Cov yam ntxwv ntawm kws tshuaj ntawm Isofan yuav tham txog hauv kev yees duab hauv kab lus no.

1. 
   Mob ntshav qab zib - M .: Tshuaj, 1964. - 603 p.
2. 
   Rudnitsky L.V. Cov kab mob qog. Kev kho thiab tiv thaiv, Peter - M., 2012. - 128 c.
3. 
   Kennedy Lee, Basu Ansu Kev kuaj mob thiab kho mob hauv endocrinology. Cov teeb meem daws teeb meem, GEOTAR-Media - M., 2015. - 304 p.

Cia kuv qhia kuv tus kheej. Kuv lub npe yog Elena. Kuv tau ua haujlwm li endocrinologist rau ntau dua 10 xyoo. Kuv ntseeg hais tias tam sim no kuv yog tus kws tshaj lij hauv kuv daim teb thiab kuv xav pab txhua tus neeg tuaj saib lub vev xaib kom daws qhov nyuaj thiab tsis yog li cov haujlwm. Txhua cov ntaub ntawv rau lub xaib tau sau thiab ua tib zoo ua kom tiav thiaj li xa ntau li ntau tau cov ntaub ntawv tsim nyog. Ua ntej thov cov ntaub ntawv uas tau piav qhia hauv lub vev xaib, yuav tsum tau sab laj nrog tus kws kho mob tshwj xeeb.

Cov lus qhia rau kev siv

Cov lus qhia rau kev siv qhia tseem ceeb ntawm hom kabmob uas siv tshuaj tua kab mob ntshav yog siv - insulin-tiv thaiv ntshav qab zib mellitus. Kev kho mob nyob rau hauv cov teeb meem no yog nqa tawm thoob plaws lub neej. Hauv qhov no, nws yog ib qho tseem ceeb kom ua raws li kev txhaj tshuaj qauv. Ntxiv rau, Isofan yog siv rau hom 1 thiab ntshav qab zib hom 2.

Tus kws kho mob tuaj yeem sau ntawv rau cov tshuaj yog tias tsis muaj qhov cuam tshuam los ntawm cov tshuaj uas muaj suab thaj txo qis. Tom qab ntawd cov tshuaj insulin yog tshuaj kho ua ke.

Qhov kev nce ntxiv ntawm cov ntshav qab zib kuj tseem tuaj yeem ua rau muaj kev mob tshwm sim, piv txwv, tom qab phais mob. Hauv qhov no, cov tshuaj insulin kuj tseem raug sau cia ua ib qho kev kho mob nyuaj. Nws yog tshuaj rau cov poj niam cev xeeb tub uas muaj ntshav qab zib.

Isofan tsuas yog siv rau hom 1 thiab ntshav qab zib hom 2!

Cov tshuaj yog contraindicated rau hauv cov neeg mob nws nquag muaj kev fab tshuaj thiab muaj ntshav qab zib tsawg.

Cov nyhuv txiav ua tiav

Cov kev phiv loj los ntawm kev noj Isofan yog:

1. Cov kev tsis zoo tshwm sim ntawm cov metabolism carbohydrate. Qhov no qhia hauv daim pallor ntawm daim tawv nqaij, hws ua rau lub ntsej muag, lub plawv dhia ceev ceev, lub ntsej muag ntawm kev tshee, ib tus neeg xav noj tas li, muaj kev ntxhov siab ntxhov siab, nquag mob taub hau.
2. Kev ua xua qhia los ntawm daim tawv nqaij ua pob, Quincke's edema. Tsawg tsawg zaus, cov tshuaj ua rau anaphylactic kev poob siab.
3. Kev o tuaj yeem tshwm sim.
4. Tom qab txhaj tshuaj, khaus lossis o, ua pob tuaj. Yog tias kev kho mob ntev ntev, lipodystrophy yog tsim.

Hauv qhov no, thaum pib ntawm kev kho mob, kev kho tshuaj insulin tuaj yeem nqa tawm tsuas yog tom qab kev teem caij ntawm tus kws kho mob thiab nyob hauv kev saib xyuas nws.

Kev noj tshuaj ntau dhau

Nyob rau hauv cov ntaub ntawv ntawm kev qhia txog kev nce ntawm cov tshuaj, tus neeg mob yuav muaj cov cim qhia ntawm hypoglycemia. Hauv qhov no, koj yuav tsum noj ib qho piam thaj lossis cov zaub mov muaj txiaj ntsig nrog cov khoom noj (carbohydrates). Nws tuaj yeem yog cov ncuav qab zib, kua txiv hmab txiv ntoo, khoom qab zib.

Qhia ntau dhau heev ntawm Isofan tuaj yeem ua rau tsis nco qab. Nws raug nquahu kom koj txhaj tshuaj rau ntawm cov tshuaj 40% dextrose. Glucagon tuaj yeem muab tshuaj intramuscularly, leeg pob zeb lossis subcutaneously.

Hla kev sib tshuam

Cov lus qhia rau kev siv yeeb tshuaj piav qhia txhua yam ntawm tus yam ntxwv ntawm cov tshuaj thiab nuances ntawm nws txoj kev siv.

Isofan human genetic engineering haj yam muaj zog yog tias siv cov tshuaj hauv qab no tib lub sijhawm:

• Kev siv tshuaj hypoglycemic qhov ncauj.
• MAO thiab ACE inhibitors, carbonic anhydrase.
• Sulfonamides.
• Anabolics.
• Tetracyclines.
• Cov tshuaj muaj tshuaj ethanol.

Kev ua haujlwm ntawm Isofan txo qis nrog kev siv: tshuaj tiv thaiv qhov ncauj, tshuaj glucocorticoid, cov thyroid hormones, tshuaj tiv thaiv kab mob, morphine. Yog tias nws tsis tuaj yeem thim cov tshuaj uas cuam tshuam rau kev ua haujlwm ntawm insulin, nws yog qhov yuav tsum ceeb toom rau tus kws kho mob uas tuaj koom txog qhov no.

Cov tshuaj zoo sib xws

Cov neeg mob ntshav qab zib txaus siab xav txog cov lus nug uas txhais tau li cas tuaj yeem hloov kho insulin. Nws raug nquahu kom siv cov analogues li ntawm Isofan rau kev kho mob: Humulin (NPH), Protafan-NM, Protafan-NM Penfill, Insumal, Actrafan.

Ua ntej hloov Isofan mus rau ib qho piv txwv, nws yog ib qhov tsim nyog yuav tsum sab laj nrog koj tus kws kho mob. Kev kho tshuaj Insulin yog ib qho kev kho mob hnyav. Nws yuav tsum muaj kev qhuab qhia ntawm ib feem ntawm tus neeg mob thiab kev soj ntsuam los ntawm tus kws kho mob.