Cov tshuaj insulin glargine

Cov tshuaj insulin glargine yog ib qho piv txwv ntawm tib neeg cov tshuaj insulin, uas tau los ntawm kev rov ua kom zoo ntawm DNA ntawm cov kab mob ntawm cov hom Escherichia coli (lim ntshav K12). Cov tshuaj insulin glargine, khi rau cov kab mob insulin tshwj xeeb (qhov khi khi zoo ib yam li cov tib neeg ntawm insulin), kho cov kev siv roj ntsha uas zoo ib yam li insulin endogenous. Cov tshuaj insulin glargine tswj cov metabolism hauv qabzib. Cov tshuaj txo cov concentration ntawm cov piam thaj hauv cov ntshav los ntawm kev txhawb nws txoj kev noj los ntawm lub cev nqaij daim tawv (tshwj xeeb tshaj yog cov ntaub so ntswg adipose thiab cov leeg pob txha) thiab inhibiting gluconeogenesis (txheej txheem ntawm kev tsim cov piam thaj hauv lub siab). Cov tshuaj Insulin txhim kho cov protein synthesis, inhibits proteolysis thiab lipolysis hauv adipocytes. Thaum txhaj rau cov roj ntsha subcutaneous, cov kua roj acid ntawm insulin glargine yog neutralized thiab microprecipitates raug tsim, los ntawm lawv muaj qhov tso tawm tas li ntawm cov tshuaj me me, qhov no ua kom ntev dua ntawm kev ua thiab qhov kwv yees tau yooj yim ntawm qhov kev txiav txim siab-lub sijhawm nkhaus. Tom qab li 1 teev, qhov kev txiav txim tsim nrog subcutaneous thawj coj ntawm cov tshuaj. Qhov nruab nrab ntawm kev nqis tes yog 1 hnub, qhov siab tshaj yog 29 teev. Tom qab 2 txog 4 hnub tom qab txhaj koob tshuaj thawj zaug hauv cov ntshav, lub siab xav tau nruab nrab yog ua tiav. Piv nrog tshuaj insulin-isophan, insulin glargine muaj kev nqus qis dua thiab ntev dua, thiab insulin glargine tsis muaj kev kub siab tshaj. Hauv ib tus neeg nyob hauv cov roj ntsha subcutaneous, insulin glargine los ntawm carboxyl kawg ntawm cov saw B yog qee qhov tawg thiab cov metabolites tau tsim: 21A-Gly-insulin (M1) thiab 21A-Gly-des-30B-Thr-insulin (M2). Cov tshuaj insulin glargine tsis hloov thiab nws cov khoom ua kom tsis muaj qhov ntsej muag yog nyob rau hauv cov ntshav ntshav. Mutagenicity ntawm insulin glargine nyob rau hauv kev ntsuam xyuas rau chromosome aberration (hauv vivo hauv Suav hamster, cytogenetic nyob rau hauv vitro ntawm V79 hlwb), hauv kev sim ntau (kuaj nrog hypoxanthine-guanine phosphoribosyltransferase ntawm cov hlwb mammalian, Ames kuaj), tsis raug kuaj. Lub carcinogenicity ntawm insulin glargine tau kawm txog nas thiab nas, uas tau txais ntau npaum li 0.455 mg / kg (kwv yees li 10 thiab 5 npaug ntawm koob tshuaj rau tib neeg thaum muab tshuaj subcutaneously) rau ob xyoos. Cov txiaj ntsig ntawm kev tshawb fawb tsis tso cai rau peb kos cov lus xaus zaum kawg hais txog poj niam nas vim muaj kev tuag hauv txhua pawg, tsis hais koob tshuaj. Keebkwm tshuaj tivthaiv tau raug tshawb pom ntawm cov chaw txhaj tshuaj hauv txiv neej cov nas (tsis yog cov ntaub ntawv tseem ceeb) hauv cov txiv neej nas (cov lus sau) thiab thaum siv cov kua qaub. Cov qog zoo li tsis raug kuaj pom nyob hauv cov poj niam tsiaj thaum insulin tau yaj rau hauv lwm cov kev daws teeb meem lossis thaum tswj ntsev tau siv. Rau tib neeg, qhov tseem ceeb ntawm cov kev soj ntsuam no tsis tau paub. Hauv kev tshawb nrhiav txog kev muaj menyuam, hauv kev tshawb fawb tom qab thiab kev yug menyuam hauv cov poj niam thiab txiv neej nas nrog kev coj noj coj ua ntawm cov tshuaj nyob rau hauv cov koob tshuaj uas muaj kwv yees li 7 lub sijhawm pom zoo pib rau kev noj tshuaj subcutaneous hauv tib neeg, niam lub cev muaj tshuaj lom tau qhia, uas tshwm sim los ntawm koob tshuaj hypoglycemia, suav nrog ob peb tuag.

Mob ntshav qab zib mellitus, uas yuav tsum muaj kev kho mob insulin, hauv cov neeg mob laus dua 6 xyoo.

Kev Sib Sau thiab daim ntawv ntawm tso tawm

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Txoj kev siv cov tshuaj insulin glargine thiab koob tshuaj

Cov tshuaj insulin glargine yog txhaj rau cov roj ntsha hauv qab ntawm lub xub pwg, plab lossis ncej puab, 1 zaug hauv ib hnub, ib txwm tib lub sijhawm. Nrog rau txhua qhov kev tswj hwm tshiab, cov chaw txhaj tshuaj yuav tsum tau hloov chaw nyob rau thaj chaw pom zoo. Lub sijhawm ntawm hnub thiab koob rau kev tswj hwm tau teeb tsa ib tus zuj zus. Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, cov tshuaj yuav siv tau ob qho tib si hauv kev kho mob monotherapy, thiab ua ke nrog lwm cov tshuaj hypoglycemic.
Kev tswj hwm ntawm cov tshuaj ib txwm muaj, uas tau npaj rau kev tswj hwm hauv subcutaneous, tuaj yeem ua rau mob ntshav qab zib tsis txaus. Kev siv tshuaj insulin glargine yuav tsum tsis txhob siv tshuaj ntxiv, txij li lub sijhawm ua haujlwm yog vim nws cov lus qhia nkag mus rau cov nqaij rog subcutaneous.
Thaum hloov cov tshuaj nruab nrab lossis ntev ntev ntawm cov tshuaj insulin uas muaj kev tiv thaiv kab mob glargine, koj yuav tsum tau hloov cov tshuaj txhua hnub ntawm cov kab mob basal insulin thiab cov tshuaj tiv thaiv kab mob tiv thaiv kab mob (kev tswj hwm kev noj tshuaj thiab koob tshuaj ntxiv uas siv cov insulins luv luv lossis koob tshuaj hypoglycemic rau kev tswj hwm qhov ncauj). Thaum hloov cov neeg mob los ntawm kev tswj hwm ntawm insulin-isofan 2 zaug hauv ib hnub rau kev tswj hwm ntawm insulin glargine 1 zaug hauv ib hnub, txhawm rau txo qis kev tsaus ntuj thiab sawv ntxov hypoglycemia, nws yog qhov yuav tsum tau txo qis thawj zaug ntawm basal insulin los ntawm 20-30% hauv thawj lub lis piam ntawm kev kho. Cov koob tshuaj ntawm cov yeeb yam luv luv yuav ua tau nce ntxiv thaum lub sijhawm txo qis dua, tom qab ntawd cov koob tshuaj yuav tsum tau kho raws li tus kheej. Thaum hloov mus rau insulin glargine thiab hauv thawj lub lis piam tom qab nws, nws yog ib qho tsim nyog yuav tsum ua tib zoo saib xyuas qib ntawm cov piam thaj hauv cov ntshav.
Nrog txhim kho kev paub txog kev tswj kev zom zaub mov thiab ua kom cov tshuaj insulin pab tau ntau ntxiv, yuav tsum tau txhaj tshuaj ntxiv rau. Kev hloov kho koob tshuaj kuj tseem xav tau, piv txwv li, thaum hloov pauv tus neeg mob lub neej, lub cev qhov hnyav, lub sijhawm ntawm hnub ntawm kev tswj hwm tshuaj, thiab lwm yam xwm txheej uas ua rau muaj kev pheej hmoo ntawm mob ntshav qab zib - lossis ntshav qab zib tsawg.
Cov tshuaj insulin glargine tsis yog cov tshuaj ntawm kev xaiv rau kev kho mob ketoacidosis (nyob rau hauv qhov no, kev tswj hwm ntawm cov tshuaj insulin luv luv tau pom zoo).
Cov kev paub ntawm kev siv cov tshuaj muaj tsawg, yog li tsis muaj txoj hauv kev los ntsuas nws txoj kev nyab xeeb thiab kev ua haujlwm hauv kev kho mob ntawm cov neeg mob uas muaj lub raum lossis lub siab tsis zoo. Hauv cov neeg mob uas lub raum khiav tsis zoo, qhov xav tau cov tshuaj insulin yuav txo qis vim qhov ua kom tsis muaj zog ntawm nws cov txheej txheem ua haujlwm. Hauv cov neeg laus neeg laus, kev ploj zuj zus hauv lub raum ua haujlwm tuaj yeem ua rau cov tshuaj insulin tsis tu ncua. Hauv cov neeg mob uas muaj qhov tsis zoo ntawm lub cev ua haujlwm ntawm lub siab, qhov xav tau rau insulin tej zaum yuav txo qis vim qhov txo qis ntawm kev muaj peev xwm biotransformation ntawm insulin thiab gluconeogenesis. Yog tias cov ntshav qabzib hauv cov ntshav tsis ua haujlwm, yog tias muaj lub peev xwm dhau los ua tus mob hyper- lossis hypoglycemia, ua ntej kho cov tshuaj ntawm cov tshuaj, nws yog qhov yuav tsum tau soj ntsuam cov txheej txheem ntawm kev txhaj tshuaj subcutaneous kom raug, qhov tseeb ntawm kev ua raws li cov txheej txheem kho mob thiab cov chaw tswj hwm tshuaj, suav txog txhua yam cuam tshuam rau cov teeb meem.
Qhov kev txiav txim siab profile ntawm kev siv tshuaj insulin muaj cov txiaj ntsig rau lub sijhawm ntawm kev txhim kho ntshav qab zib, yog li nws tuaj yeem hloov pauv nrog kev hloov pauv ntawm kev kho mob. Vim tias qhov nce ntxiv hauv lub sijhawm nws yuav siv rau kev tswj hwm ntawm cov insulin ntev thaum siv Lantus, qhov kev pheej hmoo ntawm kev muaj ntshav qab zib tsawg tsawg thaum hmo ntuj txo qis, thaum sawv ntxov qhov kev pheej hmoo yuav nce ntxiv. Cov neeg mob hauv leej twg hypoglycemia yog qhov tseem ceeb tshwj xeeb (mob hnyav ntawm cov hlab ntsha ntawm cov hlab ntshav ntawm lub paj hlwb lossis hlab ntsha txhaws, kev loj hlob ntawm lub siab) xav kom muaj kev tiv thaiv kev nyab xeeb tshwj xeeb, thiab nws raug pom zoo los txhawb kev tswj ntshav ntxiv hauv cov ntshav. Cov neeg mob yuav tsum paub txog cov xwm txheej uas cov neeg mob ntshav qab zib ua tsawg dua, hloov lossis tsis tuaj, nrog rau cov neeg mob uas tau txhim kho kev tswj ntshav qabzib, cov neeg laus, cov neeg mob uas tus mob ntshav qab zib tsawg zuj zus, cov neeg mob uas muaj ntshav qab zib mellitus ntau, cov neeg mob neuropathy, cov neeg mob uas muaj kev puas hlwb, cov neeg mob uas tau txais kev kho nrog concomitant nrog lwm cov tshuaj. Cov xwm txheej no tuaj yeem ua rau mob ntshav qab zib tsawg (nrog rau tsis nco qab zoo) txawm tias ua ntej tus neeg mob paub tseeb tias nws muaj kev mob ntshav qab zib tsawg.
Nws yog ib qho tsim nyog yuav tsum tau coj mus rau hauv qhov muaj peev xwm ntawm qhov tsis paub txog kev rov muaj dua ntawm cov ntshav qog ntshav qis (tshwj xeeb tshaj yog thaum tsaus ntuj) thaum kuaj pom qhov txo qis lossis ib txwm glycosylated hemoglobin.
Kev ua raws nrog cov neeg mob kev noj haus, kev noj haus, kev noj tshuaj, kev noj tshuaj kom zoo, kev tswj hwm ntawm cov tsos mob hypoglycemia ua rau txo qis kev pheej hmoo ntawm hypoglycemia. Qhov tseeb uas ua rau kom qhov mob ntshav siab tsis txaus yuav tsum tau ua tib zoo saib xyuas, vim tias lawv tuaj yeem ua rau qhov xav tau ntawm kev hloov tshuaj. Cov xwm txheej no suav nrog: kev nce hauv insulin rhiab heev (thaum tshem tawm cov teeb meem kev ntxhov siab), kev hloov pauv ntawm qhov chaw ntawm insulin tswj hwm, txawv txav, ua kom lub cev ntev lossis nce lub cev, ua txhaum kev noj haus thiab kev noj haus, cuam tshuam cov kab mob uas nrog raws plab, ntuav, hla zaub mov, tsis pom tseeb endocrine kev cuam tshuam (tsis txaus ntawm adrenal cortex lossis adenohypophysis, hypothyroidism), haus cawv ntau, tsis txaus siab siv qee yam tshuaj ntxiv.
Yuav tsum muaj kev tswj xyuas ntau ntxiv ntawm cov concentration ntawm cov piam thaj hauv cov ntshav yuav tsum muaj rau cov kab mob ua ke. Hauv ntau qhov xwm txheej zoo li no, urinalysis rau qhov muaj cov ketone lub cev thiab ib qho kev kho tas li ntawm cov tshuaj ntau dua kev noj tshuaj yog tsim nyog. Feem ntau yuav xav tau cov tshuaj insulin. Cov neeg mob ntshav qab zib hom 1 yuav tsum tau txuas ntxiv kev noj haus tsawg kawg ntawm cov khoom noj carbohydrates, txawm tias qhov tseeb tias lawv tsis tuaj yeem noj txhua yam lossis tuaj yeem noj zaub mov hauv qhov ntau me me (nrog ntuav thiab zoo li no). Cov neeg mob zoo li no yuav tsum tsis txhob txwv cov tshuaj insulin.

Cev xeeb tub thiab lactation

Teratogenicity thiab kev tshawb fawb luam tau ua nyob rau hauv Himalayan luav thiab nas nrog subcutaneous insulin (tib neeg insulin thiab insulin glargine). Cov luav tau txhaj nrog cov tshuaj insulin thaum lub sijhawm organogenesis ntawm kev txhaj tshuaj ntawm 0.072 mg / kg hauv ib hnub (kwv yees li 2 lub sijhawm tau xav kom pib txhaj rau cov tib neeg nrog kev tswj hwm subcutaneous). Cov poj niam nas tau raug txhaj tshuaj nrog insulin ua ntej thiab ua ntej sib deev, thaum cev xeeb tub ntawm koob tshuaj ntau npaum li 0.36 mg / kg ib hnub (kwv yees li 7 zaus qhov xav kom pib noj rau cov tib neeg nrog subcutaneous tswj hwm). Feem ntau, qhov cuam tshuam los ntawm kev ua haujlwm ntawm insulin thiab insulin glargine hauv cov tsiaj no tsis txawv. Tsis muaj qhov tsis hnov ​​qab txog kev loj hlob embryonic thaum ntxov thiab kev xeeb tub menyuam sau tseg.
Rau cov neeg mob uas muaj ntshav qab zib lossis yav dhau los nws muaj ntshav qab zib hauv lub cev muaj mob, nws yog ib qho tseem ceeb kom tau txais kev cai kom txaus mus ntxiv thaum cev xeeb tub. Nyob rau thawj peb lub hlis thaum cev xeeb tub, qhov xav tau rau insulin tuaj yeem txo qis thiab nce ntxiv thaum txiav thib ob thiab thib peb lub hlis. Qhov xav tau insulin tam sim ntawd tom qab yug me nyuam sai sai (qhov kev pheej hmoo ntawm cov ntshav qog ntshav nce siab). Yog li ntawd, nyob rau lub sijhawm no nws yog ib qho tseem ceeb uas yuav tau ua tib zoo saib xyuas qhov kev nyeem ntawm cov piam thaj hauv cov ntshav.
Thaum cev xeeb tub, nws yog ib qho tsim nyog yuav tsum siv cov tshuaj nrog ceev faj (hauv cov poj niam cev xeeb tub, nruj tswj hwm kev tshawb fawb soj ntsuam tsis tau ua).
Siv cov tshuaj nrog kev ceev faj thaum pub niam mis (nws tsis paub meej tias insulin glargine ua tawm hauv niam cov kua mis ntawm cov poj niam). Yuav tsum tau hais txog kev kho cov pluas noj tsis haum thiab tshuaj noj insulin rau cov poj niam laus.

Kev phiv los ntawm insulin glargine

Kev mob ntshav qab zib yog qhov ntau tshaj qhov tsis xav tau ntawm kev noj tshuaj insulin, nws tuaj yeem tshwm sim thaum siv cov tshuaj insulin ntau dua piv rau qhov kev xav tau. Mob ntshav qab zib tsawg heev (tshwj xeeb yog rov muaj dua) tuaj yeem ua kev puas tsuaj rau cov hlab ntshav ntawm cov hlab ntsha. Cov ntshav qog ntshav ntev thiab ntshav hnyav tuaj yeem tsim kev puas tsuaj rau cov neeg mob lub neej. Cov tsos mob ntawm adrenergic txee-kev tswj hwm (nyob rau hauv teb rau hypoglycemia, kev ua haujlwm ntawm lub cev sympathoadrenal) feem ntau tshwm sim ua ntej muaj kev cuam tshuam ntawm cov hlab ntsha tsis zoo thiab psyche thaum mob ntshav qab zib (mob huam, tsis nco qab los yog twilight nco qab): txob taus, tshaib plab, tachycardia, txias hws (lawv tau tshaj tawm nrog tseem ceeb thiab sai sai txhim kho hypoglycemia).
Ib yam li lwm yam tshuaj insulin, kev ncua sijhawm hauv zos hauv insulin nqus thiab lipodystrophy yuav pib txhim kho ntawm qhov chaw txhaj tshuaj. Thaum lub sijhawm kuaj mob nrog kev siv cov tshuaj insulin glargine hauv 1 - 2% ntawm cov neeg mob, kuaj pom lipodystrophy, thiab lipoatrophy tsis muaj qhov tsis paub txog kev xav. Kev hloov pauv tsis tu ncua ntawm cov ntsiab lus txhaj tshuaj hauv thaj chaw ntawm lub cev uas pom zoo rau kev tswj hwm ntawm cov tshuaj tuaj yeem txo qhov hnyav ntawm qhov tshwm sim no lossis tiv thaiv nws qhov tshwm sim.
Cov cim kev hloov pauv ntawm txoj cai ntawm cov piam thaj hauv cov ntshav tuaj yeem ua rau tsis pom kev ib ntus vim yog qhov hloov pauv ntawm qhov ntsuas qhov zoo ntawm lub teeb ntawm lub qhov muag thiab cov nqaij mos. Lub sij hawm ntev li niaj zaus ntawm cov ntshav qabzib concentration txo txoj kev pheej hmoo ntawm kev muaj mob ntawm cov ntshav qab zib retinopathy. Kev siv cov insulin, uas nrog los ntawm cov kev hloov pauv siab hauv cov ntshav qabzib hauv lub ntsej muag, tuaj yeem ua rau muaj kev cuam tshuam ib ntus thaum muaj mob ntshav qab zib. Hauv cov neeg mob uas muaj kev tu ncua sai, tshwj xeeb tshaj yog cov uas tsis tau txais kev kho photocoagulation, mob ntshav qab zib tsawg tuaj yeem ua rau tsis pom kev hauv lub cev.
Thaum kuaj mob nrog kev siv cov tshuaj insulin glargine hauv 3 txog 4% ntawm cov neeg mob, cov tshuaj tiv thaiv tau pom ntawm qhov chaw txhaj tshuaj (liab, khaus, mob, urticaria, mob, edema). Ntau yam kev tshwm sim me me feem ntau daws nyob hauv ob peb hnub - ntau lub lis piam. Tsis tshua muaj qhov tsis txaus, insulin (suav nrog insulin glargine) lossis excipients tsim cov kev ua xua sai sai (kev tsis haum ntawm daim tawv nqaij, bronchospasm, angioedema, hlab ntsha hypotension lossis poob siab), uas ua rau muaj kev hem thawj rau tus neeg mob lub neej.
Kev siv cov insulin tuaj yeem ua rau tsim cov tshuaj tiv thaiv rau nws. Thaum lub sijhawm kuaj mob hauv cov pab pawg ntawm cov neeg mob uas tau txais insulin glargine thiab insulin-isophan txoj kev kho, kev tsim cov tshuaj tiv thaiv uas cuam tshuam nrog tib neeg cov insulin raug pom nrog tib zaus. Qee zaum, thaum muaj cov tshuaj tiv thaiv rau cov tshuaj insulin, kev kho tshuaj ntau dua yog tsim nyog los tshem tawm cov nyiam ua mob hyper- lossis hypoglycemia. Qee qhov xwm txheej, insulin tuaj yeem ua rau ncua sij hawm dhau los ntawm kev tshem tawm sodium thiab o, tshwj xeeb tshaj yog tias siv tshuaj insulin ua rau muaj kev tswj hwm zoo dua ntawm cov txheej txheem metabolic, uas yav dhau los tsis muaj txiaj ntsig.

Kev cuam tshuam ntawm insulin glargine nrog lwm yam tshuaj

Cov tshuaj insulin glargine yog tshuaj tsis haum nrog kev daws teeb meem ntawm lwm yam tshuaj. Cov tshuaj insulin glargine yuav tsum tsis txhob xyaw nrog lwm cov insulins lossis diluted (kev zom lossis sib xyaw tuaj yeem hloov cov ntaub ntawv ntawm insulin glargine dhau sijhawm, nrog rau kev sib xyaw nrog lwm cov insulins tuaj yeem ua rau dej nag).Qee cov tshuaj ua rau cov metabolism hauv qabzib; qhov no yuav xav tau hloov pauv ntawm cov tshuaj insulin glargine. Kev npaj uas txhim kho cov nyhuv hypoglycemic ntawm insulin thiab nce qhov kev xav ua rau kev txhim kho hypoglycemia suav nrog angiotensin hloov enzyme inhibitors, qhov ncauj hypoglycemic, fibrates, disopyramide, fluoxetine, pentoxifylline, monoamine oxidase inhibitors, propoxyphene, sulfanilamide tshuaj. Txhais tau hais tias qhov tsis muaj zog tiv thaiv hypoglycemic ntawm insulin muaj xws li danazol, glucocorticoids, diazoxide, glucagon, diuretics, isoniazid, gestagens, estrogens, somatotropin, thyroid hormones, sympathomimetics (salbutamol, epinephrine, terbutaline), phenolazinase inhibitors, protease inhibitors. Clonidine, beta-blockers, cawv, lithium ntsev tuaj yeem ua rau ob leeg tsis muaj zog thiab txhim kho cov nyhuv hypoglycemic ntawm insulin. Pentamidine tuaj yeem ua rau hypoglycemia, qee zaum tom qab los ntawm hyperglycemia. Hauv qab ntawm cov tshuaj uas muaj kev cuam tshuam sympatholytic (clonidine, beta-blockers, reserpine, guanfacine), cov cim ntawm adrenergic counter-regulation tuaj yeem tsis tuaj lossis txo qis.

Noj ntau dhau

Nrog kev siv tshuaj ntau dhau ntawm insulin, glargine muaj kev pheej hmoo loj thiab qee zaum ua rau lub qog ntshav nce siab, uas tsim kev hem rau tus neeg mob lub neej. Kev kho mob: mob ntshav qog ntshav siab feem ntau yog kev maj mam los ntawm kev noj zaub mov zom zaub mov yooj yim, nws yuav tsum hloov cov tshuaj ntawm lub cev, kev tawm dag zog, kev noj zaub mov rau lub cev, mob ntshav qab zib tsawg, uas yog los ntawm kev tsis nco qab, mob hlwb, ua kom mob, yuav tsum tau hloov tshuaj lossis dej cawv ntau ntau ntawm glucagon, kev tswj hwm ntawm lub cev kev daws teeb meem. Lub sijhawm ntev kom tau cov carbohydrate ntau thiab kev saib xyuas kev noj qab haus huv yuav tsum muaj, txij li tom qab pom kev soj ntsuam Ib qho kev rov qab los ntawm hypoglycemia yog ua tau.

Kev siv cov tshuaj insulin glargine

Cov koob tshuaj tau teeb tsa ib tus zuj zus. Lawv siv s / c ib zaug ib hnub, ib txwm tib lub sijhawm. Cov tshuaj insulin glargine yuav tsum tau txhaj rau cov roj ntsha hauv plab, xub pwg lossis sab ncej puab. Qhov chaw txhaj tshuaj yuav tsum tau hloov mus rau txhua txoj kev tswj hwm tshiab ntawm cov tshuaj. Ntawm mob ntshav qab zib insulin-hom mob ntshav qab zib hom (hom I) cov tshuaj yog siv los ua cov tshuaj insulin tseem ceeb. Ntawm cov mob ntshav qab zib uas tsis yog insulin-hom mob ntshav qab zib (hom II) cov tshuaj yuav siv tau ob qho tib si li monotherapy, thiab hauv kev sib xyaw nrog lwm cov tshuaj hypoglycemic. Thaum hloov mus rau tus neeg mob los ntawm insulin nrog ntev lossis nruab nrab ntawm kev txiav txim ntawm insulin glargine, nws yuav tsum tau kho qhov tshuaj txhua hnub ntawm cov tshuaj insulin tseem ceeb lossis hloov cov tshuaj tiv thaiv kab mob tiv thaiv kab mob (koob tshuaj thiab kev tswj hwm ntawm cov tshuaj insulins luv luv lossis lawv cov tshuaj noj, nrog rau cov tshuaj noj tshuaj tiv thaiv kab mob). kev tswj hwm ntawm insulin-isofan rau ib qho kev txhaj tshuaj ntawm insulin glargine yuav tsum txo qis cov tshuaj txhua hnub ntawm basal insulin los ntawm 20-30% hauv thawj lub lis piam ntawm kev kho mob cov dej haus nyob rau hauv kev txiav txim yuav txo tau kev pheej hmoo ntawm hypoglycemia nyob rau hauv lub hmo ntuj thiab thaum sawv ntxov thaum sawv ntxov. Nyob rau lub sijhawm no, qhov kev txo qis ntawm cov tshuaj insulin glargine yuav tsum tau them nyiaj rau los ntawm kev nce ntxiv ntawm cov koob tshuaj tiv thaiv luv luv ntawm insulin.

Cov Tshuaj Hauv Tshuaj

Kev sib txuas lus nrog insulin receptors: cov lus sib khi rau cov insulin glargine thiab tib neeg cov insulin receptors yog qhov sib ze heev, thiab nws muaj peev xwm los tawm kev lom neeg uas zoo ib yam li insulin endogenous.

Qhov kev txiav txim siab tseem ceeb tshaj plaws ntawm insulin, thiab vim li no insulin glargine, yog kev cai ntawm cov metabolism hauv cov piam thaj. Cov tshuaj Insulin thiab nws cov tshuaj noj kuj txo cov ntshav qabzib los ntawm kev ua kom cov piam thaj los ntawm qhov nqaij (tshwj xeeb cov leeg pob txha thiab cov nqaij mos), nrog rau qhov ua kom cov ntshav qabzib nyob hauv lub siab (gluconeogenesis). Cov tshuaj insulin inhibits adipocyte lipolysis thiab proteolysis, thaum ua kom cov protein synthesis zoo.

Lub sijhawm ntev ntawm kev ua ntawm insulin glargine yog ncaj qha ntsig txog qhov txo tus nqi ntawm nws nqus, uas tso cai rau cov tshuaj no siv ib hnub ib zaug. Tom qab kev tswj hwm sc, qhov pib ntawm kev tshwm sim tshwm sim, nyob rau nruab nrab, tom qab 1 teev Lub sijhawm nruab nrab ntawm kev ua yog 24 teev, qhov siab tshaj yog 29 teev.

Cov Tshuaj Pharmacokinetics

Kev sib piv kev kawm txog cov ntsiab lus ntawm cov tshuaj insulin glargine thiab insulin-isofan nyob rau hauv cov ntshav ntshav hauv cov neeg muaj mob thiab cov neeg mob ntshav qab zib mellitus tom qab sc tswj kev siv tshuaj tau qhia qeeb dua thiab ntev dua qhov kev nqus, nrog rau qhov tsis muaj lub siab tshaj plaws hauv insulin glargine piv rau insulin-isofan Cov.

Nrog tib lub luag haujlwm SC ntawm Lantus ib zaug ib hnub, ib qho kev txiav txim siab nruab nrab ntawm cov tshuaj insulin glargine hauv cov ntshav tau mus txog 2-4 hnub tom qab txhaj thawj zaug.

Nrog kev tswj hwm iv, ib nrab-lub neej ntawm insulin glargine thiab insulin tib neeg tau sib piv.

Hauv ib tus neeg nyob rau hauv cov roj ntsha subcutaneous, insulin glargine yog ib feem los ntawm carboxyl kawg (C-terminus) ntawm B saw (Beta saw) los ua 21 A -Gly-insulin thiab 21 A -Gly-des-30 B -Thr-insulin. Hauv ntshav, ob qho tib si tsis hloov pauv ntawm insulin glargine thiab nws cov khoom kom txav tau yooj yim.

Tsuas tshuaj thiab tswj hwm

S / c hauv cov roj subcutaneous ntawm lub plab, xub pwg lossis ncej puab, ib txwm tib lub sijhawm 1 zaug hauv ib hnub. Qhov chaw txhaj tshuaj yuav tsum tau hloov pauv nrog txhua qhov kev txhaj tshuaj tshiab hauv thaj chaw pom zoo rau kev tswj hwm sc ntawm cov tshuaj.

Hauv / hauv kev qhia ntawm cov koob tshuaj ib txwm, npaj rau sc tswj hwm, tuaj yeem ua rau kev txhim kho ntshav nce siab ntau dhau.

Cov koob tshuaj ntawm Lantus thiab lub sijhawm ntawm hnub rau nws cov kev taw qhia tau xaiv ib tus zuj zus. Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, Lantus tuaj yeem siv ob qho tib si li monotherapy thiab hauv kev sib xyaw nrog lwm cov tshuaj hypoglycemic.

Hloov los ntawm kev kho mob nrog lwm cov tshuaj hypoglycemic mus rau Lantus. Thaum hloov cov tshuaj nruab nrab lossis ntev ntev rau kev kho cov tshuaj insulin nrog cov tshuaj tua kab mob Lantus, nws yuav tsum tau kho cov tshuaj txhua hnub ntawm cov tshuaj insal basal, zoo li nws yuav tsim nyog hloov cov tshuaj tiv thaiv kab mob siab (noj tshuaj thiab kev tswj hwm ntawm ntxiv siv cov tshuaj insulins luv luv lossis lawv cov tshuaj sib ntxiv lossis cov tshuaj ntawm qhov ncauj hypoglycemic) ) Thaum hloov cov neeg mob los ntawm kev tswj hwm cov tshuaj insulin-isophan ob zaug thaum nruab hnub rau ib leeg tswj hwm ntawm Lantus hauv kev txiav txim siab txhawm rau txo cov ntshav qog ntshav qab zib thaum hmo ntuj thiab thaum sawv ntxov ntxov, cov koob tshuaj pib ntawm basal insulin yuav tsum txo 20-30% hauv thawj lub lis piam ntawm kev kho mob. Thaum lub sijhawm txo cov tshuaj, koj tuaj yeem nce lub koob tshuaj luv luv ntawm cov tshuaj insulin, thiab tom qab ntawd cov tshuaj noj tshuaj yuav tsum tau kho raws li tus kheej.

Daim roj pleev kab yuav tsum tsis txhob xyaw nrog lwm cov tshuaj insulin los yog diluted. Thaum muab sib xyaw los yog zom, qhov profile ntawm nws qhov kev txiav txim siab yuav hloov zuj zus, ntxiv rau, kev sib xyaw nrog lwm cov insulins tuaj yeem ua rau nag lossis daus.

Ib yam li lwm yam tshuaj tiv thaiv kab mob rau tib neeg, cov neeg mob tau txais tshuaj ntau heev vim tias muaj cov tshuaj tiv thaiv rau tib neeg cov tshuaj insulin tuaj yeem ntsib kev txhim kho hauv cov lus teb rau insulin thaum hloov mus rau Lantus.

Nyob rau hauv txheej txheem ntawm hloov mus rau Lantus thiab hauv thawj lub lis piam tom qab nws, ua tib zoo saib xyuas ntshav qabzib yuav tsum muaj.

Nyob rau hauv cov ntaub ntawv ntawm kev hloov kho cov kev cai ntawm cov metabolism thiab qhov tshwm sim ntau ntxiv hauv rhiab rau insulin, kev txhim kho ntxiv ntawm kev noj tshuaj ntxiv yuav tsim nyog. Kev hloov kho koob tshuaj kuj tseem xav tau, piv txwv li, thaum hloov tus neeg mob lub cev qhov hnyav, kev ua neej, lub sijhawm ntawm hnub rau kev tswj hwm tshuaj, lossis thaum muaj lwm yam tshwm sim uas ua rau muaj kev cuam tshuam rau kev txhim kho hypo- lossis hyperglycemia.

Cov tshuaj yuav tsum tsis txhob siv iv. Lub sijhawm ua haujlwm ntawm Lantus yog vim nws qhov kev taw qhia nkag mus rau cov nqaij mos subcutaneous adipose.

Cov lus qhia tshwj xeeb

Lantus tsis yog cov tshuaj ntawm kev xaiv rau kev kho mob ketoacidosis. Hauv cov xwm txheej zoo li no, iv kev tswj hwm ntawm kev ua yeeb yam luv luv yog kev pom zoo. Vim tias kev ua haujlwm nrog Lantus tsawg tsawg, nws tsis tuaj yeem txheeb xyuas nws qhov ua tau zoo thiab kev nyab xeeb hauv kev kho cov neeg mob uas lub siab tsis ua haujlwm lossis cov neeg mob uas muaj mob me lossis mob raum tsis ua haujlwm. Hauv cov neeg mob uas lub raum khiav tsis zoo, qhov xav tau cov tshuaj insulin yuav txo qis vim qhov ua tsis muaj zog ntawm nws cov txheej txheem tshem tawm. Hauv cov neeg laus neeg laus, kev ploj zuj zus hauv lub raum ua haujlwm tuaj yeem ua rau cov insulin txuas ntxiv kom tsawg. Hauv cov neeg mob uas muaj kev tiv thaiv kabmob hepatic txaus, qhov kev xav tau rau insulin tuaj yeem raug txo vim muaj kev txo qis hauv kev muaj peev xwm gluconeogenesis thiab biotransformation ntawm insulin. Kev tswj hwm qhov tsis zoo ntawm cov theem ntawm cov piam thaj hauv cov ntshav, nrog rau yog tias muaj tus cwj pwm ntawm kev txhim kho hypo- lossis hyperglycemia, ua ntej taug kev nrog kev txhim kho ntawm kev noj tshuaj, nws yog qhov yuav tsum tau kuaj xyuas qhov tseeb ntawm kev ua raws li cov txheej txheem kev kho mob, qhov chaw ntawm kev tswj hwm tshuaj thiab cov txheej txheem ntawm kev tsim nyog sc txhaj tshuaj. xav txog txhua yam cuam tshuam rau cov teeb meem.

Kev ntshav siab. Lub sijhawm ntawm kev txhim kho hypoglycemia yog nyob ntawm qhov profile ntawm qhov kev ua ntawm kev siv tshuaj insulin thiab yuav, yog li ntawd, hloov nrog kev hloov pauv ntawm kev kho mob. Vim tias qhov nce ntxiv hauv lub sijhawm nws yuav siv sijhawm ntev rau insulin nkag mus rau hauv lub cev thaum siv Lantus, qhov ntxim nyiam ntawm kev txhim kho nocturnal hypoglycemia tsawg zuj zus, thaum sawv ntxov tej zaum yuav muaj ntau ntxiv. Cov neeg mob uas cov neeg mob ntshav qab zib tsawg yuav muaj tej yam tseem ceeb hauv kev kho mob, xws li cov neeg mob uas mob hlab ntsha hauv lub plawv lossis cov hlab ntsha tsis zoo (muaj kev pheej hmoo ntawm kev mob plawv thiab mob hlwb ntawm cov ntshav qog ntshav qab zib), thiab cov neeg mob uas tau txais kev pab kho hlwb, tshwj xeeb yog tias lawv tsis tau txais kev kho mob photocoagulation (muaj kev pheej hmoo transient poob ntawm lub zeem muag vim yog txo ntshav qab zib), yuav tsum tau saib xyuas tshwj xeeb, thiab nws tseem pom zoo kom mob siab saib xyuas cov ntshav qabzib. Cov neeg mob yuav tsum paub txog cov xwm txheej uas ua ntej ntawm cov qog ntshav qab zib yuav hloov, ua tus neeg hais tsis tshua pom zoo lossis tsis tuaj koom nrog qee pab pawg muaj kev pheej hmoo. Cov pab pawg no suav nrog:

- cov neeg mob uas tau txhim kho txoj cai ntawm cov ntshav piam thaj,

- cov neeg mob uas tus mob ntshav qab zib tsawg zuj zus,

- Cov neeg laus laus,

- cov neeg mob neuropathy,

- cov neeg mob mob ntshav qab zib,

- cov neeg mob ntsib mob hlwb,

- cov neeg mob tau txais kev kho mob concomitant nrog lwm cov tshuaj (saib "Kev sib cuam tshuam").

Cov xwm txheej zoo li no tuaj yeem ua rau muaj kev tiv thaiv qog ntshav qab zib (nrog rau qhov ua rau tsis nco qab) ua ntej tus neeg mob paub tseeb tias nws muaj kev mob ntshav qab zib tsawg.

Thaum muaj xwm txheej lossis qis dua glycosylated hemoglobin qib raug sau tseg, nws yog ib qho tsim nyog yuav tsum tau coj mus rau hauv tus lej muaj peev xwm tsim rov tshwm sim tsis paub lub sijhawm ntawm hypoglycemia (tshwj xeeb tshaj yog thaum tsaus ntuj).

Cov neeg mob ua raws li lub caij teem tseg, kev noj haus thiab kev noj haus, kev siv tshuaj insulin kom zoo thiab tswj kev pib ntawm cov tsos mob ntawm tus mob ntshav qab zib tsawg ua rau muaj kev txo qis hauv kev pheej hmoo ntawm lub qog ntshav qab zib. Qhov tseeb uas ua rau kom qhov mob ntshav siab tsis txaus txog qhov yuav tsum tau saib xyuas tshwj xeeb, raws li tej zaum yuav siv tshuaj kho cov tshuaj insulin. Tej yam no suav nrog:

- kev hloov chaw ntawm cov thawj coj ntawm insulin,

- kev rhiab ntxiv rau insulin (piv txwv li, thaum tshem tawm cov kev ntxhov siab),

- txawv txav, nce lossis lub sijhawm ua haujlwm lub cev ntev,

- cov kab mob sib xyaw nrog ntuav, zawv plab,

- ua txhaum kev noj haus thiab kev noj haus,

- skipped noj mov

- qee qhov tsis cuam tshuam ntawm cov tshuaj endocrine (piv txwv li hypothyroidism, tsis muaj txiaj ntsig ntawm adenohypophysis lossis adrenal cortex),

- concomitant kev kho mob nrog rau lwm yam tshuaj.

Cov kab mob sib kis. Hauv cov kab mob sib cuam tshuam, yuav tsum muaj kev saib xyuas ntshav qabzib ntau dua. Feem ntau, kev tshawb xyuas tau ua rau muaj ketone lub cev nyob hauv cov zis, thiab kev noj tshuaj insulin feem ntau xav tau. Qhov kev xav tau rau insulin feem ntau nce. Cov neeg mob ntshav qab zib hom 1 yuav tsum txuas ntxiv kev haus tsawg kawg yog ib qho me me ntawm carbohydrates, txawm tias lawv tsuas tuaj yeem haus tau me me ntawm cov zaub mov lossis tsis tuaj yeem noj tsis txhua, yog tias lawv ntuav, thiab lwm yam. Cov neeg mob no yuav tsum tsis txhob tso tseg txoj kev siv tshuaj insulin.

Kev phiv los ntawm cov tshuaj insulin glargine

Txuam nrog kev cuam tshuam ntawm cov metabolism hauv carbohydrate: kev mob ntshav qog ntshav (tachycardia, tawm hws, pallor, nqhis dej, chim siab, mob nrwm plab, tsis meej pem lossis tsis nco qab). Cov tshuaj tiv thaiv hauv zos: lipodystrophy (1-2%), yaug ntawm daim tawv nqaij, khaus, o ntawm thaj chaw txhaj tshuaj. Kev tsis haum tshuaj: urticaria, Quincke's edema, bronchospasm, arterial hypotension, poob siab. Lwm yam: kev hloov pauv tsis raug, kev hloov pauv ntawm tus mob ntshav qab zib (nrog rau cov ntshav ntawm cov ntshav qabzib), edema. Feem ntau qhov tsis tshua pom kev ntawm qhov chaw txhaj tshuaj yog daws tsis pub dhau ob peb hnub (ntau lub lis piam) txij li pib kho.

Kev sib cuam tshuam yeeb tshuaj Insulin glargine

Cov nyhuv hypoglycemic ntawm insulin yog txhim kho los ntawm MAO inhibitors, tshuaj tiv thaiv hypoglycemic qhov ncauj, ACE inhibitors, fibrates, disopyramides, fluoxetine, pentoxifylline, propoxyphene, salicylates thiab sulfanilamides Cov nyhuv hypoglycemic ntawm insulin yog txo los ntawm danazole, diazoxide, phenogcose, phenosecose. , somatotropin, sympathomimetics thiab cov thyroid hormones. Clonidine, β-adrenergic blockers, lithium ntsev thiab ethanol tuaj yeem ob leeg txhim kho thiab ua kom cov ntshav tsis txaus ntawm insulin, Pentamidine tuaj yeem ua rau mob ntshav qab zib, uas nyob rau qee kis ua rau hyperglycemia. adrenergic counterregulation tuaj yeem txo los yog qhaj.