Kev nthuav tawm insulin, basal thiab bolus: nws yog dab tsi?

Hmoov tsis zoo, tam sim no, ntshav qab zib yog yam mob txaus ntshai, feem ntau ua rau tuag taus. Txhua txhua xyoo, cov ntaub ntawv tuag muaj ntau zuj zus. Raws li cov kws tshawb fawb, txog xyoo 2030, ntshav qab zib yuav yog ib qho kev kho mob uas feem ntau siv tib neeg lub neej.

Coob leej xav tias mob ntshav qab zib yog kab lus. Txawm li cas los xij, qhov no yog deb ntawm rooj plaub. Ntawm chav kawm, koj yuav tsum radically hloov koj txoj kev ua neej thiab noj tshuaj txhua hnub. Txawm li cas los xij, ib tus tuaj yeem nyob ntev txog kaum xyoo yam tsis muaj mob.

Kab lus no tham txog yuav suav cov tshuaj insulin basal, nws yog dab tsi thiab vim li cas nws thiaj xav tau. Ua tib zoo nyeem cov ntaub ntawv muab nyob rau hauv thiaj li yuav nyob rau hauv qhov siab tshaj plaws riam phom.

Mob ntshav qab zib yog dab tsi

Cov kab mob no yog cov kab mob hormonal uas tshwm sim vim yog qib dhau los hauv cov piam thaj hauv cov ntshav. Qhov tshwm sim no ua rau muaj kev ua haujlwm tsis zoo ntawm lub txiav. Nws ib nrab los yog tag nrho ceases los tsim cov tshuaj hormones - insulin. Lub hom phiaj tseem ceeb ntawm cov khoom no yog tswj cov qib qab zib. Yog tias lub cev tsis tuaj yeem tiv thaiv cov piam thaj ntawm nws tus kheej, nws pib siv cov protein thiab cov rog rau nws lub luag haujlwm tseem ceeb. Thiab qhov no ua rau muaj kev cuam tshuam loj hauv lub cev.

Vim li cas siv insulin rau cov neeg mob ntshav qab zib

Raws li tau hais los saum toj no, nyob ntawm qhov muaj tus kab mob no, tus txiav ua kom tiav tsis tuaj yeem tsim tawm cov tshuaj insulin, lossis nws tsis muaj txiaj ntsig txaus. Txawm li cas los xij, lub cev xav tau nws rau qee yam. Yog li, yog tias koj tus kheej los ntawm lub cev tsis txaus, nws yuav tsum los ntawm sab nraud. Hauv qhov no, insulins basal ua lub keeb kwm yav dhau los rau cov haujlwm tib neeg ib txwm muaj. Yog li, txhua tus neeg mob ntshav qab zib yuav tsum tswj hwm kev txhaj tshuaj ntawm cov tshuaj no. Qhov kev xam ntawm cov kab mob basal insulin yog ib qho tseem ceeb heev rau tus neeg mob, vim nws qhov mob txhua hnub thiab kev cia siab nyob ntawm qhov no yuav yog nyob ntawm qhov no. Nws yog qhov tseem ceeb heev kom nkag siab yuav ua li cas kho kom raug tseeb txog qib theem ntawm cov tshuaj hormones no txhawm rau txhawm rau tswj cov qib hauv koj lub neej.

Tshuaj insulin ntev li cas?

Qhov hom insulin no hu ua tsis tsuas yog basal, tab sis kuj yog keeb kwm yav dhau los lossis ntev ntev. Cov tshuaj zoo li no yuav muaj qhov nruab nrab lossis ua kom ntev, nyob ntawm tus yam ntxwv ntawm txhua yam muaj sia. Nws lub hom phiaj tseem ceeb yog los them nyiaj rau insulin hauv tus neeg mob ntshav qab zib. Txij li thaum tus txiav tsis ua hauj lwm zoo nyob rau hauv cov ntshav qab zib, nws yuav tsum tau txhaj tshuaj insulin los ntawm sab nraud. Rau qhov no, cov tshuaj zoo li tau tsim.

Hais txog insulin basal

Hauv kev lag luam kws tshuaj niaj hnub, muaj ntau qhov tshuaj sib txawv uas muaj kev nyab xeeb rau tib neeg lub cev dua li yav tas los. Lawv cuam tshuam zoo rau kev noj qab haus huv ntawm tus neeg mob, thiab tib lub sijhawm ua rau muaj qhov tsawg kawg ntawm kev phiv. Tsuas yog kaum xyoo dhau los, cov kab mob hauv paus pob txha yog tsim los ntawm cov khoom xyaw ntawm cov tsiaj keeb kwm. Tam sim no lawv muaj tib neeg los yog hluavtaws lub hauv paus.

Hom kis tau ntev

Niaj hnub no, muaj ntau qhov sib txawv ntawm ntau hom insulin. Lawv xaiv nyob ntawm theem pib ntawm insulin. Piv txwv, cov tshuaj uas muaj qhov nruab nrab yuav cuam tshuam rau lub cev rau kaum ob txog rau kaum rau teev.

Kuj tseem muaj tshuaj kho mob thiab tau ntev ntev. Ib qho tshuaj ntawm cov tshuaj yog txaus rau nees nkaum plaub teev, yog li koj yuav tsum nkag mus rau cov tshuaj noj ib zaug ib hnub.

Cov kws tshawb fawb kuj tseem tau tsim txoj kev txhaj tshuaj-tso kev tiv thaiv tsis tu ncua. Nws cov nyhuv kav txog plaub caug-yim teev. Txawm li cas los xij, cov tshuaj uas yog rau koj yuav tsum tau sau tseg los ntawm koj tus kws kho mob.

Txhua qhov ua tau zoo ntawm cov tshuaj insulins muaj tus cwj pwm zoo rau lub cev, uas tsis tuaj yeem hais txog cov tshuaj uas muaj cov nyhuv luv-luv. Qhov kev txhaj tshuaj no feem ntau yog ntsuas ua ntej noj mov kom tswj tau cov piam thaj ncaj qha nrog zaub mov. Cov tshuaj yeeb yaj kiab ntev dhau los feem ntau ntawm cov khoom siv hluavtaws, thiab ntxiv rau ib qho ntxiv - cov protein protein.

Yuav ua li cas los suav

Cov yam ntxwv zoo ntawm insulin basal insulin yog los txhawb kev poob nrawm ntawm cov piam thaj, nrog rau kev ncaj qha thaum pw tsaug zog. Yog vim li ntawd lub cev thiaj li tseem ceeb heev uas coj nws mus rau lub neej tsis xws luag.

Thiab yog li, xav txog yuav ua li cas los ua cov lus teb kom raug:

• ua ntej koj yuav tsum paub qhov loj ntawm koj lub cev,
• tam sim no muab cov txiaj ntsig los ntawm tus lej 0.3 lossis 0.5 (thawj coefficient yog rau cov ntshav qab zib hom 2, zaum ob rau thawj),
• yog tias yam kabmob ntshav qab zib hom 1 tau muaj ntau dua kaum xyoo los lawm, ces yuav tsum nce qhov sib tshooj nce ntxiv rau 0.7,
• pom peb caug feem pua ​​ntawm qhov tshwm sim, thiab tawg tawm dab tsi tshwm sim, mus rau hauv ob daim ntawv thov (qhov no yuav yog thaum yav tsaus ntuj thiab thaum sawv ntxov tus thawj coj ntawm lub tshuaj).

Txawm li cas los xij, muaj cov tshuaj uas tuaj yeem siv ib hnub ib zaug lossis ib zaug txhua ob hnub. Tham nrog koj tus kws kho mob txog qhov no thiab tshawb xyuas seb koj puas tuaj yeem siv tshuaj ntev.

Cov xwm txheej kos

Yog hais tias cov kua dej zais cia kom tsis muaj zog, thiab koj tau suav qhov ntau npaum ntawm cov tshuaj uas qog nws, tom qab ntawd nws yog qhov tseem ceeb heev los txiav txim seb qhov nyiaj no puas haum rau koj. Ua li no, koj yuav tsum ua ib qho kev kuaj tshwj xeeb, uas kav ntev li peb hnub. Tsis kam noj tshais rau thawj hnub, yauv su noj rau hnub ob, thiab tsis pub koj noj hmo rau hnub peb. Yog tias koj tsis hnov ​​qhov kev dhia tshwj xeeb thaum nruab hnub, ces ntau npaum li cas tau xaiv qhov raug.

Qhov twg nkaug

Cov neeg mob ntshav qab zib yuav tsum kawm paub txhaj tshuaj lawv tus kheej, vim hais tias tus kab mob no nyob tag lub neej thiab xav tau kev pab txhua hnub. Nco ntsoov them sai sai rau qhov tseeb tias cov tshuaj muaj cov tshuaj insulin yog npaj tshwj xeeb rau kev coj ua subcutaneous. Nyob rau hauv tsis muaj qee yam ua kev txhaj tshuaj rau hauv cov leeg, thiab tseem ntau dua - rau hauv txoj leeg.

Thawj qhov koj yuav tsum tau ua ua ntej txhaj tshuaj yog xaiv qhov chaw zoo tshaj plaws rau nws. Rau lub hom phiaj no, lub plab, lub xub pwg, pob tw thiab lub duav uas zoo tshaj plaws. Nco ntsoov soj ntsuam koj cov tawv nqaij mob. Hauv qhov tsis muaj xwm txheej tsis txhob ntxig rab koob rau hauv moles, ntxiv rau hauv wen, thiab lwm yam tawv nqaij ua tsis tiav. Txav mus deb ntawm lub pij ntaws ntawm tsawg kawg tsib centimeters. Kuj muab ib qho kev txhaj tshuaj, thim tawm tsawg kawg ntawm ob peb centimeters ntawm mole.

Cov kws kho mob pom zoo kom txhaj cov tshuaj rau hauv qhov chaw tshiab txhua zaus. Yog li qhov no yuav tsis provoke mob. Txawm li cas los xij, nco ntsoov tias qhov ua tau zoo tshaj plaws yog kev qhia ntawm cov tshuaj mus rau hauv lub plab. Hauv qhov no, cov tshuaj yeeb dej caw tuaj yeem sib kis sai sai hauv lub cev.

Kev yuav txhaj li cas

Thaum koj tau txiav txim siab rau ntawm ib qho chaw, nws tseem ceeb heev uas yuav tsum tau txhaj tshuaj kom yog. Ua ntej ntxig ib rab koob nyob hauv qab ntawm daim tawv nqaij, ua tib zoo kho thaj chaw koj xaiv nrog ethanol. Tam sim no nyem rau ntawm daim tawv nqaij, thiab ntxig sai ntawm rab koob rau hauv nws. Tab sis tib lub sijhawm, Nkag mus tshuaj nws tus kheej qeeb heev. Suav rau koj tus kheej nce mus txog kaum, mam li rub tawm rab koob tawm. Ua nws kuj ceev. Yog koj pom ntshav, koj tau hno ntshav hlab ntsha. Hauv qhov no, tshem rab koob thiab ntxig rau hauv lwm thaj chaw ntawm daim tawv nqaij. Kev tswj hwm ntawm cov tshuaj dej yuav tsum tsis muaj mob. Yog tias koj hnov ​​mob, sim thawb lub koob kom tob dua me ntsis.

Txiav txim siab qhov xav tau bolus insulin

Txhua tus neeg mob ntshav qab zib yuav tsum muaj peev xwm txiav txim siab kev noj tshuaj insulin lub sij hawm luv luv. Txhawm rau ua qhov no, koj yuav tsum paub koj tus kheej nrog lub tswv yim zoo li chav tsev mov (XE). Ib qho kev ntsuas ntawd yog sib npaug ntawm kaum ob grams ntawm carbohydrates. Piv txwv li, ib qho XE muaj ib qho mov me me ntawm qhob cij, lossis ib nrab bun, lossis ib nrab ntawm kev ua zaub mov.

Txhua yam khoom muaj qee tus nqi ntawm XE. Koj yuav tsum tau laij lawv, suav txog qhov ntim ntawm koj feem, nrog rau ntau yam khoom. Ua li no, siv lub rooj tshwj xeeb thiab nplai. Txawm li cas los xij, tsis ntev koj yuav kawm paub txog kev txiav txim siab cov khoom noj uas lub qhov muag xav tau, yog li qhov xav tau teev thiab lub rooj yuav ploj mus.

Cov tshuaj uas nrov tshaj plaws

Txog rau tam sim no, tsuas yog siv tshuaj ntau dhau los ua lub hauv paus ntawm cov hluavtaws insulin, tsim los muab cov txiaj ntsig nruab nrab thiab siv ntev. Xav txog cov neeg nyiam tshaj plaws ntawm lawv:

• Cov tshuaj xws li Protafan thiab InsumanBazal tau sau tseg los ntawm cov kws kho mob rau cov neeg mob uas xav tau tshuaj ntawm nruab nrab lub sijhawm tiv thaiv. Lawv cov yeeb yam kav ntev txog li kaum txog kaum yim teev, yog li kev txhaj tshuaj yuav tsum tau txhaj ob zaug ib hnub.
• "Humulin", "Biosulin" thiab "Levemir" muaj peev xwm muaj cov nyhuv ntev dua. Ib qho kev txhaj tshuaj yog txaus rau txog kaum yim txog nees nkaum plaub teev.
• Tab sis ib cov tshuaj xws li Tresiba muaj cov nyhuv ntev heev. Nws cov nyhuv kav txog plaub caug-yim teev, yog li koj tuaj yeem siv cov tshuaj ib zaug txhua ob hnub. Yog vim li cas cov tshuaj no yog li nrov ntawm cov neeg mob ntshav qab zib.

Raws li koj tuaj yeem pom, ntau cov tshuaj noj nrog lub sij hawm sib txawv tau hais txog cov tshuaj insulin basal. Txawm li cas los xij, dab tsi ntawm cov tshuaj insulin-cov tshuaj haum rau hauv koj kis koj yuav tsum nrhiav kom tau los ntawm cov kws tshaj lij. Txawm li cas los xij tsis koom nrog kev pib xyaum ua, vim tias xaiv tsis raug tshuaj lossis qhov yuam kev ntawm kev noj tshuaj ntau npaum li cas yuav ua rau muaj qhov tsis zoo, nce txog qhov tsis nco qab.

Ntshav qab zib mellitus yog ib qho txaus ntshai heev uas tuaj yeem hloov pauv koj txoj kev ua neej. Txawm li cas los xij, koj yuav tsum twv yuav tsum tsis txhob tag kev cia siab, vim tias koj tseem tuaj yeem ua tus neeg zoo siab. Qhov loj tshaj plaws yog hloov koj txoj kev ua neej, thiab noj cov tshuaj tsim nyog rau sijhawm. Raws li cov kws kho mob, cov neeg mob uas tsis hnov ​​qab noj cov tshuaj insulin basal nyob ntev dua li cov uas tsis nco qab ua nws.

Kev siv cov tshuaj insulin basal yog qhov tseem ceeb ntawm lub neej ntawm cov neeg mob ntshav qab zib. Tus kab mob no tsis tuaj yeem kho, tab sis koj tuaj yeem tswj hwm koj tus mob.

Kev tawm dag zog koj txoj kev noj qab haus huv txij thaum hluas. Noj mov kom zoo, ua kom tawm dag zog lub cev, thiab tawm kev tawm dag zog ua haujlwm thiab so kom txaus. Saib xyuas koj kev noj qab haus huv thiab koj yuav pom tias nws saib xyuas koj li cas. Saib xyuas koj tus kheej thiab muaj kev noj qab nyob zoo.

Cov khoom tsim ntawm basal insulin npaj

Basal lossis, raws li lawv kuj hu ua, tom qab insulins yog tshuaj ntawm nruab nrab lossis ntev ua. Lawv muaj raws li cov raug muab tshem tawm npaj rau kev txhaj tshuaj subcutaneous nkaus xwb. Tshaj tawm cov tshuaj insulin basal hauv txoj hlab ntshav yog qhov txaus siab.

Tsis zoo li cov insulins luv-luv, insulins basal tsis yog pob tshab thiab zoo li cov kua huab. Qhov no yog vim qhov tseeb tias lawv muaj ntau yam impurities, xws li zinc lossis protamine, uas cuam tshuam nrog kev nqus sai ntawm insulin thiab yog li ua kom ntev nws qhov kev txiav txim.

Thaum lub sijhawm khaws cia, cov impurities no yuav ua rau kub sai, yog li ntawd, ua ntej txhaj tshuaj, lawv yuav tsum tau sib xyaw nrog lwm yam ntawm cov tshuaj. Txhawm rau ua qhov no, yob lub raj mis hauv xib teg ntawm koj txhais tes lossis tig nws thiab nqis thiab ntau zaus. Kev tsem cov tshuaj yog nruj me ntsis txwv tsis pub.

Cov tshuaj siv tshiab niaj hnub no, uas suav nrog Lantus thiab Levemir, muaj qhov ua kom pom tseeb, vim tias lawv tsis muaj qhov tsis txaus. Qhov kev txiav txim ntawm cov insulins tau ntev ntev vim yog kev hloov pauv hauv cov qauv molecular ntawm cov tshuaj, uas tsis tso cai rau lawv nkag mus sai.

Kev npaj insulin Basal thiab lawv lub sijhawm ua:

Lub npe tshuaj	Hom tshuaj insulin	Nkaus
Protafan NM	Isofan	10-18 teev
Neeg tsis ntseeg xav	Isofan	10-18 teev
Humulin NPH	Isofan	18-20 teev
Biosulin N	Isofan	18-24 teev
Gensulin N	Isofan	18-24 teev
Levemir	Detemir	22-24 teev
Lauj Teeb	Glargin	24-29 teev
Tresiba	Degludek	40-42 teev

Tus naj npawb ntawm kev txhaj tshuaj ntawm basal insulin ib hnub twg nyob ntawm ntau hom tshuaj uas siv los ntawm cov neeg mob. Yog li thaum siv Levemir, tus neeg mob yuav tsum ua ob qho kev txhaj tshuaj insulin ib hnub - thaum tsaus ntuj thiab ib zaug ntxiv nyob nruab nrab ntawm cov pluas noj. Qhov no pab tswj cov qib insulin hauv paus hauv lub cev.

Kev ua haujlwm ntev dhau los ntawm kev siv tshuaj insulin, xws li Lantus, tuaj yeem txo qhov tsawg ntawm qhov kev txhaj tshuaj rau ib qho kev txhaj tshuaj ib hnub. Vim li no, Lantus yog qhov muaj npe nrov tshaj plaws nyob ntev ntawm cov tshuaj ntshav qab zib. Yuav luag ib nrab ntawm cov neeg mob kuaj mob ntshav qab zib siv nws.

Yuav ua li cas los xam cov koob tshuaj ntawm basal insulin

Tshuaj insulin Basal yog lub luag haujlwm tseem ceeb hauv kev tswj hwm tus mob ntshav qab zib kom ua tiav. Nws yog qhov tsis muaj qhov tom qab ntawm cov tshuaj insulin uas feem ntau ua rau muaj kev mob hnyav rau hauv tus neeg mob lub cev. Txhawm rau tiv thaiv kev txhim kho ntawm cov kab mob kev tuaj yeem, nws yog ib qho tseem ceeb uas yuav tsum xaiv cov tshuaj kom haum rau cov tshuaj.

Raws li tau sau tseg saum toj no, kev noj tshuaj txhua hnub ntawm cov tshuaj insal hauv ib hnub yuav tsum yog ntawm 24 txog 28 chav nyob. Txawm li cas los xij, ib qho tshuaj ntawm cov keeb kwm yav dhau los insulin haum rau txhua tus neeg mob ntshav qab zib tsis muaj nyob. Txhua tus mob ntshav qab zib yuav tsum txiav txim siab cov tshuaj haum rau nws tus kheej tshaj plaws.

Hauv qhov no, ntau ntau yam yuav tsum raug coj los txiav txim siab, xws li tus neeg mob lub hnub nyoog, qhov hnyav, ntshav qab zib thiab seb nws muaj ntshav qab zib tau pes tsawg xyoo. Tsuas yog nyob rau hauv cov ntaub ntawv no, txhua yam kev kho mob ntshav qab zib yuav ua tau zoo tiag.

Txhawm rau xam qhov tseeb koob tshuaj ntawm basal insulin, tus neeg mob yuav tsum xub txiav txim siab nws lub cev qhov ntsuas. Qhov no tuaj yeem ua tau raws li cov qauv hauv qab no: Lub cev qhov ntsuas = = hnyav (kg) / qhov siab (m²). Yog li, yog tias kev loj hlob ntawm cov ntshav qab zib yog 1.70 m thiab qhov hnyav yog 63 kg, ces nws lub cev qhov ntsuas yuav yog: 63 / 1.70² (2.89) = 21.8.

Tam sim no tus neeg mob xav tau los xam nws lub cev hnyav. Yog tias qhov ntsuas ntawm nws lub cev nqaij daim tawv tiag tiag yog nyob rau hauv thaj tsam ntawm 19 txog 25, tom qab ntawd los laij rau huab hwm coj zoo tagnrho, koj yuav tsum siv qhov ntsuas 19. Qhov no yuav tsum tau ua raws li cov qauv hauv qab no: 1.70² (2.89) × 19 = 54.9≈55 kg.

Tau kawg, txhawm rau kom suav cov koob tshuaj ntawm basal insulin, tus neeg mob tuaj yeem siv nws lub cev qhov hnyav, txawm li cas los xij, qhov no tsis txaus siab rau qee yam:

• Cov tshuaj Insulin yog hais txog anabolic steroids, uas txhais tau tias nws pab ua kom tus neeg lub cev hnyav. Yog li, qhov ntau dua cov koob tshuaj ntawm cov tshuaj insulin, cov neeg mob muaj zog tuaj yeem rov qab,
• Ntau cov insulin ntau dhau lawm txaus ntshai dua li lawv qhov tsis muaj peev xwm, vim tias nws yuav ua rau muaj ntshav qab zib tsawg heev. Yog li ntawd, nws yog qhov zoo dua los pib nrog kev pib qis, thiab tom qab ntawd maj mam ntxiv rau lawv.

Qhov ntau npaum ntawm cov tshuaj insal hauv paus tuaj yeem raug xam siv cov qauv yooj yim, uas yog: Lub cev qhov hnyav × 0.2, i.e. 55 × 0.2 = 11. Yog li, qhov koob tshuaj txhua hnub ntawm cov tshuaj tiv thaiv tom qab yuav tsum yog 11 chav nyob. Tab sis xws li cov mis no tsis tshua muaj siv los ntawm cov mob ntshav qab zib, vim nws muaj qhov ua kom siab.

Muaj lwm qhov nyuaj dua ntxiv rau kev suav cov koob tshuaj ntawm keeb kwm tshuaj insulin, uas pab ua kom tau qhov tshwm sim zoo tshaj plaws. Rau qhov no, tus neeg mob yuav tsum xub xam cov tshuaj ntawm txhua cov tshuaj insulin txhua hnub, ob qho tib si basal thiab bolus.

Txhawm rau kom paub cov tshuaj tag nrho cov insulin uas tus neeg mob xav tau nyob rau ib hnub, nws yuav tsum txhawm rau qhov hnyav ntawm lub cev zoo tshaj plaws los ntawm qhov ntsuas raug rau nws lub sijhawm, uas yog:

1. Los ntawm 1 xyoo txog 5 xyoos - qhov coefficient ntawm 0.5,
2. Txij li 5 xyoos txog 10 xyoo - 0.7,
3. Tshaj 10 xyoo - 0.9.

Yog li, yog tias tus neeg mob lub cev zoo tshaj yog 55 kg, thiab nws tau mob ntshav qab zib tau 6 xyoo, tom qab ntawd los mus laij nws cov tshuaj insulin txhua hnub nws tsim nyog: 55 × 0.7 = 38.5. Qhov tshwm sim tau yuav sib haum rau qhov zoo tshaj plaws ntawm cov tshuaj insulin rau ib hnub.

Tam sim no, los ntawm tag nrho cov koob tshuaj tiv thaiv kab mob, nws yog qhov tsim nyog yuav tsum tau cais tawm feem uas yuav tsum tau nyob rau ntawm qhov nqus insulin. Qhov no tsis yog qhov nyuaj ua, vim tias raws li koj paub, tag nrho cov ntim ntawm cov tshuaj insal hauv qab yuav tsum tsis pub tshaj 50% ntawm tag nrho cov koob tshuaj insulin npaj. Thiab tseem zoo dua yog tias nws yuav yog 30-40% ntawm kev noj tshuaj txhua hnub, thiab tshuav 60 yuav noj los ntawm bolus insulin.

Yog li, tus neeg mob yuav tsum tau ua cov kev suav sau hauv qab no: 38.5 ÷ 100 × 40 = 15.4. Kev sib hloov ntawm qhov ua tiav tiav, tus neeg mob yuav tau txais kev noj haus zoo tshaj plaws ntawm cov tshuaj insalin, uas yog 15 qhab nia. Qhov no tsis txhais tau hais tias qhov tshuaj no tsis tas yuav tsum muaj kev hloov kho, tab sis nws yog ze rau qhov xav tau ntawm nws lub cev.

Yuav kho cov tshuaj li cas ntawm cov tshuaj insal basal

Txhawm rau tshuaj xyuas cov koob tshuaj tom qab lub cev tiv thaiv kab mob thaum kho mob ntshav qab zib hom 1, tus neeg mob xav tau kev sim tshwj xeeb hauv qhov chaw pib. Txij li lub siab tso tawm glycogen nyob ib ncig ntawm lub moos, qhov tseeb ntawm koob tshuaj yuav tsum tau kuaj xyuas nruab hnub thiab hmo ntuj.

Qhov kev kuaj no tau nqa tawm ntawm lub plab khoob nkaus xwb, yog li ntawd, thaum lub sijhawm coj tus cwj pwm, tus neeg mob yuav tsum tsis kam noj zaub mov, hla tshais, vow lossis noj hmo. Yog tias cov kev hloov pauv hauv cov piam thaj hauv ntshav thaum lub sijhawm kuaj tsis ntau tshaj 1.5 mmol thiab tus neeg mob tsis qhia tias cov ntshav qog ntshav qab zib, yog li cov tshuaj ntawm cov tshuaj insulin basal yog qhov txaus.

Yog tias tus neeg mob tau poob qis lossis nce siab hauv cov ntshav qab zib, ntau npaum li cas ntawm cov tshuaj insulin yav dhau los yuav tsum tau kho sai. Nce lossis txo cov koob tshuaj yuav tsum maj mam tsis ntau tshaj 2 units. ntawm lub sijhawm thiab tsis pub ntau tshaj 2 zaug hauv ib lub lis piam.

Lwm qhov paib uas ntev ntev insulins siv los ntawm tus neeg mob hauv cov tshuaj kom raug yog cov piam thaj hauv ntshav thaum lub sijhawm kuaj xyuas thaum sawv ntxov thiab yav tsaus ntuj. Hauv qhov no, lawv yuav tsum tsis pub tshaj qhov kev txwv siab tshaj ntawm 6.5 mmol.

Ua kev sim basal thaum hmo ntuj:

• Txog hnub no, tus neeg mob yuav tsum tau noj hmo kom ntxov li ntxov tau. Nws yog qhov zoo dua yog tias noj mov kawg ua rau tsis pub dhau 6 teev tsaus ntuj. Qhov no yog qhov tsim nyog yog li thaum lub sijhawm ntsuas, qhov kev txiav txim ntawm luv luv insulin, muab rau noj hmo, yog tiav lawm. Raws li txoj cai, qhov no yuav siv sijhawm tsawg kawg 6 teev.
• Ntawm 12 a.m., kev txhaj tshuaj yuav tsum tau muab los ntawm kev tswj cov kab mob hauv nruab nrab (Protafan NM, InsumanBazal, Humulin NPH) lossis ntev (Lantus) insulin.
• Tam sim no koj yuav tsum ntsuas ntsuas ntshav qab zib txhua ob teev (thaum 2:00, 4:00, 6:00 thiab 8:00), ceeb toom nws qhov tsis txawv txav. Yog tias lawv tsis ntau tshaj 1.5 mmol, ces cov koob tshuaj yog xaiv kom raug.
• Nws yog ib qho tseem ceeb kom tsis txhob qhaj ntawm qhov siab tshaj plaws ntawm cov kua dej, uas nyob rau hauv nruab nrab cov tshuaj tshwm sim tom qab txog 6 teev. Nrog rau txoj cai muab tshuaj rau lub sijhawm no, tus neeg mob yuav tsum tsis txhob muaj cov piam thaj hauv qhov siab thiab qhov kev loj hlob ntawm cov ntshav qabzib. Thaum siv Lantus, cov khoom no tuaj yeem raug hla, vim nws tsis muaj kev ua ub no ntxiv.
• Qhov ntsuas yuav tsum tau muab tshem tawm yog tias ua ntej pib ua rau tus neeg mob tau muaj hyperglycemia lossis ntshav qabzib tau nce siab tshaj 10 mmol.
• Ua ntej kev kuaj mob, tsis muaj ib yam dab tsi yuav tsum koj ua kev txhaj tshuaj ntawm luv luv insulin.
• Yog tias thaum qhov kev kuaj ntawd tus neeg mob tau muaj kev tawm tsam ntawm lub qog ntshav qab zib, nws yuav tsum nres thiab qhov kev sim ntawd yuav tsum nres. Yog tias cov piam thaj hauv ntshav, ntawm qhov tsis sib xws, tau nce mus rau qhov tsis txaus ntshai, koj yuav tsum tau txhaj me me ntawm cov tshuaj insulin luv thiab ncua lub sijhawm kuaj mus txog hnub tom qab.
• Kev kho qhov tseeb ntawm cov insulin hauv paus yog qhov ua tau tsuas yog siv tau los ntawm peb qho kev ntsuam xyuas no.

Ua kev sim basal nruab hnub:

• Txhawm rau ua qhov no, tus neeg mob yuav tsum ua kom tsis txhob noj thaum sawv ntxov thiab tsis txhob siv cov tshuaj insulin luv luv, txhaj cov insulin nruab nrab.
• Tam sim no tus neeg mob yuav tsum kuaj ntshav qib ntshav qab zib txhua teev ua ntej noj su. Yog tias nws poob lossis nce, qhov ntau ntawm cov tshuaj yuav tsum tau kho, yog tias nws tseem nyob qib, ces yuav tsum ua kom zoo li qub.
• Hnub tom qab, tus neeg mob yuav tsum noj tshais ib txwm ua thiab txhaj cov tshuaj insulin luv thiab nruab nrab.
• Noj su thiab lwm koob ntawm luv luv insulin yuav tsum dhia dhau. 5 teev tom qab noj tshais, koj yuav tsum kuaj koj cov ntshav qab zib thawj zaug.
• Ntxiv mus, tus neeg mob yuav tsum kuaj xyuas theem ntawm cov piam thaj hauv lub cev txhua txhua teev kom txog thaum noj hmo. Yog tias tsis pom muaj qhov hloov siab tsis sib xws, qhov koob tshuaj yog qhov tseeb.

Rau cov neeg mob siv insulin Lantus rau cov ntshav qab zib, tsis tas yuav ua qhov kev ntsuam xyuas txhua hnub. Vim tias Lantus yog ib qho insulin ntev, nws yuav tsum muab rau tus neeg mob tsuas yog ib zaug ib hnub, ua ntej mus pw. Yog li, nws yog qhov yuav tsum tau kuaj xyuas qhov tsim nyog ntawm nws cov tshuaj tsuas yog thaum tsaus ntuj.

Cov ntaub ntawv hais txog cov hom insulin yog muaj nyob rau hauv video hauv tsab xov xwm no.

Dab tsi yog qhov pib kho bolus insulin

Mob ntshav qab zib insulin txoj kev kho mob tuaj yeem yog cov tshuaj ib txwm lossis ib txwm siv (ntxiv zuj zus). Saib seb nws yog dab tsi thiab lawv txawv li cas. Nws raug nquahu kom nyeem kab lus “Seb cov insulin tswj ntshav qab zib li cas rau cov neeg noj qab haus huv thiab dab tsi hloov nrog ntshav qab zib.” Yog koj nkag siab zoo dua txog cov ntsiab lus no, koj yuav ua tiav ntau dua hauv kev kho mob ntshav qab zib.

Hauv cov neeg noj qab haus huv uas tsis muaj ntshav qab zib, qhov me me thiab ruaj khov ntawm cov tshuaj insulin ib txwm khiav rau hauv cov ntshav ceev ceev. Qhov no yog hu ua basal lossis basal insulin concentration. Nws txwv tsis pub gluconeogenesis, i.e., kev hloov pauv ntawm cov khw muag khoom protein rau hauv qabzib. Yog tias tsis muaj qhov tsis txaus ntshav qab zib ntshav hauv ntshav, ces tus neeg ntawd yuav “piam thaj rau hauv qab zib thiab dej,” raws li cov kws kho mob thaum ub piav txog kev tuag los ntawm ntshav qab zib hom 1.

Hauv lub plab khoob (thaum pw tsaug zog thiab nruab nrab ntawm cov pluas noj), cov zaub mov zoo ua rau lub cev insulin. Ib feem ntawm nws yog siv los tswj lub hauv paus ruaj khov concentration ntawm cov tshuaj insulin hauv cov ntshav, thiab cov feem tseem ceeb yog khaws cia. Cov khoom noj no yog hu ua bolus zaub mov. Nws yuav tsum tau muaj thaum ib tus neeg pib noj khoom noj txhawm rau txhawm rau noj cov zaub mov kom zoo thiab tib lub sijhawm tiv thaiv kev dhia hauv ntshav qab zib.

Txij thaum pib noj mov thiab rau kwv yees li 5 teev, lub cev tau txais insulin bolus. Qhov no yog qhov tso tawm kom meej los ntawm kev mob siab ntawm cov kua ntshav ntawm cov tshuaj insulin, uas tau npaj ua ntej. Nws tshwm sim kom txog thaum tag nrho cov kua nplaum hauv lub plhaws yog nqus los ntawm cov nqaij hauv cov ntshav. Tib lub sijhawm, cov tshuaj tiv thaiv ua qog ua yeeb yam tseem ua kom cov ntshav qab zib tsis poob thiab tsis muaj ntshav qab zib.

Kev kho cov insulin hauv basis-bolus - txhais tau hais tias "qhov pib" (basal) cov tshuaj insulin hauv cov ntshav yog tsim los ntawm cov tshuaj insulin nruab nrab lossis ntev ntev thaum hmo ntuj thiab / lossis thaum sawv ntxov. Tsis tas li ntawd, ib qho bolus (ncov) cov tshuaj ntawm cov tshuaj insulin tom qab noj mov tau tsim los ntawm kev ntxiv ntawm cov insulin ntawm luv luv lossis ultrashort kev txiav txim ua ntej txhua pluas noj. Qhov no pub rau, txawm hais tias yog ntxhib, los qog ua haujlwm ntawm kev noj qab nyob zoo txiav.

Tsoos insulin kho mob suav nrog kev qhia txog cov tshuaj insulin txhua txhua hnub, hloov kho nyob rau lub sijhawm thiab koob tshuaj. Hauv qhov no, tus neeg mob ntshav qab zib feem ntau tsis tshua muaj kev ntsuas qib ntawm cov piam thaj hauv nws cov ntshav nrog lub ntsej muag glucometer. Cov neeg mob tau qhia kom noj cov zaub mov zoo nrog cov zaub mov noj txhua hnub. Cov teeb meem tseem ceeb nrog rau qhov no yog tsis muaj kev yoog hloov kho ntawm cov koob tshuaj insulin mus rau tam sim no cov ntshav qab zib. Thiab cov mob ntshav qab zib tseem “khi” rau kev noj haus thiab teem caij rau tshuaj insulin. Hauv kev coj noj coj ua ntawm kev kho insulin, kev txhaj tshuaj insulin ob zaug feem ntau yog muab ob zaug ib hnub: luv thiab nruab nrab ntev ntawm kev nqis tes ua. Lossis sib tov sib txawv ntawm ntau hom tshuaj insulin raug txhaj rau thaum sawv ntxov thiab yav tsaus ntuj nrog ib qho kev txhaj tshuaj.

Pom tseeb, kev mob ntshav qab zib hom insulin txoj kev kho yog yooj yim dua li lub hauv paus bolus. Tab sis, hmoov tsis, nws ib txwm ua rau cov txiaj ntsig tsis txaus ntseeg. Nws tsis tuaj yeem ua tiav cov txiaj ntsig zoo rau cov ntshav qab zib, uas yog, coj cov ntshav qab zib kom ze rau qhov tseem ceeb nrog kev kho mob insulin ib txwm muaj. Qhov no txhais tau hais tias cov mob ntshav qab zib, uas ua rau muaj mob xiam oob qhab lossis tuag ntxov, tab tom tsim sai heev.

Tsoos tshuaj insulin yog siv tsuas yog tias nws tsis yooj yim sua los yog ua kom tsis haum los tswj cov tshuaj insulin raws li ib qho kev ua kom muaj zog. Qhov no feem ntau tshwm sim thaum:

• cov neeg laus mob ntshav qab zib, muaj lub neej qis qis dua,
• tus neeg mob tau mob hlwb
• tus kws kho ntshav qab zib tsis muaj peev xwm tswj tau theem ntawm cov piam thaj hauv nws cov ntshav,
• tus neeg mob xav tau kev saib xyuas sab nraud, tab sis nws tsis tuaj yeem muab cov khoom zoo.

Txhawm rau kho ntshav qab zib nrog cov tshuaj insulin uas siv cov qauv zoo ntawm kev kho mob bolus, koj yuav tsum ntsuas qab zib nrog glucometer ntau zaus thaum nruab hnub. Tsis tas li, cov ntshav qab zib yuav tsum muaj peev xwm suav qhov ntau npaum li cas ntawm cov insulin ntev thiab ceev kom thiaj li hloov kho cov tshuaj insulin rau qib ntshav qab zib tam sim no.

Yuav teem cov tshuaj insulin rau hom 1 lossis hom 2 ntshav qab zib li cas

Nws xav tias koj twb muaj qhov txiaj ntsig ntawm kev tswj tus kheej hauv cov ntshav qab zib hauv ib tus neeg mob ntshav qab zib tau 7 hnub sib law liag. Peb qhov kev pom zoo yog rau cov neeg mob ntshav qab zib uas ua raws li cov zaub mov tsis muaj rog ntau thiab siv txoj kev teeb tsa khoom. Yog tias koj ua raws li kev noj zaub mov "sib npaug", dhau ntawm kev ua kom muaj carbohydrates, ces koj tuaj yeem xam qhov kev noj tshuaj ntawm cov tshuaj insulin hauv txoj kev yooj yim dua li cov tau hais hauv peb cov lus. Vim tias cov khoom noj rau cov ntshav qab zib muaj ntau ntawm cov carbohydrates, yog li koj tseem tuaj yeem zam tsis dhau cov ntshav qab zib kom muaj ntshav.

Yuav ua li cas kos ib qho kev qhia txog tshuaj insulin - ib qib zuj zus ntawm txheej txheem:

1. Txiav txim siab yog tias koj xav tau cov tshuaj tiv thaiv ntev tshaj thaum hmo ntuj.
2. Yog tias koj xav tau cov tshuaj txuas ntxiv ntawm cov insulin thaum hmo ntuj, tom qab ntawd xam qhov pib siv tshuaj, thiab tom qab ntawd kho nws ntawm hnub tom qab.
3. Txiav txim siab yog tias koj xav tau cov tshuaj ntxiv ntawm cov insulin txuas thaum sawv ntxov. Qhov no yog qhov nyuaj tshaj plaws, vim hais tias rau kev sim koj yuav tsum hla lub tshais thiab su.
4. Yog tias koj xav tau cov tshuaj ntxiv ntawm cov insulin txuas thaum sawv ntxov, tom qab ntawd xam qhov kev pib noj ntawm cov tshuaj insulin rau lawv, thiab tom qab ntawd kho nws rau ob peb lub lis piam.
5. Txiav txim siab seb koj puas xav tau txhaj tshuaj insulin sai ua ntej noj tshais, noj su thiab noj hmo, thiab yog tias muaj, ua ntej yuav tsum tau noj cov zaub mov twg, thiab ua ntej twg - tsis yog.
6. Xam xyuas qhov pib noj ntawm luv luv lossis ultrashort insulin rau kev txhaj tshuaj ua ntej noj mov.
7. Kho cov tshuaj noj ntawm luv luv lossis ultrashort insulin ua ntej noj mov, raws li cov hnub dhau los.
8. Ua qhov kev sim ua kom paub tseeb tias pes tsawg feeb ua ntej noj mov koj yuav tsum txhaj tshuaj insulin.
9. Kawm paub yuav ua li cas los luas qhov ntau thiab tsawg ntawm cov tshuaj insulin rau cov mob thaum koj yuav tsum normalize cov ntshav qab zib.

Yuav ua li cas kom ua tiav cov ntsiab lus 1-4 - nyeem hauv kab lus "Lantus thiab Levemir - ncua ntev-ua yeeb yam insulin. Nquag qab zib rau ib plab khoob thaum sawv ntxov. " Yuav ua li cas kom ua tiav cov ntsiab lus 5-9 - nyeem hauv cov xwm txheej "Ultrashort insulin Humalog, NovoRapid thiab Apidra. Tib neeg Yuav Tsum insulin "thiab" Insulin Txhaj Tshuaj ua ntej noj mov. Yuav ua li cas kom qab qab zib thiaj li qis dua yog tias nws nce tuaj. " Yav dhau los, koj kuj yuav tsum kawm kab lus "Kev kho mob ntshav qab zib nrog insulin. Dab tsi yog hom insulin. Cov cai rau kev muab tshuaj insulin. ” Ib zaug ntxiv, peb nco qab tias kev txiav txim siab txog qhov xav tau ntawm kev txhaj tshuaj txuas ntxiv thiab nrawm insulin yog ua ntawm nyias tus kheej. Ib tus mob ntshav qab zib tsuas xav tau cov tshuaj insulin ntxiv thaum tsaus ntuj thiab / lossis thaum sawv ntxov xwb. Lwm tus tsuas yog muab cov tshuaj insulin sai ua ntej noj mov kom cov piam thaj tseem tom qab noj mov tas. Thib peb, lub sijhawm ntev thiab ceev insulin yog qhov xav tau nyob rau tib lub sijhawm. Qhov no yog txiav txim los ntawm cov txiaj ntsig ntawm kev tswj tus kheej ntawm cov ntshav qab zib rau 7 hnub sib law liag.

Peb tau sim piav qhia kom nkag siab thiab nkag siab txoj hauv kev yuav ua li cas kos duab cov tshuaj insulin kom zoo rau hom 1 thiab ntshav qab zib hom 2. Txhawm rau txiav txim siab qhov insulin los txhaj, lub sijhawm twg thiab yam tshuaj twg, koj yuav tsum nyeem ob peb kab lus ntev ntev, tab sis lawv raug sau rau hom lus uas nkag siab tshaj plaws. Yog tias koj muaj lus nug, nug lawv hauv cov lus, peb yuav teb koj sai.

Kev kho mob ntshav qab zib hom 1 nrog kev txhaj tshuaj insulin

Txhua tus neeg mob tus mob ntshav qab zib hom 1, tshwj tsis yog cov uas muaj mob hnyav, yuav tsum tau txhaj tshuaj insulin sai ua ntej txhua pluas noj. Nyob rau tib lub sijhawm, lawv xav tau kev txhaj tshuaj ntxiv ntawm cov insulin thaum hmo ntuj thiab yav sawv ntxov los tswj cov piam thaj sai. Yog tias koj muab cov tshuaj insulin txuas ntxiv rau yav sawv ntxov thiab yav tsaus ntuj nrog kev txhaj tshuaj ntawm cov insulin ceev ceev ua ntej noj mov, qhov no tso cai koj ua kom ntau lossis tsawg dua qhov sim kho cov txiav ua ke ntawm tus neeg noj qab haus huv.

Nyeem tag nrho cov ntawv hauv kab ntawv “Insulin hauv kev kho tus mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2.” Ua tib zoo saib rau cov lus sau "Ncua cov insulin Lantus thiab Glargin. Nruab Nrab NPH-Insulin Protafan ”thiab“ Kev txhaj tshuaj sai ntawm cov insulin ua ntej noj mov. Yuav ua li cas kom qis qab zib rau li qub yog tias nws dhia. " Koj yuav tsum to taub kom zoo tias yog vim li cas ntev siv cov tshuaj insulin siv thiab dab tsi nrawm. Kawm paub dab tsi txoj kev thauj khoom qis yog tswj cov ntshav qab zib kom zoo thaum lub sij hawm them tus nqi qis qis ntawm insulin.

Yog tias koj muaj rog nyob rau hauv lub xub ntiag ntawm mob ntshav qab zib hom 1, tom qab ntawd Siofor lossis Glucofage ntsiav tshuaj tuaj yeem pab txo qis tshuaj insulin thiab ua rau nws yuag dua. Thov noj cov tshuaj no nrog koj tus kws kho mob, tsis txhob sau lawv rau koj tus kheej.

Hom ntshav qab zib hom 2 thiab tshuaj

Raws li koj paub, qhov tseem ceeb ntawm cov ntshav qab zib hom 2 yog qhov kev hloov pauv tsis tshua mob ntawm cov cell mus rau kev ua haujlwm ntawm insulin (insulin resistance). Hauv feem ntau cov neeg mob nrog qhov kev kuaj mob no, cov txiav txiav txuas ntxiv tsim nws cov tshuaj insulin, qee zaum txawm tias ntau dua li cov neeg noj qab haus huv. Yog tias koj cov piam thaj hauv ntshav dhia tom qab noj mov, tab sis tsis ntau dhau, tom qab ntawd koj tuaj yeem sim hloov cov kev txhaj tshuaj ntawm cov insulin ceev ua ntej noj nrog Metformin ntsiav tshuaj.

Metformin yog ib yam khoom uas ua rau muaj kev cuam tshuam ntawm cov hlwb ua rau insulin. Nws muaj nyob hauv cov ntsiav tshuaj Siofor (kev txiav txim siab ceev) thiab Glucophage (kev tso tawm ntev). Qhov kev tuaj yeem no muaj peev xwm txaus siab rau cov neeg mob uas muaj ntshav qab zib hom 2, vim tias lawv muaj peev xwm noj tshuaj ntau dua li txhaj tshuaj insulin, txawm hais tias tom qab lawv tau ua cov txheej txheem ntawm cov kev siv tshuaj tsis mob. Ua ntej noj mov, txhob siv cov tshuaj insulin, koj tuaj yeem sim noj tshuaj Siofor ua yeeb yam sai, maj mam nce lawv cov koob tshuaj.

Koj tuaj yeem pib noj cov zaub mov noj tsis dhau 60 feeb tom qab noj cov ntsiav tshuaj. Nws yog qee zaum yooj yim dua rau kev nqus luv lossis ultrashort insulin ua ntej noj mov kom koj tuaj yeem pib noj tom qab 20-45 feeb. Yog tias, txawm hais tias noj ntau tshaj plaws ntawm Siofor, qab zib tseem nce siab tom qab noj mov, ces yuav tsum tau txhaj tshuaj insulin. Tsis li, mob ntshav qab zib yuav pib tshwm sim. Tom qab tag nrho, koj twb muaj ntau dua cov teeb meem kev noj qab haus huv txaus. Nws yog qhov tsis txaus los ntxiv kev txiav tawm ceg, dig muag lossis lub raum tsis ua haujlwm rau lawv. Yog tias muaj pov thawj, tom qab ntawd kho koj cov ntshav qab zib nrog cov tshuaj insulin, tsis txhob ua dag.

Yuav ua li cas txo cov tshuaj insulin nrog hom 2 mob ntshav qab zib

Txog hom ntshav qab zib hom 2, koj yuav tsum siv tshuaj ntsiav nrog insulin yog tias koj rog dhau thiab qhov tshuaj ntawm insulin thaum hmo ntuj yog 8-10 lossis ntau dua. Hauv cov xwm txheej no, cov tshuaj kho ntshav qab zib kom txaus yuav pab txhawb kev tiv thaiv cov tshuaj insulin thiab pab txo qis tshuaj insulin. Nws yuav zoo li, dab tsi yog qhov zoo? Tom qab txhua tus, koj tseem yuav tsum tau txhaj tshuaj, tsis muaj teeb meem dab tsi ntawm cov koob tshuaj insulin hauv cov koob txhaj tshuaj. Qhov tseeb yog hais tias insulin yog lub cev tseem ceeb uas ua rau lub cev zuj zus tuaj. Cov insulin loj loj ua rau nce hauv lub cev qhov hnyav, txwv tsis pub yuag poob thiab ntxiv insulin tsis kam. Yog li, koj txoj kev noj qab haus huv yuav muaj txiaj ntsig zoo yog tias koj tuaj yeem txo qhov tshuaj ntawm cov tshuaj insulin, tab sis tsis ua rau tus nqi ntawm cov ntshav qab zib nce siab.

Cov ntsiav tshuaj siv regimen nrog insulin rau hom ntshav qab zib hom 2 yog dab tsi? Ua ntej tshaj plaws, tus neeg mob pib noj cov ntsiav tshuaj Glucofage thaum hmo ntuj, nrog rau nws qhov kev txhaj tshuaj ntawm cov insulin txuas ntxiv.Qhov kev txhaj tshuaj ntawm Glucofage yog maj mam nce, thiab lawv sim txo qis qis ntawm cov insulin ntev li thaum hmo ntuj yog tias kev ntsuas suab thaj thaum sawv ntxov nyob rau ntawm lub plab khoob qhia tias qhov no tuaj yeem ua tau. Thaum tsaus ntuj, nws raug nquahu kom noj Glucophage, tsis yog Siofor, vim tias nws siv sijhawm ntev dua thiab kav ntev hmo. Glucophage kuj tseem tsawg dua Siofor los ua kom lub plab zom mov. Tom qab qhov kev txhaj tshuaj ntawm Glucofage tau maj mam nce mus rau qhov siab tshaj plaws, pioglitazone tuaj yeem raug ntxiv rau nws. Tej zaum qhov no yuav pab txo qis kev tsim tawm cov tshuaj insulin.

Nws xav tias kev noj pioglitazone tiv thaiv cov tshuaj insulin kuj nce me ntsis ua rau muaj kev pheej hmoo ua rau lub plawv khiav tsis zoo. Tab sis Dr. Bernstein ntseeg hais tias lub peev xwm yuav pab tau ntau dua qhov kev pheej hmoo. Nyob rau hauv txhua kis xwm txheej, yog tias koj pom tias koj ob txhais ceg tsawg kawg yog me ntsis o, tam sim ntawd tsum tsis txhob noj pioglitazone. Glucophage yog tsis zoo li yuav ua rau muaj kev phiv loj heev dua li ntawm lub plab zom mov, thiab tom qab ntawd tsis tshua muaj. Yog tias, raws li kev noj cov tshuaj pioglitazone, nws tsis tuaj yeem txo qhov tshuaj ntawm cov tshuaj insulin, tom qab ntawd nws raug lawb tawm. Yog tias, txawm hais tias noj ntau tshaj plaws ntawm Glucofage thaum hmo ntuj, nws tsis yog txhua lub peev xwm los txo qhov ntau npaum li cas ntawm cov tshuaj insulin ntev, ces cov ntsiav tshuaj no tseem raug muab tso tseg.

Nws yog qhov tsim nyog kom rov qab qhia qhov no tias kev kawm paub lub cev nce lub siab ntawm cov hlwb rau insulin ntau zaus muaj zog dua li ib hom tshuaj ntshav qab zib. Kawm tawm kev tawm dag zog nrog kev txaus siab rau hom ntshav qab zib 2, thiab pib hloov mus. Kev tawm dag zog lub cev yog qhov txuj ci tseem ceeb kho rau cov ntshav qab zib hom 2, uas nyob hauv qhov chaw thib ob tom qab kev noj zaub mov kom tsis rog. Tsis kam los ntawm kev txhaj tshuaj ntawm cov tshuaj insulin tau nyob rau hauv 90% ntawm cov neeg mob uas muaj ntshav qab zib hom 2, yog tias koj ua raws li cov zaub mov tsis muaj carbohydrate thiab tib lub sijhawm ua rau kev tawm dag zog.

Tom qab nyeem tsab xov xwm, koj tau kawm paub yuav kos kab mob insulin kho mob ntshav qab zib li cas, uas yog, txiav txim siab txog qhov tshuaj insulin rau qhov twg, lub sijhawm thiab sijhawm twg. Peb tau piav txog lub nuances ntawm cov tshuaj insulin kho mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2. Yog tias koj xav kom ua tiav cov txiaj ntsig zoo rau cov ntshav qab zib, uas yog, kom coj koj cov ntshav qab zib kom ze li ib txwm muaj, koj yuav tsum ua tib zoo nkag siab siv insulin rau qhov no. Koj yuav tsum nyeem ob peb tshooj ntev hauv ntu “Insulin hauv kev kho hom 1 thiab ntshav qab zib hom 2.” Tag nrho cov nplooj ntawv no tau sau kom meej meej li muaj peev xwm ua tiav thiab nkag tau rau tib neeg yam tsis muaj kev kawm kho mob Yog tias koj muaj lus nug, tom qab ntawd koj tuaj yeem nug lawv hauv cov lus - thiab peb yuav teb tam sim ntawd.

Nyob zoo Kuv niam muaj mob ntshav qab zib hom 2. Nws muaj hnub nyoog 58 xyoo, 170 cm, 72 kg. Teeb meem - cov ntshav qab zib ua kom rov zoo ntxiv. Raws li tus kws kho mob tau hais tseg, nws noj Glibomet 2 zaug ib hnub 15 feeb ua ntej noj mov. 3 xyoo dhau los, kws kho mob tau sau tshuaj insulin protafan thaum sawv ntxov thiab yav tsaus ntuj ntawm 14-12 units. Qib yoo mov ceev tau 9-12 mmol / L, thiab thaum yav tsaus ntuj nws ncav cuag 14-20 mmol / L. Kuv pom tias tom qab lub sijhawm teem ntawm protafan, retinopathy tau pib ua tiav, ua ntej tias nws tau ua raws li lwm qhov kev cuam tshuam - tus mob ko taw. Tam sim no nws ob txhais ceg tsis thab nws, tab sis nws yuav luag tsis pom. Kuv muaj kev kawm ntawv kho mob thiab ua txhua yam txheej txheem rau nws tus kheej. Kuv suav nrog cov kua qab zib thiab cov tshuaj ntsuab ntxiv rau hauv nws cov zaub mov noj. Qib thaj pib zuj zus mus rau 6-8 mmol / L thaum sawv ntxov thiab 10-14 thaum yav tsaus ntuj. Tom qab ntawd kuv txiav txim siab txo qis nws cov tshuaj insulin thiab pom tias cov ntshav qab zib cov ntshav pauv li cas. Kuv pib txo qhov koob tshuaj insulin los ntawm 1 chav nyob rau ib lim tiam, thiab nce qhov koob tshuaj Glibomet rau 3 ntsiav tshuaj hauv ib hnub. Thiab hnub no kuv txawb rau nws hauv 3 chav ua sawv ntxov thiab yav tsaus ntuj. Tab sis qhov txaus siab tshaj plaws yog tias qib ntawm cov piam thaj zoo ib yam - 6-8 mmol / L thaum sawv ntxov, 12-14 mmol / L thaum yav tsaus ntuj! Nws hloov tawm hais tias kev niaj hnub niaj hnub ntawm Protafan tuaj yeem hloov nrog bioadditives? Thaum cov piam thaj hauv qib siab dua 13-14, Kuv txhaj tshuaj AKTRAPID 5-7 IU thiab qib qab zib sai sai thiaj li zoo. Thov qhia rau kuv tias puas tsim nyog muab nws cov tshuaj insulin txhua lub sijhawm. Tsis tas li, Kuv pom tias kev noj haus pab rau nws ntau. Kuv xav paub ntau ntxiv txog cov tshuaj zoo tshaj plaws kho mob hom 2 mob ntshav qab zib thiab mob hlwb retinopathy. Ua tsaug rau koj!

> Raws li tus kws kho mob tau hais tseg, nws coj lub ntsej muag Glibomet

Glibomet suav nrog glibenclamide. Nws hais txog cov tshuaj mob ntshav qab zib, uas peb pom zoo kom muab tso. Hloov mus rau cov ntshiab metformin, i.e. Siofor lossis Glucofage.

> yog nws haum txhua
> tswj hwm cov tshuaj insulin rau nws?

Peb pom zoo kom koj pib kho cov tshuaj insulin tam sim ntawd yog tias muaj piam thaj tom qab noj mov dhau 9.0 mmol / L tsawg kawg ib zaug thiab siab dua 7.5 mmol / L ntawm cov zaub mov tsis muaj carbohydrate tsawg.

> Kawm paub ntau ntxiv txog cov tshuaj uas zoo tshaj plaws

Nov yog tsab xov xwm “Kho Cov Mob Ntshav Qab Zib”, koj yuav paub txhua yam nyob ntawd. Txog kev rov qab kho txoj hauv kev, txoj kev zoo tshaj yog kev noj ntshav qab zib kom zoo li qub yog ua raws li peb qhov kev kho mob ntshav qab zib hom 2. Ntsiav tshuaj thiab, yog tias tsim nyog, laser coagulation ntawm cov hlab ntshav - kws kho los ntawm tus kws kho qhov muag.

Nyob zoo Kuv tus ntxhais muaj mob ntshav qab zib hom 1. Nws muaj 4 xyoos, siab 101 cm, hnyav 16 kg. Ntawm cov tshuaj insulin rau 2.5 xyoo. Txhaj tshuaj - Lantus 4 chav nyob thaum sawv ntxov thiab ib lub vias mus noj mov rau 2 chav nyob. Qab zib thaum sawv ntxov 10-14, thaum yav tsaus ntuj qab zib 14-20. Yog tias, ua ntej yuav mus pw, lwm 0.5 ml ntawm lub humalogue yog pricked, tom qab ntawd thaum sawv ntxov cov suab thaj nce siab dua. Peb tau sim nyob rau hauv kev saib xyuas ntawm cov kws kho mob txhawm rau nce qhov koob tshuaj ntawm lantus 4 chav nyob thiab humalogue los ntawm 2.5 units. Tom qab tag kis thiab noj hmo tom qab tau txais cov tshuaj insulin ntau ntxiv, thaum yav tsaus ntuj peb muaj cov acetone hauv peb cov zis. Peb hloov mus ua lantus 5 chav nyob thiab ib qho txuas lus ntawm 2 chav nyob txhua, tab sis qab zib tseem tseem siab. Lawv ib txwm sau peb tawm hauv tsev kho mob nrog qab zib thaum 20. Muaj mob hnyav - mob plab hnyuv. Nyob hauv tsev, peb pib yoog dua. Tus ntxhais yog nquag, tom qab lub cev ua si qab zib feem ntau pib tawm ntawm qhov ntsuas. Tam sim no peb tab tom noj zaub mov noj kom txo qis ntshav qab zib. Qhia rau kuv yuav ua li cas kom ua tiav cov piam thaj ib txwm? Tej zaum cov insulin ntev ntev yuav tsis zoo rau nws? Yav dhau los, lawv tau pib ntawm tshuaj tiv thaiv - los ntawm nws tus menyuam muaj mob. Raws li nws muab tawm, kev ua xua. Tom qab ntawd lawv hloov mus rau levemir - cov suab thaj tau ruaj khov, nws los txog rau qhov lawv tsuas yog tso levemir nkaus thaum hmo ntuj. Thiab yuav ua li cas nws pauv rau lantus - qab zib yog tas li siab.

> Qhia kuv yuav ua li cas kom ua tiav cov suab thaj?

Ua ntej tshaj plaws, hloov mus rau qhov kev noj haus kom tsawg cov zaub mov kom tsawg thiab txo koj cov tshuaj insulin hauv cov ntshav qab zib. Ntsuas qab zib nrog glucometer tsawg kawg 8 zaug hauv ib hnub. Ua tib zoo kawm tag nrho peb cov lus nyob rau hauv nqe lus hais txog insulin.

Tom qab ntawv, yog tias koj muaj lus nug, nug.

Thaum tus menyuam muaj ntshav qab zib hom 1 noj “zoo ib yam li sawv daws,” kev tham txog tej yam tsis muaj qab hau.

Nws zoo li rau kuv tias koj muaj tsawg cov ntaub ntawv hais txog ntshav qab zib zoo li LADA. Vim li cas qhov no lossis kuv puas yog nrhiav lwm qhov chaw tsis ncaj ncees lawm?

> los yog Kuv puas yog nrhiav lwm qhov chaw tsis ncaj ncees lawm?

Cov ncauj lus kom ntxaws txog LADA hom 1 mob ntshav qab zib hauv tsab ntawv me ntawm no. Nws muaj cov ntaub ntawv tseem ceeb rau cov neeg mob uas muaj ntshav qab zib hom no. Hauv Lavxias, tsis nyob qhov twg.

Nyob zoo
Kuv muaj ntshav qab zib hom 2. Kuv hloov mus rau qhov kev txwv qis-carbohydrate cov zaub mov 3 lub lis piam dhau los. Kuv tseem noj thaum sawv ntxov thiab yav tsaus ntuj Gliformin 1 ntsiav tshuaj 1000 mg. Qab zib thaum sawv ntxov nyob rau ntawm lub plab khoob, ua ntej thiab tom qab noj mov thiab ua ntej yuav mus pw yuav luag zoo li qub - los ntawm 5.4 txog 6, tab sis qhov hnyav tsis poob.
Kuv puas yuav tsum hloov pauv tshuaj insulin hauv kuv kis? Yog tias yog, txhaj dabtsi?
Ua tsaug rau koj!

> luj tsis txo

cia nws nyob nws ib leeg

> Kuv puas xav tau nyob hauv kuv kis
> hloov mus rau insulin?

Nyob zoo Kuv muaj hnub nyoog 28 xyoo, qhov siab 180 cm, nyhav 72 kg. Kuv tau mob hom mob ntshav qab zib hom 1 txij xyoo 2002 los. Cov tshuaj Insulin - Humulin P (36 units) thiab Humulin P (28 units). Kuv txiav txim siab ua qhov kev sim - saib seb kuv cov ntshav qab zib yuav coj zoo li cas. Thaum sawv ntxov, yam tsis noj dab tsi, nws ntsuas ntshav qab zib - 14.7 mmol / l. Nws txhaj tshuaj insulin R (3 chav nyob) thiab txuas ntxiv mus txuas ntxiv nrawm, haus dej nkaus xwb. Txog yav tsaus ntuj (18:00) nws ntsuas cov piam thaj - 6.1 mmol / l. Nws tsis raug txhaj tshuaj insulin. Kuv txuas ntxiv haus dej xwb. Thaum 22.00 kuv qab zib twb yog 13 mmol / L. Kev sim ntev ntev li 7 hnub. Rau tag nrho lub sijhawm ua kev yoo mov, nws haus ib qho dej. Rau xya hnub thaum sawv ntxov, muaj piam thaj thaj tsam li 14 mmol / L. Txog 6:00 p.m. nws ntaus insulin Humulin R rau li qub, tab sis twb txog 10 teev ua suab thaj nce txog 13 mmol / l. Nyob rau txhua lub sijhawm ntawm kev yoo mov, tsis tau muaj lub siab ntshav qab zib. Kuv xav paub los ntawm koj yog vim li cas rau kev coj tus cwj pwm ntawm kuv cov suab thaj, vim hais tias kuv tsis tau noj dab tsi? Ua tsaug rau koj

Kuv xav paub koj los ntawm koj yog vim li cas qhov kev coj cwj pwm ntawm kuv cov piam thaj

Kev ntxhov siab cov tshuaj hormones zais cia los ntawm qog adrenal ua rau cov ntshav qab zib muaj spikes txawm tias thaum yoo mov. Vim tias cov ntshav qab zib hom 1, koj tsis muaj cov insulin txaus rau cov kev co no.

Koj yuav tsum hloov mus rau kev noj haus cov zaub mov tsis muaj roj, thiab tseem ceeb tshaj, kom kawm thiab siv cov hau kev rau kev suav cov tshuaj insulin kom tsawg. Txwv tsis pub, tsiaj plaub ntxhov tsuas yog ncig ntawm lub kaum.

Qhov tseeb yog tias thaum pib, thaum kuv muaj mob, cov suab thaj nyob hauv ib qho kev txwv, kev them nyiaj tsawg kawg ntawm cov tshuaj insulin. Tom qab qee lub sijhawm, "kws kho mob ntse" qhia txoj kev yoo mov, xav tias kev tshaib plab tuaj yeem kho tau ntshav qab zib. Thawj thawj zaug uas kuv tau tshaib plab rau 10 hnub, thib ob ib qho twb 20 Qab zib nyob ntawm kev tshaib plab txog 4.0 mmol / L, nws tsis tau nce siab saum toj, Kuv tsis tau txhaj tshuaj insulin txhua. Kuv tsis kho cov ntshav qab zib, tab sis kev siv cov tshuaj insulin raug txo tsawg rau 8 units hauv ib hnub. Tib lub sijhawm, kev noj qab haus huv tag nrho zoo dua. Tom qab qee lub sijhawm, nws tau tshaib plab dua. Ua ntej pib, Kuv haus ntau qhov kua txiv. Yog tias tsis tau txhaj tshuaj insulin, nws tau tshaib plab rau 8 hnub. Tsis muaj lub sijhawm los ntsuas kev qab zib thaum lub sijhawm ntawd. Raws li qhov tshwm sim, Kuv tau pw hauv tsev kho mob nrog cov tshuaj acetone hauv cov zis +++, thiab qab zib 13.9 mmol / L. Tom qab qhov xwm txheej ntawd, Kuv ua tsis tau yam tsis muaj insulin txhua yam, tsis hais kuv noj lossis tsis. Nws yog qhov tsim nyog los ntsaws rau hauv txhua kis tau. Qhia kuv, thov, muaj dab tsi tshwm sim hauv kuv lub cev? Tej zaum qhov laj thawj tiag tiag tsis yog kev ntxhov siab cov tshuaj hormones? Ua tsaug rau koj

muaj dab tsi tshwm sim hauv kuv lub cev?

Koj tsis tau haus dej txaus thaum lub sijhawm yoo mov, uas ua rau tus mob hnyav dua li, yuav tsum tau pw hauv tsev kho mob

Nyob zoo Tav Kuv xav tau koj cov lus ntuas. Niam tau raug tus mob ntshav qab zib hom 2 tau ntev li 15 xyoos. Tam sim no nws muaj 76 xyoo, qhov siab 157 cm, hnyav 85 kg. Rau lub hlis dhau los, cov tshuaj tsis ua rau kom cov suab thaj nyob li qub. Nws coj maninil thiab metformin. Thaum lub Rau Hli, glycated hemoglobin yog 8.3%, tam sim no nyob rau lub Cuaj Hli 7.5%. Thaum ntsuas nrog glucometer, qab zib yog ib txwm 11-15. Qee zaum nws khoob khoob plab 9. Cov ntshav biochemistry - qhov ntsuas yog qhov qub, tshwj tsis yog muaj roj (cholesterol) thiab TSH ntau ntxiv. Tus kws endocrinologist tau pauv leej niam tawm mus rau insulin Biosulin N 2 zaug hauv ib hnub, thaum sawv ntxov 12 units, yav tsaus ntuj 10 ntu, thiab tseem noj cov tshuaj thaum sawv ntxov thiab yav tsaus ntuj ua ntej noj mov. Peb txhaj tshuaj insulin rau ib lim piam, thaum suab thaj “seev cev”. Nws tshwm sim 6-15. Qhov pib, ntsuas 8-10. Siab tsis tu ncua nce mus txog 180 - kho nrog Noliprel forte. Ob txhais ceg tau tshuaj xyuas tas li rau qhov puas thiab pob - thaum txhua yam zoo. Tab sis kuv txhais ceg mob tiag tiag.
Cov lus nug: Nws puas muaj peev xwm ua rau nws thaum nws lub hnub nyoog nruj me ntsis rau cov zaub mov tsis muaj carbohydrate? Vim li cas cov piam thaj “dhia”? Cov txheej txheem ntxig tsis yog, koob, koob tshuaj? Los yog nws tsuas yog lub sijhawm txiav txim siab ib txwm? Siv cov tshuaj insulin tsis yog? Kuv zoo siab tos ntsoov rau koj cov lus teb, ua tsaug.

nws puas tuaj yeem ua raws li kev noj zaubmov uas tsis muaj rog nyob rau lub hnub nyoog?

Nws nyob ntawm qhov mob ntawm nws ob lub raum. Yog xav paub ntxiv, saib kab lus “Noj rau raum mob ntshav qab zib.” Txawm li cas los xij, koj yuav tsum hloov mus rau txoj kev noj haus no yog tias koj tsis xav mus raws koj niam txoj hauv kev.

Vim tias koj tsis tau ua txhua yam zoo.

Peb ua raws txhua cov lus qhia ntawm tus kws kho mob endocrinologist - nws hloov tawm, tus kws kho mob sau tawm hauv kev kho tsis raug?

Yuav ua li cas thiaj ua tau nws txoj cai? Tshem tawm cov tshuaj maninil, ntxiv cov tshuaj insulin?

Tus kws kho mob puas tau sau ntawv rau kev kho mob tsis ncaj ncees?

Txhua lub tsev kawm ntawv muaj cov kws khomob txog kev kho ntshav qab zib yam tsis raug

Ua ntej tshaj plaws, tshawb xyuas lub raum. Txhawm rau ntxiv, saib kab lus hais txog kev kho mob ntshav qab zib hom 2 + txhaj tshuaj insulin yog qhov xav tau, vim hais tias rooj plaub yog tsis quav ntsej.

Xaiv cov tshuaj kom haum ntawm cov tshuaj insulin raws li qhia hauv cov lus ntawm lub xaib. Nws raug nquahu kom siv cov tshuaj insulin cais thiab sai thiab tsis zoo li koj tau raug xaj.

Ua tsaug rau koj Peb yuav kawm.

Nyob zoo, kuv puas siv tshuaj insulin thaum yav sawv ntxov 36 ib qho ntawm cov protafan thiab yav tsaus ntuj thiab txawm tias noj cov zaub mov 30 ib pawg, Kuv tau qab qab zib thiab tamsis no kuv tsis muag cov zaub mov, tab sis kuv haus tam sim ntawd, Kuv hleb 1 thiab ua kom qab zib zoo dua thaum yav tsaus ntuj thiab yav sawv ntxov.

Nyob zoo. Kuv tus txiv muaj mob ntshav qab zib hom 2 txij xyoo 2003. Ib tug txiv neej 60 xyoo tau ib txwm nyob rau hauv cov ntsiav tshuaj ntawm ntau yam tshuaj pom zoo los ntawm cov kws kho mob (siofor, glucophage, pioglar, onglise,). Txhua xyoo nws tau raug kho hauv tsev kho mob, tab sis qab zib tau nce txhua lub sijhawm. Tau 4 xyoos dhau los, qab zib tau siab tshaj 15 thiab nce mus txog 21. Rau cov tshuaj insulin lawv tsis hloov lawv li, nws yog 59. Dhau li ntawm 1.5 xyoo dhau los, kuv poob 30 kg thaum kuv siv Victoza (txhaj rau 2 xyoo) raws li kws kho mob tau qhia. Thiab Kuv tau siv tshuaj kho thiab glycophage 2500. Cov piam thaj tsis poob rau hauv qab 15. Thaum kho ntxiv rau lub Kaum Ib Hlis, AKTAPID insulin raug tso cai ntawm 8 ntu 3 zaug hauv ib hnub thiab hmo ntuj LEVOMIR 18ED. Hauv tsev kho mob, acetone +++ raug kuaj pom ntawm keeb kwm ntawm kev kho mob tag nrho, nws tsis kam lees. 15 chav tsev yog tau sau npe nrog cov khoom siv ntawm acetone thiab qab zib. Acetone tas li cia nyob rau hauv 2-3 (++) Dej haus 1.5-2 litres ib hnub tas li. Ib lub lim tiam dhau los, lawv tig mus rau kev sab laj dua hauv tsev kho mob, hloov chaw ntawm Actrapid, NOVO RAPID tau raug tshaj tawm thiab cov tshuaj yuav tsum tau tuaj tos lawv tus kheej, thiab tus kws kho mob acetone yuav tsum tsis txhob mob siab rau acetone. Kuv tus txiv tsis mloog zoo. Nyob rau hnub so peb xav hloov mus rau NOVO RAPID. Koj tau qhia dab tsi rau kuv ntawm koob tshuaj dab tsi. Kuv yuav xav thov ua tsaug heev. Tus txiv tsis muaj qhov tsis zoo.

Dab tsi yog lub ntsiab lus ntawm kev noj zaub mov tsis muaj carbohydrate? Dab tsi ntawm dev paus? Kuv yog hom 1 mob ntshav qab zib nrog 20 xyoo kev paub. Kuv pub kuv tus kheej noj txhua yam! Kuv tau noj cov ncuav mog qab zib pancake. Kuv tsuas yog ua cov insulin ntxiv. Thiab qab zib yog ib txwm. Knead kuv koj cov khoom noj muaj roj tsawg, piav qhia?

Nyob zoo Tav
Kuv yog 50 xyoo. 4 xyoo hom 2 mob ntshav qab zib. Nws tau pw tsev kho mob nrog piam thaj 25 mmol. Lub Sijhawm: 18 ntu ntawm lub lantus thaum hmo ntuj + metformin 0.5 mg 3-4 ntsiav tshuaj ib hnub nrog zaub mov noj. Tom qab noj cov khoom noj carbohydrates (txiv hmab txiv ntoo, piv txwv), muaj ib txwm tingling hauv thaj chaw ceg qis thiab kuv yeej tsis nyiam nws. Tab sis kuv xav tias tsis muaj carbohydrates nws yog qhov tsis yooj yim sua, tshwj xeeb tshaj yog tsis muaj txiv hmab txiv ntoo, muaj cov vitamins. Qab zib thaum sawv ntxov tsis siab tshaj 5 (5 yog qhov tsis tshua muaj, tshaj txog 4), feem ntau qis dua qhov nruab nrab ntawm 3.6-3.9. tom qab noj mov (tom qab 2 teev) mus rau 6-7. Thaum kuv ua txhaum kev noj haus nws yog txog li 8-9 ntau zaus.
Qhia rau kuv, Kuv tuaj yeem nkag siab qhov kev coj mus rau qhov tsiv mus rau qhov twg, yog tias kuv tso tseg cov khoom noj carbohydrates - txo cov ntsiav tshuaj lossis cov tshuaj insulin? thiab yuav ua li cas thiaj ua nws nyob hauv kuv qhov xwm txheej? Cov kws kho mob yeej tsis xav ua txhua yam. Tsaug ua ntej.

Kuv tau mob T2DM rau 30 xyoo, Kuv hno Levemir rau 18 units thaum sawv ntxov thiab yav tsaus ntuj Kuv haus cov tshuaj metformin + glimepiride 4 thaum sawv ntxov + Galvus 50 mg 2 zaug, thiab qab zib thaum sawv ntxov 9-10 thaum nruab hnub 10-15. Puas muaj lwm yam kev txwv nrog tsawg dua cov ntsiav tshuaj? Nruab hnub insulin kws kho mob tsis pom zoo glycated hemoglobin 10

Nyob zoo Kuv muaj ntshav qab zib hom 2. Kuv yog 42 xyoo thiab hnyav 120 kg. qhov siab 170. Tus kws kho mob tau hais rau kuv tshuaj kho mob ua ntej noj mov 12 units Novorapid thiab hmo ntuj 40 units Tujeo. Qab zib thaum nruab hnub ib hnub tsawg dua 12 tsis tshwm sim. Thaum sawv ntxov 15-17. Kuv puas muaj txoj kev kho mob uas yog thiab qhov koj tuaj yeem qhia

Nyob zoo Tav Yog tias koj tuaj yeem paub tias kuv tau raug tshuaj kho kom raug raws li C-peptide tsom, 1.09 qhov tshwm sim, insulin 4.61 μmE / ml, TSH 1.443 μmE / ml, Glycohemoglobin 6.4% Cov Kua Muag 7.9 mmol / L, ALT 18.9 U / L Cov Roj (Cholesterol) 5.41 mmol / L, Urea 5.7 mmol / L Creatinine 82.8 μmol / L, AST 20.5 hauv cov zis txhua yam zoo. Glimepiride tau noj 2 g thaum sawv ntxov Metformin 850 thaum yav tsaus ntuj, Thioctic acid rau 2-3 lub hlis nrog nce ntxiv ntawm cov piam thaj, ntxiv 10 mg mg rau lub sijhawm tam sim no muaj 8-15 piam thaj 5.0 yog tias kuv tsis noj dab tsi rau ib nrab hnub. Qhov siab 1.72 nyhav 65kg los ua, yog 80kg. ua tsaug

Kho Bolus

Raws li koj nco, qhov insulin rhiab heev yog siv los ntsuas qhov tseeb, uas txiav txim siab ntau npaum li cas cov piam thaj hauv ntshav yuav txo nrog qhov kev qhia ntawm ib chav ntawm insulin. Piv txwv, insulin rhiab heev ntawm 10 qhia tau tias thaum ib lub zog ntawm cov tshuaj insulin raug tswj, cov ntshav qabzib yuav tsawg dua 10 mmol / L.

Txhawm rau ntsuas qhov ua tau zoo ntawm kev kho kom sai, ntshav qabzib tau ntsuas ua ntej cov tshuaj insulin thiab tom qab 2 thiab 4 teev (sijhawm ua haujlwm tseem ceeb ntawm insulin) tom qab kev tswj hwm. Nrog cov koob tshuaj kom yog ntawm bolus kho, cov ntshav qabzib cov ntshav tom qab 2 teev tsawg dua li 50% ntawm qhov xav tias yuav txo qis, thiab tom kawg ntawm lub sijhawm tseem ceeb ntawm cov tshuaj insulin, cov piam thaj yuav tsum nyob hauv lub hom phiaj (yoo ntshav cov ntshav qabzib uas koj tau ua tiav).

Kos rau kho bolus:

• Kho lus bolus yog xam raws li insulin rhiab heev tau(PSI)
• Ntsuas cov ntshav qabzib 2 thiab 4 teev tom qab kho bolus (KB)
• Txheeb xyuas KB rau hyperglycemia thiab qhov tsis muaj lwm yam boluses thiab zaub mov noj hauv 3-4 teev dhau los
• Nrog rau txoj cai koob tshuaj ntawm KB, cov ntshav qabzib feem ntau:

- 2 xuab moos tom qab kev tswj hwm tau raug txo los ntawm 50% qhov kev cia siab txo qis,
- 4 teev tom qab tswj tau nyob rau hauv hom phiaj

Daim duab piav qhia yuav ua li cas kwv yees li thaj tsam ntawm cov piam thaj hauv cov ntshav yuav tsum txo tom qab kev tswj hwm.

Daim duab 1. Li qub tsis muaj ntshav qabzib (GC) tom qab kev sivkho bolus

Piv txwv thaum 9:00 ib tus neeg muaj ntshav qabzib nyob rau qib 12 mmol / L nrog lub hom phiaj ntawm 6 txog 8 mmol / L thiab PSI ntawm 5. Nws txhaj ib chav ntawm cov tshuaj tiv thaiv bolus insulin (tsis muaj zaub mov noj), thiab tom qab 2 teev lub suab thaj nyob rau hauv cov ntshav txo qis mus rau 6.5 mmol / L, thiab tom qab 4 teev ntawm 13:00 cov ntshav ntawm cov ntshav nyob qis dua lub hom phiaj thiab tau muaj li 4 mmol / L.

Hauv qhov no, cov ntshav qabzib nyob rau qhov kawg ntawm qhov kev nqis tes tseem ceeb ntawm cov tshuaj tiv thaiv bolus qhia tau hais tias ib qho kev txhim kho ntau dhau ntawm bolus, thiab koj yuav tsum nce PSI los ntawm 10-20% txog 5.5-6 nyob rau hauv cov chaw ntawm lub tshuab xam zauv bolus, kom lwm zaus lub twj tso kua mis pom zoo ib yam txhaj cov tshuaj insulin tsawg dua.

Daim duab 2. KB - kho bolus, PSI - insulin rhiab heev tau

Hauv lwm kis, 4 teev tom qab kev tswj hwm ntawm txoj cai kho bolus, ntshav qabzib nyob siab dua qhov hom phiaj tau. Hauv cov xwm txheej no, qhov yuav tsum tau txo cov tshuaj insulin yog li xav tau cov insulin ntau dua.

Daim duab 3. KB - kho bolus

Khoom noj bolus

Txhawm rau suav cov bolus rau cov khoom noj, cov pa roj carbon carbohydrate coefficient yog siv. Kev soj ntsuam ib qho tshuaj bolus rau cov zaub mov yuav xav tau ntsuas ntawm ntshav cov ntshav ua ntej noj mov, 2 thiab 4 teev tom qab noj mov. Nrog rau cov koob tshuaj kom txaus ntawm cov zaub mov bolus, cov ntshav qabzib muaj nuj nqis ntawm qhov kawg ntawm kev ua haujlwm tseem ceeb ntawm insulin, tom qab 4 teev, yuav tsum nyob hauv tus nqi qub ua ntej noj mov. Kev nce me ntsis ntawm cov ntshav qab zib tau pub 2 teev tom qab tswj hwm ib qho khoom noj rau cov zaub mov, qhov no yog vim qhov kev txuas ntxiv ntawm cov tshuaj insulin nyob rau lub sijhawm no, vim tias nrog cov ntshav qabzib nyob rau hauv qhov sib npaug sib luag li thawj zaug, kev txo qis ntxiv hauv cov ntshav qabzib yuav tshwm sim, uas tuaj yeem ua rau lub qog ntshav qab zib.

Xyuas bolus rau zaub mov:

• Khoom noj khoom haus bolus tau muab xam raws li Piv rau carbohydrate (UK)
• Ntsuas cov piam thaj hauv ntshav ua ntej noj mov, 2 thiab 4 teev tom qab noj mov
• Nrog rau txoj cai koob ntawm PB, ntshav qabzib nyeem:

- 2 teev tom qab noj 2-3 mmol / l ntau dua tus nqi qub,
- 4 teev tom qab noj hauv tus nqi qub

Daim duab 4. Li qub tsis tshua muaj nyob hauv HA tom qab kev tswj hwm ntawm bolus rau zaub mov (BE). UK - carbohydrate coefficient; BE - zaub mov bolus

Kev kho kho cov carbohydrate

Yog 2 teev tom qab noj mov tas, koj cov ntshav qabzib yog:

• nce ntxiv ntau dua 4 mmol / l piv nrog qib ntsuas ua ntej noj mov - nce UK los ntawm 10-20%,
• poob los ntawm ntau dua 1-2 mmol / l piv nrog rau qib ua ntej noj mov - txo cov UK los ntawm 10-20%

Daim duab 5. BE - zaub mov bolus

Xav txog tias tom qab tswj hwm cov zaub mov ntawm 5 ntu ntawm 9:00, tom qab 2 teev, cov ntshav qabzib yog 2 mmol / l siab dua, thiab tom qab 4 teev, cov piam thaj hauv ntshav tau qis dua li ua ntej noj mov. Hauv qhov no, bolus rau zaub mov tau ntau dhau lawm. Muab cov carbohydrate piv yuav tsum raug txiav kom thiaj li muaj cov tshuab xam zauv bolus suav cov tshuaj insulin tsawg dua.

Daim duab 6. BE - zaub mov bolus

Lwm qhov, cov ntshav qabzib 4 teev tom qab ib pluas noj tau hloov dua siab dua qhov tseem ceeb thawj zaug, uas qhia tau tias tsis muaj bolus rau cov zaub mov. Nws yog ib qho tsim nyog yuav tsum nce tus lej carbohydrate coefficient kom cov koob tshuaj ntawm cov tshuaj insulin xam los ntawm bolus lub laij lej loj dua.

Thaum koj muab cov tshuaj bolus kho thiab bolus rau cov zaub mov (piv txwv li, nrog cov ntshav siab cov ntshav ua ntej noj mov), nws yog qhov nyuaj heev los soj ntsuam qhov tseeb tshuaj ntawm txhua bolus, yog li ntawd nws raug nquahu kom ntsuas qhov txhim kho bolus thiab bolus rau cov zaub mov tsuas yog thaum cov boluses no tau faib cais.

Txheeb xyuas qhov ntau npaum li cas ntawm cov tshuaj kho bolus thiab bolus rau cov zaub mov tsuas yog thaum lawv muab cais los ntawm ib leeg.

Dab tsi cuam tshuam bolus insulin hauv zaub mov?

Tus nqi ntawm cov insulin hauv ib pluag noj, lossis "bolus zaub mov" hauv txhua tus neeg, nyob ntawm ntau yam. Ua ntej tshaj plaws, ntawm chav kawm, qhov no yog qhov ntau ntawm cov carbohydrates uas ib tug neeg tau noj lossis yuav tau noj, nrog rau tus kheej piv ntawm carbohydrates thiab insulin - cov carbohydrate coefficient. Carbohydrate coefficient, raws li txoj cai, hloov pauv nruab hnub. Feem ntau cov neeg mob ntshav qab zib muaj feem ntau thaum sawv ntxov thiab qis dua yav tsaus ntuj. Qhov no yog vim qhov tseeb tias nyob hauv thawj ib nrab ntawm ib hnub ntawm qib ntawm cov tshuaj hormones contrainsular yog siab dua, uas txo cov hauj lwm zoo ntawm kev siv tshuaj insulin.

Lwm qhov tseem ceeb cuam tshuam rau bolus insulin yog cov khoom xyaw. Koj tuaj yeem nug: vim li cas, vim tias bolus nyob ntawm tus nqi ntawm cov khoom noj carbohydrates? Txawm hais tias qhov tseeb tias cov khoom xyaw ua ke tsis cuam tshuam ncaj qha rau cov tshuaj insulin, nws yuav ua raws li ntau npaum li cas sai thiab ntev li cas cov zaub mov yuav nce siab nyob rau hauv cov ntshav.

Kem 1. Qhov cuam tshuam ntawm cov zaub mov tseem ceeb ntawm cov zaub mov ntawm ntshav ntshav

Vim li cas nws thiaj li tseem ceeb uas yuav tsum xav txog khoom noj ua ke? Cov zaub mov sib txawv, txawm tias muaj tib lub txiaj sib npaug ntawm cov carbohydrates, tuaj yeem ua rau cov ntshav qab zib nyob sib txawv. Qhov feem pua ​​ntawm cov piam thaj hauv cov ntshav tom qab noj mov feem ntau nyob ntawm seb tus nqi tso tawm ntawm lub plab los ntawm cov zaub mov, uas nyob rau hauv lem ntau nyob ntawm cov khoom sib xyaw ua ke, nrog rau ob peb lwm yam. Yuav kom ua tiav cov kev tswj ntshav qab zib kom zoo dua, cov ntsiab lus no yuav tsum tau txiav txim siab txhawm rau kom ua tiav cov ntshav qab zib tom qab noj mov.

Kem 2. Dab tsi cuam tshuam qhov feem pua ​​ntawm cov ntshav qabzib nce tom qab noj mov

Noj qab nyob zoo txiav tawm zais zis insulin, nyob ntawm seb cov piam thaj xa li cas: yog tias cov piam thaj nkag mus rau hauv cov ntshav, maj mam ua kom cov kua ntshav zais insulin maj mam;

Thaum siv cov koob txhaj tshuaj, tsuas yog txoj hauv kev los tswj cov tshuaj insulin yog kom muab tag nrho cov tshuaj insulin ib zaug lossis faib rau ntau qhov, uas tuaj yeem tsis yooj yim thiab ua rau muaj kev tsis xis nyob ntxiv. Thaum siv lub tshuab raj insulin, ntau txoj hauv kev tshwm sim vim tias muaj ntau yam kev tswj hwm bolus thiab qhov tsis muaj qhov xav tau los ntawm kev txhaj tshuaj.

Cov hom ntawm Boluses

Los ntawm cov ntsiab lus qhia, muaj ob peb hom boluses (tsis hais seb cov zaub mov yog bolus lossis raug kho). Lub luag haujlwm tseem ceeb ntawm ntau hom kev tswj hwm bolus ntawm insulin yog los kho cov khoom sib xyaw ua ke (los ntawm nws cov txiaj ntsig ntawm qhov ceev thiab lub sijhawm nce ntawm cov piam thaj hauv cov ntshav), lub sijhawm noj mov thiab siv cov tshuaj insulin. Yuav luag txhua tus qauv ntawm insulin twj muaj peb hom kev tswj hwm bolus: txheem bolus, ncua bolus, ob npaug bolus.

Rooj 3. Hom Boluses

Dua zaum ob Bolus

Hom bolus no yog qhov sib xyaw ntawm ob yav dhau los (yog li lub npe "sib xyaw"), uas yog, ib feem ntawm cov insulin raug txhaj tam sim ntawd, thiab ib feem tau txhaj maj mam dhau ib lub sijhawm. Thaum sau hom bolus no, koj yuav tsum teeb tsa tag nrho cov insulin, qhov ntau ntawm cov insulin uas koj yuav tsum nkag mus tam sim (thawj nthwv dej), thiab lub sijhawm ntawm yoj ob. Hom bolus no tuaj yeem siv thaum noj cov zaub mov sib xyaw ua ke uas muaj cov rog thiab cov roj zom tau yooj yim (pizza, kib qos yaj ywm).

Thaum siv ob npaug bolus, tsis txhob faib rau cov khoom siv ncav ntau dua
50%, thiab lub sijhawm ntawm ob nthwv dej teeb tsa ntau tshaj 2 teev.

Tus nqi ntawm cov tshuaj insulin hauv thawj nthwv dej thib ib thiab ntu thib ob, nrog rau lub sijhawm ntawm ob nthwv dej, nyob ntawm seb cov khoom noj twg, cov piam thaj hauv cov ntshav ua ntej noj mov, thiab lwm yam. Koj yuav tsum tau xyaum txhawm rau txhawm rau pom kev ua kom zoo dua nthwv dej dual-wave nruas. Thawj thawj zaug, nws tsis raug nquahu kom txhaj ntau dua 50% ntawm tag nrho cov tshuaj insulin rau hauv nthwv dej thib ob, thiab lub sijhawm sijhawm ntawm nws cov thawj coj yuav tsum tau teem rau ntau dua 2 teev. Sij hawm dhau mus, koj tuaj yeem txiav txim siab pom qhov tsis zoo rau koj lossis koj tus menyuam uas yuav txhim kho cov ntshav qabzib tom qab noj mov.

Superbolus

Superbolus - qhov no yog qhov kev taw qhia ntawm ib feem ntawm cov insulin hauv basal hauv daim ntawv ntawm insulin bolus ntxiv, thaum cov khoom ntawm basal insulin yog kiag li nres lossis txo qis.

Ua kom ntau ntxiv ntawm cov tshuaj bolus insulin vim yog qhov pib ntawm qhov ncauj yuav pab tau thaum muaj kev cuam tshuam sai ntawm cov tshuaj insulin. Superbolus tuaj yeem qhia rau cov khoom noj, piv txwv li, thaum noj mov nrog lub siab glycemic index lossis nyob rau hauv rooj plaub ntawm "zaub mov" ceev.

Daim duab 7. Superbolus rau khoom noj

Tom qab noj cov zaub mov "nrawm" thiab cov txheej txheem bolus ntawm 6 units hauv ib pluag noj, ntshav qabzib nce ntau tshaj 11 mmol / l. Hauv qhov xwm txheej no, cov hauv paus pib rau 2 teev tom qab noj mov yog 1 U / teev. Txhawm rau los qhia qhov superbolus, nws muaj peev xwm tig VBS 0% rau ob teev, thiab lub sijhawm no 2 chav dej ntawm insulin yuav tsis muab tshuaj. Cov 2 PIECES ntawm insulin yuav tsum tau ntxiv rau cov zaub mov bolus (6 + 2 PIECES). Ua tsaug rau superbolus ntawm 8 units, qhov nce ntxiv ntawm cov piam thaj hauv cov ntshav tom qab noj mov yuav pom tias tsawg dua li nrog ib qho bolus zoo tib yam.

Tsis tas li, cov superbolus tuaj yeem qhia rau kev kho ntawm cov ntshav qabzib hauv cov ntshav, thiaj li yuav txo cov ntshav qabzib mus rau cov hom phiaj sai li sai tau.

Daim duab 8. Kho Superbolus

Txhawm rau tswj hwm cov superbolus, cov tshuaj basal yog muab tua (VBS - tus nqi them ib ntus 0%) rau ob teev. Qhov kev txhaj tshuaj ntawm cov tshuaj insulin tsis muab rau lub sijhawm no ntawm qhov ceev ntawm 1 U / teev yuav yog 2 U. Cov tshuaj insal hauv qab no ntxiv rau txoj kev tiv thaiv bolus. Kev kho cov tshuaj insulin rau ib qho ntshav qabzib yog 4 PIECES, yog li tus superbolus yuav yog 6 PIECES (4 + 2 PIECES). Kev qhia ntawm lub superbolus yuav txo cov ntshav qabzib sai dua thiab ua tiav cov hom phiaj nyob rau lub sijhawm tsawg dua piv rau bolus txheem.

Nco ntsoov tias thaum siv superbolus, txhua qhov kev txhaj tshuaj insulin yog suav tias yog kev nquag, txawm hais tias qee qhov ntawm nws yog, qhov tseeb, qhov tsis txaus noj. Khaws qhov no hauv siab thaum qhia cov bolus tom ntej.

I.I. Yawg cov yawg, V.A. Peterkova, T.L. Kuraeva D.N. Laptev