Kev qhia rau kev kho insulin:

Ketoacidotic coma (txhua ntu), tseem ceeb ua rau muaj kev mob ntshav qab zib mellitus nrog kev txhim kho ketosis lossis ketoacidosis

Yam 1 mob ntshav qab zib mellitus

Cev xeeb tub, yug menyuam, lactation

Kev raug mob thiab kev phais mob hauv cov neeg mob ntshav qab zib mellitus ntawm ib yam (tshwj xeeb yog mob plab)

Mob myocardial infarction

Mob cerebrovascular mob

Kab mob ntshav (mob leukemia, thrombocytopenia, suav nrog ntshav liab)

Organic theem ntawm microangiopathies

Kab Mob Kis thiab Kis Mob

Exacerbation ntawm cov kab mob mus ntev (mob ntsws, mob cholecystitis, mob peptic, thiab lwm yam)

Cov kab mob ntev ntev (mob ntsws, thiab lwm yam)

Cov mob qog ua paug thiab mob kis rau daim tawv nqaij (mob pob khaus, ua paug, mob rwj, mob carbuncles)

Cov kab mob ntawm daim siab thiab lub raum nrog nrog kev ua txhaum ntawm lawv txoj haujlwm

Kev tawm tsam kev siv tshuaj ntawm qhov ncauj hypoglycemic (tsis muaj cov nyhuv hypoglycemic thaum sau ntawv yuav tsum tau txhaj ntau tshaj plaws txhua hnub)

Kev hnyav hnyav

Nws yuav tsum raug qhia meej tias kev teem sij hawm ntawm insulin yog qhia kiag rau tus mob ntshav qab zib hom 1, nrog kev txhim kho mob ntshav qab zib (hyperglycemic), ketoacidosis, thaum cev xeeb tub, yug menyuam thiab lactation, kev phais mob.

Tam sim no, hauv cov neeg mob ntshav qab zib tau txais kev kho mob insulin, tshuaj tiv thaiv kab mob ua rau tib neeg cov tshuaj insulin thiab nws cov analogues tau siv, uas tsis txawv tus tib neeg hauv cov qauv tshuaj, tab sis txawv ntawm qhov kev txiav txim ntawm cov amino acids thiab pharmacokinetics.

Cov yam ntxwv ntawm cov tshuaj insulin:

Lub npe siv thoob ntiaj teb

Lub npe lag luam tau sau npe nyob rau hauv Lavxias Federation

Cov kev txiav txim siab ultrasound (tib neeg cov tshuaj insulin)

Tom qab 5-15 feeb

Soluble tib neeg cov roj ntsha tsim cov tshuaj insulin

Tom qab 20-30 feeb

Lub sijhawm nruab nrab

Isofan - Tib neeg Kev Tshawb Fawb Hauv Kev Tsim Kho Kev Tshawb Fawb Hauv Tib Neeg

Tom qab 6-10 teev

Ua si ntev (tib neeg cov tshuaj insulin)

Kev sib xyaw ntawm cov tshuaj insulin luv luv thiab NPH-insulin

Tib neeg-noob insulin biphasic insulin

Insuman Comb 25

Tib yam li rau kev ua yeeb yam luv luv thiab NPH-insulin, hauv kev sib xyaw ua ke lawv nyias ua nyias

Cov khoom sib xyaw ua ke ntawm cov kab hluav taws xob (insulin analogs) thiab cov kab mob tiv thaiv cov dej

Lizpro biphasic cov kua dej

Neej Neeg Sib Xws 25

Neej Neeg Qhia 50

Tib yam li rau analogues ntawm ultrashort kev txiav txim thiab NPH-insulin, hauv kev sib xyaw lawv ua nyias

Biphasic Insulin Aspart

Hauv cov kab mob hais txog lub cev, tus neeg noj qab haus huv tsim tau los ntawm 23 rau 60 units ntawm insulin ib hnub, uas yog los ntawm 0.6 txog 1.0 units / kg ntawm lub cev hnyav. Tshuaj insulin zais cia txhua hnub thiab yog li 1-2 units ntawm insulin nyob rau ib teev. Ntxiv rau, rau txhua pluas noj, ncov lossis bolus insulin secretion tseem tau pom, ntau npaum li cas rau 1.0-0-2.0 rau txhua qhov 10-12 g ntawm carbohydrates.

Kev ua haujlwm ntawm kev siv tshuaj insulin yog los ua qauv zoo rau lub cev kev tso dag ntawm insulin hauv tus neeg mob ntshav qab zib mellitus. Rau qhov no, txhua hom muaj insulin siv.

Muaj ob txoj kev feem ntau los ntawm kev kho insulin:

- mob siab (yooj yim - bolus)

Hauv kev siv tshuaj insulin ntau dua, 2 koob tshuaj tiv thaiv ib nrab-insulin (IDI) feem ntau siv los ua qauv rau kev zais cia ua ntej noj tshais thiab ua ntej noj hmo, lossis thaum yuav mus pw, lossis ib qho kev txhaj tshuaj insulin ntev ntev thaum mus pw. Cov zaub mov tso tawm ntawm cov kua dej los ntawm cov insulin yog simulated los ntawm kev tswj hwm ntawm luv luv lossis ultrashort insulin ua ntej noj mov loj (noj tshais, noj su, noj hmo). Qhov kev qhia tshuaj insulin no tau pom zoo rau cov neeg mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2. Nrog nws lub sijhawm teem sijhawm, nws muaj peev xwm los tswj cov nyiaj them rau qhov zoo tshaj plaws rau kev noj haus metabolism, muab rau tus neeg mob tau kawm thiab tshuaj xyuas nws tus kheej, txawm li cas los xij, hom no tseem muaj yam tsis zoo, uas yog, kev pheej hmoo ntawm kev txhim kho hypoglycemia hauv cov neeg mob tau nce.

Hauv kev siv tshuaj insulin ib txwm, luv luv thiab nruab nrab lub sij hawm txhaj tshuaj insulin tsuas muab ua ntej noj tshais thiab noj hmo. Cov tshuaj insulin luv luv (ICD) ua ntej noj su nrog cov kev cai no tsis tau txais nyob rau hauv kev cia siab tias tom qab postprandial hyperglycemia tau xaj los ntawm kev ua ntawm ib nrab-lub caij ntev insulin, uas tau noj thaum noj tshais. Nrog rau kev tswj hwm ntawm kev siv tshuaj insulin no, feem ntau tsis tuaj yeem ua tiav cov txiaj ntsig zoo rau cov metabolism hauv kev ua kom yuag. Cov tswv yim zoo li no feem ntau tsis siv thiab, raws li txoj cai, hauv cov neeg laus cov neeg mob ntshav qab zib hom 2, nyob rau hauv kev cia siab nyob ntev tsis tau thiab kev siv cov tshuaj insulin tsis tsim nyog vim qhov kev pheej hmoo ntawm hypoglycemia.

Ib qho piv txwv ntawm xam cov cim ntsuas ntawm kev kho mob insulin ntau:

Tus neeg mob A., 20 xyoo, hnyav 65 kg, qhov siab - 178 cm, tau nkag mus hauv tsev kho mob nrog kev tsis txaus siab ntawm kev nqhis dej, polyuria (txog 4-6 litres ib hnub), qhov tsis muaj zog txaus, qhov hnyav poob ntawm 8 kg hauv ib lub lis piam. Cov tsos mob no tau sau tseg txog li ntawm ib lub lim tiam. Kev soj ntsuam lub hom phiaj qhia tawm dryness ntawm daim tawv nqaij thiab pom cov leeg ua kua. Rau cov kabmob uas tsis muaj kab mob. Kev yoo mov glycemia yog 16.8 mmol / L, tso zis acetone zoo. Raws li cov ntaub ntawv soj ntsuam thiab kuaj, hom ntshav qab zib hom 1 tau kuaj pom.

1. Kev kwv yees txhua hnub ntawm kev siv tshuaj insulin nyob rau hauv tus neeg mob uas nyuam qhuav pib mob ntshav qab zib mellitus tau txiav txim siab los ntawm qhov muab xam ntawm 0.3-0.5 U / kg ntawm lub cev hnyav: 65-0.5 = 32 U

Nrog rau tus kab mob ntshav qab zib hom tshiab 1, tsuas yog siv tshuaj insulin luv luv (ICD) feem ntau yog kev kho mob, uas tau muab fractionally 3-6 zaug hauv ib hnub, nyob ntawm qhov mob hnyav ntawm hyperglycemia thiab muaj cov acetonuria nrog kev ncua sij hawm 3-4 teev. Hauv kev tswj hwm 3-zaug, ICD tau sau ua ntej noj zaub mov tseem ceeb hauv koob tshuaj noj raws li tus naj npawb ntawm cov khob cij (XE) - 1 XE 2.0 -1.5-1.0 IU ntawm insulin (feem, ua ntej noj tshais, noj su thiab noj hmo) thiab glycemia qib ua ntej noj mov. Hauv qib siab ntawm cov ntshav tsis siab tshaj 6.7 mol / L, cov tshuaj insulin raug muab rau hauv cov tshuaj uas suav los ntawm tus nqi XE; ntawm cov nqi ntau dua, qhov kev kho kom haum rau cov tshuaj insulin yog raws li qhov kev xav tias 1 U ntawm insulin txo glycemia los ntawm 2.2 hliol / L. Yog tias pom muaj cov tshuaj acetonuria, cov naj npawb ntawm insulin nce ntxiv rau 4-6 vim tau ntxiv podkolok tsa nyob nruab nrab ntawm cov kev txhaj tshuaj tseem ceeb (koob tshuaj ICD nrog ntxiv ntxiv yog feem ntau 4-6 units).

Feem ntau ntawm cov tshuaj txhua hnub ntawm insulin (2/3) yog kho nyob rau hauv 1st ib nrab ntawm lub hnub, so - thaum thib ib nrab thiab, yog tias tsim nyog, thaum tsaus ntuj. Raws li cov ntaub ntawv ntawm cov glycemic profile ua txhua hnub thaum xaiv cov tshuaj txhua hnub ntawm cov tshuaj insulin, cov koob tshuaj insulin raug kho. Raws li cov ntshav piam thaj normalizes thiab acetonuria raug tshem tawm, tus neeg mob uas muaj ntshav qab zib hom 1 tau raug muab tshuaj kho cov tshuaj insulin niaj hnub, suav nrog kev txhaj tshuaj ntawm ICD thiab ISD. Piv txwv tias hauv peb qhov piv txwv, kwv yees kwv yees niaj hnub ntawm insulin (32 PIECES) tau txaus los them rau cov kev ua kom muaj kab mob carbohydrate thiab tsis tas yuav tsum tau kho. Los ntawm cov koob tshuaj no, tus lej ntawm ICD thiab ISD yuav tsum tau laij.

2. Qhov koob tshuaj txhua hnub ntawm luv luv ua yeeb yam insulin (ICD) yog 2/3 ntawm qhov yuav tsum tau ua txhua hnub: 322 / 3 = 21ED

3. Qhov koob tshuaj txhua hnub ntawm nruab nrab ua yeeb yam insulin (ISD) yog 1/3 ntawm qhov yuav tsum tau ua txhua hnub: 321 / 3 = 11 PIECES

4. Thaum sawv ntxov ntxov, 2/3 ntawm tag nrho cov tshuaj txhua hnub ntawm ISD raug tswj hwm: 11-2 / 3 = 7 PIECES. thiab thaum yav tsaus ntuj 1/3 - 4 chav nyob

5. Cov koob tshuaj ntawm ICD tau faib raws li hauv qab no:

nyob rau lub sijhawm yav tsaus ntuj (noj hmo) ј koob tshuaj ICD ib hnub: 211 / 4 = 5 seem

rau pluas tshais thiab su noj nyob rau hauv tag nrho - 3/4 ntawm qhov tshuaj txhua hnub ntawm ICD: 21/3/4 = 16 PIECES. Kev faib rau txhua qhov kev txhaj tshuaj yog 50% (8 units) lossis noj su yog 2-4 units ntau dua, vim tias feem ntau ntau cov carbohydrates yog noj thaum noj su ntau dua thaum noj tshais (6 units thiab 10 units)

Yog li, kev suav ntawm cov koob tshuaj insulin yuav tsum xaus nrog kev npaj ntawm kev kho tshuaj insulin, uas tau sau cia hauv keeb kwm kev kho mob thiab daim ntawv teev tshuaj uas tau sau tseg:

8.30 - 6 PIECES S.Actrapidi HM + 7 PIECES S. Protafani HM

13.30 - 10 UNITS S.Actrapidi HM

32 units / hnub, sc

Kev teem sijhawm ntawm cov tshuaj insulin kho mob tam sim no feem ntau tsuas yog raug rau cov neeg laus laus uas muaj hom mob ntshav qab zib mellitus thib ob, hauv kev kho mob nrog kev noj zaub mov noj tshuaj thiab cov ntsiav tshuaj tsis ua hauj lwm zoo los yog pib ntawm tus kab mob tau qhia kev ua txhaum ntawm lub siab, ob lub raum, vascular cov teeb meem ntawm cov organic theem. Cov kev cai qub ntawm kev kho mob insulin yuav tsum to taub raws li kev qhia ntawm insulin hauv "ob" kev txhaj tshuaj: ua ntej noj tshais, ICD nrog rau ISD thiab ua ntej noj hmo, kev sib xyaw zoo sib xws.

Ib qho piv txwv ntawm kev xam lub phiaj xwm ntawm kev kho mob insulin ib txwm:

Tus neeg mob K., 72 xyoo, hnyav 70 kg, tau raug tso cai rau lub tuam tsev endocrinology hauv kev coj ua ntawm cheeb tsam endocrinologist nrog kev ntsuas ncaj qha: hom 2 mob ntshav qab zib mellitus, thawj zaug kuaj pom. Kev yoo ntshav cov ntshav yog 9.1 mmol / L, tso zis acetone tsis zoo. Thaum nug nws, nws tau muab tawm tias tus neeg mob txhawj xeeb tshaj plaws txog qhov kev txo qis ntawm kev pom tseeb zoo nkauj. Kev tsis muaj zog ntau yam, qaug zog, lub qhov ncauj qhuav me me, nqhis dej ntau txog 4-5 xyoos, tab sis tsis tau tham nrog kws kho mob. Tus kws kho qhov muag ntawm pob nyiaj tau nthuav tawm ntau txoj kev kho mob raws cov hlab ntsha, cov hlab ntsha tsim tshiab, "paj rwb" thiab cov tawv tawv ntawm qhov chaw macular, thiab qhov mob ntshav qab zib retinopathy theem tau kuaj pom.

Qhov qhia tau rau kev kho tshuaj insulin rau hauv tus neeg mob no yog cov organic ntawm kev rov ua haujlwm.

1. Kev xav tau insulin txhua hnub hauv tus neeg mob uas nyuam qhuav muaj ntshav qab zib tshiab (tsis tau txais kev kho mob insulin) yog 0.3-0.5 U / kg lub cev hnyav: 70-0.3 = 21 U. Xws li hauv rooj plaub dhau los, tsuas yog ICD xub pib sau tseg ua ntej noj mov tseem ceeb. Tom qab, raws li qhov kawg txhua hnub koob tshuaj insulin raug xaiv, cov koob tshuaj ntawm ICD thiab ISD yog laij. Piv txwv tias nyob rau hauv peb cov ntaub ntawv xav tau txhua hnub rau insulin yog 28 units.

2. 2/3 ntawm cov koob tshuaj insulin txhua hnub yog muab rau thaum sawv ntxov: 28-2 / 3 = 18ED.

3. Qhov piv ntawm ICD: ISD nyob rau thaum sawv ntxov yuav tsum muaj kwv yees li 1: 2, i.e. 6 units thiab 12 units, ntsig txog.

4. 1/3 ntawm qhov xav tau txhua hnub rau cov tshuaj insulin yog tswj hwm thaum yav tsaus ntuj 281 / 3 = 10ED.

5. Qhov piv ntawm ICD: ISD nyob rau yav tsaus ntuj tuaj yeem yog 1: 1 (uas yog, 5 units thiab 5 units, ntsig txog) lossis 1: 2.

Kev suav ntawm kev txhaj tshuaj ntawm cov tshuaj insulin yuav tsum xaus nrog kev npaj ntawm kev kho tshuaj insulin, uas tau muab teev cia hauv keeb kwm kev kho mob thiab cov npe tshuaj:

Kev kho mob ntshav dej

Kev kho tshuaj insulin Nws yog cov kev ntsuas hom phiaj ntawm kev ua tiav kev them nyiaj rau cov piam thaj ntawm lub cev metabolism los ntawm kev qhia cov tshuaj insulin rau hauv tus neeg mob lub cev. Hauv kev kuaj mob, nws yog siv rau kev kho mob ntshav qab zib mellitus ntawm ntau yam etiologies, nrog rau qee yam mob hlwb thiab lwm yam.

Kev kho tshuaj Insulin yog tsom mus rau qhov nyiaj pab ntau tshaj plaws rau kev cuam tshuam ntawm cov metabolism hauv kev ua kom rog, kev tiv thaiv hyperglycemia thiab kev tiv thaiv kev mob tshwm sim ntawm ntshav qab zib. Kev tswj hwm cov tshuaj insulin yog qhov tseem ceeb rau cov neeg muaj ntshav qab zib hom 1 thiab tuaj yeem siv rau qee qhov xwm txheej rau cov neeg muaj ntshav qab zib hom 2.

Cov Khoom Qhia

Tam sim no, muaj ntau ntawm cov tshuaj insulin, sib txawv hauv lub sijhawm ntawm kev ua (ultrashort, luv luv, nruab nrab, ntev ntev), nyob rau hauv cov ntsiab lus ntawm kev ua kom huv (monopic, monocomponent), hom kev tshwj xeeb (tib neeg, nqaij npuas, bovine, kev kho caj ces, thiab lwm tus)

Hauv tebchaws Russia, cov tshuaj insulin tau los ntawm nyuj raug tshem tawm ntawm kev siv, qhov no yog vim muaj ntau qhov tshwm sim thaum siv. Kuj muaj ntau, nrog lawv cov kev qhia, kev ua xua, lipodystrophies tshwm sim, muaj peev xwm tiv thaiv insulin.

Cov tshuaj insulin muaj nyob rau hauv qhov ntau ntawm 40 IE / ml thiab 100 IE / ml. Hauv teb chaws Russia, qhov kub siab ntawm 100 IE / ml yog tam sim no feem ntau, cov tshuaj insulin tau faib rau hauv 10 ml vials lossis hauv 3 ml koob txhaj tshuaj.

Ntu ntsuas |

Kev siv tshuaj insulin

Lub luag haujlwm ntawm "insulin" zaub mov, uas tsim tawm los ntawm cov txiav ua neeg tsis muaj mob rau cov neeg noj qab haus huv hauv kev teb rau kev noj zaub mov, yog ua los ntawm insulin luv lossis ultrashort. Cov insulins no yog tsim thaum kev ua haujlwm sai ntawm insulin xav tau ua ntej noj mov kom tiv thaiv kev nce ntshav qab zib tom qab noj mov. Yog li, cov tshuaj insulins no muab tsawg kawg 3 zaug hauv ib hnub - ua ntej noj tshais, ua ntej noj su thiab ua ntej noj hmo.

Luv luv thiab Ultrashort Insulin

Cov tshuaj insulin luv luv (insulin yooj yim, lossis insulin ua yeeb yam luv luv) yog kua ntshiab thiab tsis muaj yeeb yuj. Nws muaj qhov pib sai thiab lub sijhawm luv luv ntawm kev txiav txim.

Yog tias koj tab tom siv ib qho ntawm insulins luv luv yooj yim, nco qab cov hauv qab no.

Vim tias qhov pib qeeb ntawm qhov kev txiav txim ntawm hom insulin no, nws yog ib qho tsim nyog yuav tau soj ntsuam ib ntu ntawm 20-40 feeb ntawm kev txhaj tshuaj thiab kev noj zaub mov. Nws yog ib qho tsim nyog uas lub ncov ntawm insulin ua hauj lwm ua ke nrog lub siab ntawm kev nce hauv cov ntshav qab zib.
Yog tias txhaj tshuaj insulin, tom qab 20-40 feeb nws yuav tsum noj cov zaub mov nruj me ntsis rau cov koob tshuaj tiv thaiv kab mob tsim. Cov zaub mov me dua yuav ua rau kom cov ntshav qab zib tsawg dua (cov ntshav qab zib tsawg), thiab ib qho loj dua yuav ua rau nce ntxiv (hyperglycemia).
Nruab nrab ntawm cov zaub mov tseem ceeb, khoom noj txom ncauj yog tsim nyog (2nd pluas tshais, khoom noj txom ncauj thaum tav su, noj hmo thib 2). Qhov no yog vim qhov tseeb tias lub sijhawm ua haujlwm ntawm cov insulin yooj yim ntev dua li lub sijhawm nce ntshav qab zib cov ntshav tom qab noj mov thiab 2-3 teev tom qab noj mov muaj lub sijhawm thaum tseem muaj cov tshuaj insulin nyob hauv ntshav txaus thiab tsis muaj cov piam thaj ntxiv ntxiv lawm. Txhawm rau tiv thaiv hypoglycemia nyob rau lub sijhawm no, xav tau khoom noj txom ncauj.

Ultra-luv-ua yeeb yam insulins (Humalog thiab Novorapid) nyob rau hauv lawv cov kev ua zoo li lub cev teb rau qhov nce ntawm cov ntshav qab zib tom qab noj mov, nqus tau nyob rau hauv thaum uas tig mus nrog kev noj zaub mov.

Yog li, lawv qhov kev siv ua insulin zaub mov muaj cov zoo li hauv qab no.

Kev pib sai ntawm kev txiav txim tso cai koj tuaj yeem tso tshuaj insulin ua ntej noj mov, thaum koj twb paub qhov nyiaj ntawm kev txom nyem uas tam sim no yuav tau noj.
Qee qhov xwm txheej, thaum nws nyuaj rau kev txiav txim siab cov khoom noj no ua ntej, suav nrog hauv cov menyuam yaus, kev txhaj tshuaj tuaj yeem tsim tom qab noj mov, xaiv ib koob nyob ntawm seb khoom noj ntau npaum li cas.
Vim tias qhov tseeb tias lub sijhawm ntawm kev ua ntawm ultrashort insulins kwv yees li ntawm lub sijhawm nce ntawm cov ntshav qab zib theem tom qab noj mov, koj tsis tuaj yeem noj khoom txom ncauj ntawm cov zaub mov tseem ceeb.

Ua tsaug rau cov kev zoo no, Humalog thiab Novorapid muaj kev yooj yim dua, tshwj xeeb tshaj yog thaum tseem hluas, thaum koj xav tau kev ywj pheej ntau dua ntsib cov phooj ywg, mus saib cov koob npe thiab kev ua si kis las.

Dab tsi yog qhov txawv ntawm cov insulins no?

Cov tshuaj insulins hauv nruab nrab-sijhawm (Humulin N, Protafan) muaj nyob rau hauv daim ntawv ntawm lub turbid ncua kev kawm (vim yog ntxiv cov tshuaj rau cov kua dej uas ua rau nws nqus tau qeeb thiab ua rau cov nyhuv ntev dua).

Qhov tshuaj insulin no pib ua 1.5-2 teev tom qab txhaj tshuaj, nws cov nyhuv ntev dua li cov insulin luv. Yuav tsum muaj cov insulin pab rau kev tswj cov piam thaj hauv ntshav thaum noj mov thiab thaum hmo ntuj. Txij li txhua qhov kev ua yeeb yam txuas ntxiv uas siv rau hauv cov menyuam yaus ntev txog 14 teev los tsim ib qho insulin nyob rau hauv ib hnub, lawv yuav tsum siv tsawg kawg 2 zaug hauv ib hnub - ua ntej noj tshais thiab ua ntej noj hmo. Txhawm rau kom muaj kev sib xyaw ntawm cov tshuaj insulin, qhov kev ncua yuav tsum tau muab sib xyaw ua ntej txhaj.

Cov ua haujlwm ntev insulins (Lantus, Levemir), nyob rau hauv sib piv rau nruab nrab-ntev insulins, yog cov kua ntshiab. Cov insulins no tseem hu ua analogues ntawm tib neeg cov insulin, vim qhov tseeb tias lawv sib txawv hauv cov qauv tshuaj los ntawm insulin tsim los ntawm tib neeg tus kab mob hlwb (vim tias lub sijhawm ntawm lawv cov nyhuv ua tiav).Lub sijhawm ua haujlwm ntawm Lantus yog 24 teev, yog li ib hnub txhaj ib hnub txaus. Ib qho tseem ceeb ntxiv ntawm cov kua dej no yog qhov tsis muaj qhov kawg.

Lub sijhawm ua haujlwm ntawm Levemir yog 17-20 teev, yog li feem ntau 2 txhaj tshuaj ntawm qhov insulin no ib hnub. Tsis zoo li Protafan, nws muaj qhov hloov pauv ntau yam tsawg.

Vim tias qhov no, Levemir tau pom tias muaj dav siv hauv cov menyuam yaus, thaum Lantus tsis tuaj yeem siv vim qhov xav tau sib txawv ntawm cov kua dej qab ntsev thaum nruab hnub thiab hmo ntuj (raws li txoj cai, nws yog tsawg dua yav hmo ntuj thiab ntau dua thaum nruab hnub).

Ntawm Kev Siv Tshuaj Tiv Thaiv Ib Nrab

Nws yuav tsum tau yug los hauv lub siab tias lub sijhawm ua haujlwm ntawm kev ua haujlwm ntawm insulin yog nyob ntawm nws qhov koob tshuaj, i.e. yog tias cov tshuaj insulin ntau ntxiv raug siv, ces nws yuav ua ntev dua me dua kev txhaj tshuaj me dua.

Ua raws li hom tshuaj insulin luv siv (yooj yim lossis ultrashort) thiab qib ntawm cov ntshav qab zib ua ntej noj mov, muaj qhov sib txawv ntawm qhov sib txawv ntawm "kev txhaj tshuaj - kev noj zaub mov" (Cov Lus 9).

Cov lus 9. Lub sijhawm luv "kev txhaj tshuaj - noj" nyob ntawm hom tshuaj insulin thiab theem pib ntawm glycemia

Glycemia ua ntej noj mov, mmol / l	Luv luv ua yeeb yam insulin	Ultra Luv luv ua yeeb yam
Hauv qab 5.5	Txhaj tshuaj - 10-15 feeb - pluas noj	Noj - Kev Txhaj Tshuaj
5,5-10,0	Txhaj tshuaj - 20-30 feeb - noj mov	Txhaj - tam sim ntawd ib pluas noj
Tshaj 10.0	Txhaj tshuaj - 30-45 min - noj mov	Txhaj tshuaj - 15 min - noj mov
Tshaj 15.0	Txhaj - 60 min - noj mov	Txhaj tshuaj - 30 min - noj mov

Thov nco ntsoov tias thaum siv cov tshuaj insulin luv luv, tsis hais txog qib ntshav qab zib, ua ntej noj mov, yuav tsum txhaj tshuaj insulin XWB ua ntej yuav noj mov, thiab thaum siv cov Humalog lossis Novorapid, ua ntej UA NTEJ thiab tom qab noj mov!

Ib qho piv txwv ntawm kev suav lub cim ntsuas ntawm kev siv tshuaj insulin ntau ntxiv

Tus neeg mob A., 20 xyoo, lub cev hnyav 70 kg, qhov siab - 176 cm, tau mus pw hauv tsev kho mob nrog kev tsis txaus siab ntawm kev nqhis dej, polyuria (txog 3-4 litres ib hnub), qhov tsis muaj zog txaus, qhov hnyav poob ntawm 3 kg hauv ib lub lis piam. Cov tsos mob no tau sau tseg txog 5 hnub, koom nrog lawv cov tsos nrog tus mob hloov ARVI.

Kev kuaj lub hom phiaj qhia cov paib lub cev qhuav hauv lub cev yam tsis muaj kab mob. Kev yoo mov glycemia yog 9.8 mmol / L, tso zis acetone yog qhov tsis zoo.

1) Kev xav tau txhua hnub rau insulin hauv tus neeg mob uas nyuam qhuav soj ntsuam kab mob ntshav qab zib mellitus yog 0.3-0.5 U / kg lub cev hnyav: 70x0.5 = 35 U.
2) Niaj hnub noj tshuaj Luv luv insulin (ICD) ua 2/3 ntawm qhov yuav tsum tau ua txhua hnub: 35x2 / 3 = 23 units.
3) Cov koob tshuaj txhua hnub Nruab Nrab Sijhawm Insulin (ISD) yog 1/3 ntawm qhov yuav tsum tau ua txhua hnub: 35x1 / 3 = 12 PIECES.
4) Thaum sawv ntxov ntxov, 2/3 ntawm tag nrho cov tshuaj txhua hnub ntawm ISD raug tswj hwm: 12x2 / 3 = 8 PIECES, thiab thaum yav tsaus ntuj 1/3 - 4 PIECES.
5) Qhov txhaj tshuaj ntawm ICD thaum xub thawj yog:

nyob rau lub sijhawm yav tsaus ntuj (noj hmo)% ntawm kev txhaj tshuaj txhua hnub ntawm ICD: 23x1 / 4 = 5 PIECES,
rau pluas tshais thiab su noj nyob rau hauv tag nrho - 3/4 ib hnub twg ntawm ICD: 23x3 / 4 = 18 PIECES.

Kev faib rau txhua qhov kev txhaj tshuaj yog 50% (9 units) lossis noj su, 2-4 units ntau dua, vim tias feem ntau ntau cov carbohydrates ntau dua tshais (8 units thiab 10 units).

Yog li, kev suav ntawm cov koob tshuaj insulin yuav tsum xaus nrog kev npaj ntawm kev kho tshuaj insulin, uas tau sau cia hauv keeb kwm kev kho mob thiab daim ntawv teev tshuaj uas tau sau tseg:

8.30 - 8 PIECES ntawm S. Actrapidi HM + 8 PIECES ntawm S. Protaphani HM
13.30 - 10 PIECES S.Actrapidi HM
17.30 - 5 units ntawm S. actrapidi HM + 4 units ntawm S. protaphani HM
35 units / hnub, sc

Nrog qhov tseeb kev tsim kho cov tshuaj insulin, kev txhaj tshuaj ntawm ICD muab tshuaj yog nyob ntawm tus nqi ntawm cov khoom noj carbohydrates ua kom tau npaj rau kev noj haus thiab nyob rau theem ntawm glycemia.

Ib qho piv txwv ntawm suav lub cim ntsuas ntawm kev kho mob insulin ib txwm

Tus neeg mob K., 62 xyoo, lub cev nyhav 70 kg, tau mus pw hauv tsev kho mob nrog kev tsis txaus siab ntawm qhov txo qhov pom ntawm qhov muag pom tseeb, hais txog qhov uas nws tig mus rau tus kws kho qhov muag ntau hnub dhau los. Tom qab kuaj xyuas ntawm pob nyiaj, qhov twg ntau txoj kev puas tsuaj raws cov hlab ntsha, cov nkoj tsim tshiab, paj rwb thiab cov khoom exudates, feem ntau yog thaj chaw macular, tau kuaj pom, tus neeg mob tau kuaj mob ntshav qab zib preproliferative retinopathy.

Kev kawm txog cov roj metabolism ua kom yuag pom zoo. Theem ceev ceev glycemia yog 9.1 mmol / l, tso zis acetone tsis zoo. Nrog cov lus nug ntxaws ntxaws, nws muab tawm tias qhov tsis muaj zog, nkees, lub qhov ncauj qhuav me me, nqhis dej ntau (txog li 2,5 litres ib hnub) muaj kev ntxhov siab txog 4-5 xyoos, thiab tsis sab laj nrog kws kho mob.

Qhov qhia tau rau kev kho tshuaj insulin rau hauv tus neeg mob no yog cov organic ntawm kev rov ua haujlwm.

1) Kev xav tau insulin txhua hnub hauv tus neeg mob uas nyuam qhuav muaj ntshav qab zib tshiab (tsis tau txais kev kho mob insulin) yog 0.5 U / kg lub cev hnyav: 70x0.5 = 35 U
2) 2/3 ntawm qhov yuav tsum tau siv rau cov tshuaj insulin txhua hnub thaum sawv ntxov: 35x2 / 3 = 23 units.
3) Qhov sib piv ntawm ICD: insulin nrog qhov nruab nrab ntawm kev nqis tes ua thaum sawv ntxov yuav tsum yog 1: 2-1: 3, i.e. 6-8 U ICD thiab 14-16 U ISD.
4) 1/3 ntawm kev xav tau txhua hnub rau cov tshuaj insulin yog tswj hwm thaum yav tsaus ntuj 35 x 1/3 = 12 PIECES.
5) Qhov seem ntawm ISD: ICD nyob rau yav tsaus ntuj yuav tsum yog 1: 1, (i.e. 6 units thiab 6 units, ntsig txog) lossis 1: 2, (i.e. 4 units thiab 8 units, ntsig txog).

Qee zaum hauv cov chaw kho mob, qhov kev suav ntawm cov tshuaj thawj zaug ntawm insulin muab raws li cov ntaub ntawv ntawm txhua hnub glucosuria. Tam sim no, nws raug nquahu kom siv cov ntaub ntawv no los kho lub koob tshuaj ntawm cov tshuaj insulin. Cov ntaub ntawv no tau piav qhia hauv kev nthuav dav ntxiv hauv ntu lus qhia txog qhov teeb meem no.

Kev suav ntawm kev txhaj tshuaj ntawm cov tshuaj insulin yuav tsum xaus nrog kev npaj ntawm kev kho tshuaj insulin, uas tau muab teev cia hauv keeb kwm kev kho mob thiab cov npe tshuaj:

8.30 - 6 units S. Actrapidi HM + 16 units S. Protaphani HM
17.30 - 4 PIECES ntawm S. Actrapidi HM + 8 PIECES ntawm S. Protaphani HM
34 units / hnub, sc

Kev hloov kho cov tshuaj insulin

Kev hloov kho ntawm cov koob tshuaj insulin hauv qhov chaw kho mob feem ntau yog ua tiav (nrog kev kho mob insulin ib txwm), suav txog qhov poob ntawm cov piam thaj nrog zis ib hnub. Rau qhov no, tus naj npawb ntawm cov piam thaj hauv lub tso zis tau xam. (Tsoos insulin txoj kev xav tias tus neeg mob noj cov zaub mov nruj nrog kev noj mov ua ntej, thiab tsis tuaj yeem nthuav kev noj).

Piv txwv, qhov ntim ntawm cov zis tawm hauv ib hnub yog 4 litres, 1.5% piam thaj tau txiav txim siab hauv zis, thiab niaj hnub glucosuria yog 60 grams. Rau kev siv 4-5 grams qabzib, 1 UNIT ntawm cov tshuaj insulin yog qhov yuav tsum tau. Hauv qhov xwm txheej no, nws yog ib qho tsim nyog yuav tsum nce cov tshuaj insulin txhua hnub los ntawm 15 units.

Feem ntau, yog tias qhov ntsuas qhov tseeb ntau dua yuav tsum tau kho ntawm cov tshuaj insulin yog qhov tsim nyog, tus kws kho mob siv cov ntaub ntawv ntawm theem ntawm glycemia kawm nyob rau ntau lub sijhawm ntawm hnub (glycemic profile). Kev hloov kho ntawm cov koob tshuaj insulin muab raws li glycemic profile feem ntau tsuas yog ua tau nyob hauv tsev kho mob lossis yog tias tus neeg mob tau txhais tau tias kev tswj tus kheej - ntshav qab zib 'meter'.

Kev hloov kho ntawm cov koob tshuaj insulin muab rau hauv cov neeg mob uas muaj ntshav qab zib hom 1 ntawm cov neeg mob uas tau txais insulin kho rau glucosuria yog qhov tsis lees txais. Qhov no yog vim qhov tseeb tias:

1) glucosuria muaj kev cuam tshuam tsuas yog cov ntaub ntawv uas nyob hauv tus neeg mob glycemia dhau ntawm lub raum thiav rov qab (nws muaj peev xwm sib txawv hauv cov pab pawg sib txawv ntawm cov neeg mob: cov neeg laus laus 13.9 mmol / l lossis ntau dua, cov poj niam cev xeeb tub 5.6-6.7 mmol / l, physiological txo, ntawm tus nqi ntawm 8.9-10 mmol / l),
2) tsis muaj kev cuam tshuam qhov tshwm sim ntawm hypoglycemia,
3) cov phiaj xwm niaj hnub kom ua tiav cov nyiaj them rau cov khoom noj khoom haus metabolism (ntawm lub plab khoob 5-6 mmol / l thiab 7.5-8 mmol / l tom qab noj mov hauv cov neeg mob ntshav qab zib hom 1) hauv feem ntau cov neeg mob, pom tseeb tsawg dua glycemia, uas yuav ntau tshaj li lub raum pib.

Yog li, tsuas tso siab rau cov ntaub ntawv ntawm txhua hnub glucosuria, tus kws kho mob yuav tsis tuaj yeem xaiv cov koob tshuaj insulin kom ua tiav cov nyiaj tau los ntawm cov metabolism hauv kev noj haus, uas yog, lub hom phiaj tseem ceeb ntawm kev kho tus neeg mob ntshav qab zib yuav tsis tiav.

Thaum muaj kev siv tshuaj insulin ntau dua, kev txhim kho tsuas yog ua tiav raws li glycemia, suav nrog kev noj chav nyob qhob cij (XE), kev siv dag zog, lub sijhawm nruab hnub. Yog li, thaum siv "ntxiv" XE nyob rau thaum sawv ntxov, nws yog qhov yuav tsum tau qhia 1.3-2.5 IU ntawm cov tshuaj insulin luv luv, nruab hnub 1 IU, yav tsaus ntuj 1-1.5 IU. Tsis tas li ntawd, nws yog ib qho tsim nyog yuav tsum tau coj mus rau qhov tshwm sim ntawm kev tswj hwm tus kheej ntawm glycemia, uas (thaum muaj kev nthuav dav ntawm kev noj zaub mov) ua ua ntej txhua yam kev txhaj tshuaj.

Kev suav ntawm cov koob tshuaj insulin, nyob ntawm theem pib ntawm glycemia, txhais tau hais tias qhov txo qis ntawm cov tshuaj insulin piv rau qhov tau suav ib, yog tias glycemia ua ntej noj mov yog 3, 3 mmol / l, kev nce ntxiv kom txog thaum normoglycemia tau mus txog 6 lossis ntau dua mmol / l, kev sib tiv thaiv ntawm koob tshuaj insulin rau kev lees txais chav nyob cij, yog tias glycemia yog 3.4-5.6 mmol / l.

Piv txwv ntawm kev kho ntawm cov koob tshuaj txhua hnub ntawm insulin los ntawm glycemic profile hauv qhov xwm txheej feem ntau

Neeg Mob A., 22 xyoos, (qhov siab 165 cm, lub cev nyhav 70 kg) tiv taus ntshav qab zib hom 1 mellitus (SD-1) rau 15 xyoo, tau txais cov tshuaj insulin raws li cov qauv:

8.30 - 6 PIECES ntawm S. Actrapidi HM + 14 PIECES ntawm S. Protaphani HM
13.30 - 8 units S. Actrapidi HM
17.30 - 8 PIECES ntawm S. Actrapidi HM + 8 PIECES ntawm S. Protaphani HM
54 PHOO / HNUB.

Hauv kev kawm txog cov glycemic profile, cov cim qhia glycemic hauv qab no tau txais (tsis muaj kev cuam tshuam dab tsi ntawm kev noj haus):

6.00 - 6.5 mmol / l,
13.00 - 14, 3 mmol / l,
17.00 - 8.0 mmol / l,
22.0 - 7.5 mmol / L.

Txhawm rau ua kom muaj normoglycemia thaum 13 teev, nws muaj peev xwm nce ntxiv qhov koob tshuaj ncua sij hawm muab tshuaj thaum sawv ntxov los ntawm 4-6 units thiab / lossis ua ntej noj su kom nce lub koob ntawm cov yeeb yam luv luv ntawm 2-4 units.

Tus neeg mob K., 36 xyoo, raug kev txom nyem los ntawm DM-1, tau txais kev kho mob los ntawm insulin raws li cov qauv hauv 3 lub lis piam dhau los:

8.30 - 10 PIECES ntawm S. Insumani Rapidi + 14 PIECES ntawm S. Insumani Basali
13.30 - 8 units S. insumani nrawm
17.30 - 6 PIECES ntawm S. Insumani Rapidi + 18 PIECES ntawm S. Insumani Basali
54 PHOO / HNUB.

Hauv kev kawm txog cov glycemic profile, cov cim qhia glycemic hauv qab no tau txais (tsis muaj kev cuam tshuam dab tsi ntawm kev noj haus):

6.00 - 18.1 mmol / l,
13.00 - 6.1 mmol / l,
17.00 - 6.7 mmol / l,
22.00 - 7.3 mmol / l.

Kev kho cov koob tshuaj ntawm kev kho tshuaj insulin hauv tus neeg mob no suav nrog kev cais tawm ntawm qhov tshwm sim ntawm "thaum sawv ntxov ntxov" thiab Somoji tshwm sim.

Somoji tshwm sim - Qhov no yog posthypoglycemic hyperglycemia. Nws tshwm sim los ntawm kev noj tshuaj ntau dhau ntawm insulin, ua rau cov ntshav qog ntshav qab zib, nyob rau hauv kev teb rau cov glucagon (los ntawm β-hlwb ntawm cov txiav) thiab tom qab ntawd lwm cov tshuaj tiv thaiv cov tshuaj hormones (glucocorticoids, adrenaline, somatotropic hormone, adrenocorticotropic hormone) yog compensatedly tso tawm, ua rau cov txheej txheem ntawm cov leeg glycogen hloov dua siab tshiab. rau hauv qabzib.

Cov txheej txheem rau kev tswj cov piam thaj hauv tsev ib txwm ua haujlwm, deb tshaj qhov yuav tsum tau muaj cov piam thaj nce ntxiv, thiaj li ua rau posthypoglycemic hyperglycemia. Yog tias lub xeev hypoglycemic tsim nyob hauv npau suav (qhov teeb meem kho mob xav tias cov neeg mob tsis txaus siab ntawm cov npau suav phem), tom qab ntawd qhov tseem ceeb ntawm kev yoo glycemia yuav muaj ntau heev.

Hauv qhov no, nws yog ib qho tsim nyog yuav tau soj ntsuam cov kua nplaum thaum hmo ntuj, thaum 2-3 teev sawv ntxov. Yog tias muaj cov piam thaj nyob qis, tom qab ntawv sawv ntxov hyperglycemia yog qhov tshwm sim ntawm Somogy phenomenon. Cov koob tshuaj ntawm cov tshuaj insulin ntev ntev muab rau thaum lub sijhawm yav tsaus ntuj yuav tsum tau txo qis.

Nyob rau hauv rooj plaub uas qhov ntsuas ntawm hmo glycemia muaj siab, qhov tshwm sim Somoji raug tshem tawm. Koj yuav tsum xav txog qhov tshwm sim ntawm "thaum sawv ntxov kaj ntug." Qhov tshwm sim ntawm "thaum sawv ntxov kaj ntug" tshwm sim vim yog tus neeg qhov kev ua haujlwm siab ntawm cov tshuaj tiv thaiv contrainsular thaum sawv ntxov. Kev kho tshuaj ntawm cov tshuaj insulin muab rau hauv cov ntaub ntawv no koom nrog thawj zaug cais cov sijhawm siv sijhawm ntev thiab ntev li ntawm insulin thaum yav tsaus ntuj, uas yog, humulin R tseem tau siv ib nrab ib teev ua ntej noj hmo, humulin NPH ua kom lig li ua tau ua ntej yuav mus pw, thaum 21-22 teev. Yog tias kev yoo mov glycemia tseem siab, cov koob tshuaj humulin NPH maj mam nce ntxiv kom txog thaum cov ntsuas pom tau raws li cov qauv rau kev them nyiaj.

Tus neeg mob K., 36 xyoo (qhov siab 168 cm, lub cev hnyav 85 kg), raug mob los ntawm SD-1, tau txais insulin kho raws li tus qauv rau lub hlis rau:

8.30 - 14 PIECES S. Humulin R + 24 PIECES S. Humulin NPH
13.30 - 14 DAIM S. Humulin R
17.30 - 8 THAWJ S. Humulin R + 14 PIECES S. Humulin NPH
76 PIECES / HNUB.

Hypoglycemic tej yam kev mob tau sau tseg tsis tu ncua thaum hmo ntuj, rau ib nrab ntawm ib xyoo qhov nce hauv lub cev hnyav yog 9 kg.

Hauv kev kawm txog cov glycemic profile, cov cim qhia glycemic hauv qab no tau txais (tsis muaj kev cuam tshuam dab tsi ntawm kev noj haus):

6.00 - 16.5 mmol / l,
13.00 - 4.1 mmol / l,
17.00 - 4.5 mmol / l,
22.00 - 3.9 mmol / l,
2.00 - 2.9 mmol / L.

Qhov ua rau decompensation ntawm carbohydrate metabolism hauv tus neeg mob no yog kev muaj zog ntau dhau ntawm cov tshuaj insulin, uas ua rau lub cev qhov hnyav nce sai, nrog rau kev mob hypoglycemic heev, suav nrog thaum tsaus ntuj, thiab yoo posthypoglycemic hyperglycemia.

Hauv qhov xwm txheej no, txoj kev kho ntawm cov tshuaj insulin (nqa tawm hauv tsev kho mob nkaus xwb) txhais tau tias qhov txo qis hauv cov tshuaj txhua hnub los ntawm tsawg kawg yog 1/3 thiab kev suav ntawm cov thawj coj tswj hwm raws li cov cai saum toj no. Kev txhim kho ntxiv yuav tau nqa tawm mus rau hauv cov txiaj ntsig ntawm glycemic profile ntawm kev tshawb nrhiav tom qab kev teem caij ntawm kev siv tshuaj tshiab ntawm kev siv tshuaj insulin ntxiv.

Xaj kev kho mob nrog kev siv tshuaj insulin luv luv nkaus xwb

Kev teem sijhawm kho mob tsuas yog siv tshuaj insulin luv luv yog qhov tsim nyog thiab muaj peev xwm ua tau nyob rau cov xwm txheej nram no:

kev txhim kho ntawm decompensation ntawm metabolic kev nrog ketosis (rau ib yam ntshav qab zib),
kev loj hlob ntawm kev quab yuam ntau ntawm decompensation ntawm metabolic kev nrog ketoacidosis (nrog ib hom ntshav qab zib mellitus),
huab ntau dhau ntawm decompensation ntawm metabolic kev nrog kev txhim kho ntawm ib qho txawv ntawm hyperglycemic coma (nrog rau txhua hom ntshav qab zib mellitus),
kev txhim kho ntawm kev tsis haum ntawm cov tshuaj insulin yuav tsum tau teem sijhawm ua yeeb yam luv luv tib neeg monocomponent insulin,
kev npaj khomob kub ntxhov thiab npaj kom tau txais kev raug mob, raug mob,
tus me nyuam.

Hauv qhov no, cov lus qhia ntawm luv luv ua yeeb yam yuav ua nyob rau hauv 6-10 kev txhaj tshuaj, fractionally, hauv cov koob tshuaj me me (nrog coma - teev ib teev).

Yog tias glycemia tsawg, ces cov lus qhia ntawm insulin yuav tsum tau ua ke nrog kev qhia ntawm qabzib daws.

Lwm yam mob cuam tshuam los ntawm Insulin Therapy

Tam sim no, insulin txoj kev kho yog nrog los ntawm ntau ntau cov teeb meem me. Yog li, tom qab qhov kev siv dav ntawm kev ua kom huv ntau dhau los ua cov tib neeg cov insulins, cov ntaub ntawv loj ntawm lipodystrophy yuav luag ploj.

Ntawm cov teeb meem tshwm sim feem ntau, txoj hauj lwm ua, tau kawg, belongs rau hypoglycemic tej yam kev mob thiab hypoglycemic comas. Kev mob ua rau ntshav qab zib yog cov teeb meem txaus ntshai tshaj plaws.

Cov kev mob uas tshwm sim xws li ua xua, uas tuaj yeem yog hauv zos thiab dav dav, kuj tseem cuam tshuam. Qhov kev tsis haum tshuaj yog qhov pom tseeb nyob ntawm thaj chaw txhaj tshuaj thiab tuaj yeem pom qhov khaus, hyperemia, thiab kev cog lus tsis haum. Cov kev tawm tsam tsis haum yuav tshwm sim los ntawm Quincke's edema, urticaria, anaphylactic shock (nws tsis tshua muaj siab).

Yog tias muaj kev txhim kho ua xua, kev siv hom tshuaj tiv thaiv insulin yav dhau los yuav tsum tau hloov nrog cov tshuaj insulin luv luv (tsim nyog hauv tshuaj txhua hnub), humulin yuav yog cov tshuaj xaiv. Cov kev tsis haum ntawm kev ua xua xav tau kev kho mob tshwj xeeb (qee zaum rov ua dua) kev cuam tshuam thiab kev teem caij glucocorticosteroids, antihistamines. Kev kho mob yuav tsum tau nqa tawm hauv tsev kho mob tshwj xeeb.

Qhov tshuaj tiv thaiv kab mob tsawg kawg ntawm cov tshuaj insulins niaj hnub no, qhov tsis muaj ntau ntawm cov tshuaj tiv thaiv rau lawv, tau tso cai rau ntau tus neeg Asmeskas cov kws tshawb fawb tau hais tawm hauv kev pom zoo ntawm qhov tsis muaj lub sij hawm uas tau siv dav dhau los ua insulin resistance (immunological).

Lub siab txhua hnub xav tau rau cov tshuaj insulin nyob rau lub sijhawm tam sim no feem ntau vim muaj kev tiv thaiv insulin ib ntus cuam tshuam nrog tus neeg mob muaj qhov sib luag ntawm cov tshuaj tiv thaiv kev tiv thaiv kev tiv thaiv kab mob hauv cov mob xws li mob hnyav purulent-kis thiab kis tus kab mob, ua haujlwm loj ntawm cov kab noj hniav, hyperlipoproteinemia, lub cev qhuav dej, rog rog, thiab lwm yam. Cov.

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 qho chaw muaj sia nyob (ze zog). 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 "kom sib npaug", ntau dhau nrog cov carbohydrates, ces koj tuaj yeem xam qhov kev noj tshuaj ntawm cov 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:

Txiav txim siab yog tias koj xav tau cov tshuaj tiv thaiv ntev tshaj thaum hmo ntuj.
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.
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.
Yog tias koj xav tau cov tshuaj ntxiv ntawm insulin thaum sawv ntxov, tom qab ntawd xam qhov pib noj ntawm cov tshuaj insulin rau lawv, thiab tom qab ntawd kho nws rau ob peb lub lis piam.
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 noj cov zaub mov twg, thiab ua ntej twg - tsis muaj.
Xam xyuas qhov pib noj ntawm luv luv lossis ultrashort insulin rau kev txhaj tshuaj ua ntej noj mov.
Kho cov tshuaj noj ntawm luv luv lossis ultrashort insulin ua ntej noj mov, raws li cov hnub dhau los.
Ua qhov kev sim ua kom paub tseeb tias pes tsawg feeb ua ntej noj mov koj yuav tsum txhaj tshuaj insulin.
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 yuav tsum 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 muaj protein 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 mob, txoj hauv kev zoo tshaj yog kev noj ntshav qab zib ib txwm los ntawm kev 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 humalogue yog pricked, ces 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 nws nyuam qhuav siv tshuaj insulin ntev ntev tsis haum? 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. Cov kev sim tau 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 txhaj cov tshuaj insulin, tshaib plab rau 8 hnub. Nws tsis muaj lub sijhawm los ntsuas cov suab thaj hauv 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 ua kom ib txwm muaj? Siv cov tshuaj insulin tsis yog? Kuv zoo siab tos ntsoov rau koj cov lus teb, ua tsaug.

nws puas muaj peev xwm ua rau nws ntawm nws lub hnub nyoog kom nruj me ntsis rau cov zaub mov tsis muaj carbohydrate?

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 tabtom ua qhov tsim nyog txhawm rau txhaj tshuaj insulin thaum sawv ntxov, 36 units ntawm protafan thiab yav tsaus ntuj, thiab tseem ua rau 30 ib pawg khoom noj, Kuv tau hla qab zib, thiab tam sim no kuv tsis xaiv khoom noj rau, thiab kuv haus nws ib zaug, Kuv hle 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. Qab Zib tsis poob qis dua 15. Kev kho mob tom ntej lub Kaum Ib Hlis tau sau cov tshuaj insulin ACTRAPID ntawm 8 units 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 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 muaj hnub nyoog 42 xyoos 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 cai kho 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 nyob rau hauv cov zis txhua yam zoo. Glimepiride tau sau tshuaj 2 g thaum sawv ntxov, Metformin 850 thaum yav tsaus ntuj, Thioctic acid rau 2-3 lub hlis nrog nce ntxiv hauv cov piam thaj, ntxiv 10 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

Kev siv tshuaj insulin

Ntawm cov txheej txheem uas twb muaj lawm ntawm kev kho tshuaj insulin, 5 lub ntsiab tseem ceeb sawv:

Ib koob txhaj ntawm kev ua yeeb yam ntev lossis nruab nrab ntawm kev ua yeeb yam,
Ob chav txhaj tshuaj ntawm cov tshuaj qib nruab nrab,
Ob chav txhaj tshuaj ntawm nruab nrab thiab luv ua yeeb yam insulin,
Kev txhaj tshuaj lub sijhawm luv luv thiab lub sijhawm ua haujlwm insulin,
Cov hauv paus yog cov phiaj xwm bolus.

Cov txheej txheem ntawm cov kua dej txhua hnub tso tawm ntawm insulin tuaj yeem sawv cev raws li kab uas muaj txoj kab ntsug thaum lub sijhawm ntawm insulin ncov uas tshwm sim ib teev tom qab noj mov (Daim Duab 1). Piv txwv, yog tias ib tug neeg tau noj zaub mov thaum 7 teev sawv ntxov, 12 hnub, 18 thiab 22 teev tsaus ntuj, ces lub caij nyoog ntawm insulin yuav yog 8 teev sawv ntxov, 13 hnub, 19 thiab 23 teev tsaus ntuj.

Qhov nkhaus ntawm qhov zais ntshis muaj qhov ncaj ncaj, txuas qhov peb tau txais lub hauv paus - kab. Cov seem ncaj qha cuam tshuam rau lub sijhawm thaum tus neeg uas tsis mob ntshav qab zib tsis noj thiab insulin muaj mob me ntsis. Thaum lub sij hawm ntawm insulin tso tawm tom qab noj mov, txoj kab ncaj nraim ntawm lub ntuj tso cai muab faib los ntawm lub roob siab tshaj nrog qhov nce siab thiab ib qho kev poob qis dua.

Ib txoj kab nrog plaub saum yog qhov kev xaiv "zoo tshaj plaws", sib haum rau tso insulin nrog 4 pluas noj rau ib hnub nyob rau lub sijhawm teem nruj me ntsis. Qhov tseeb, tus neeg noj qab haus huv tuaj yeem txav lub sijhawm noj mov, hla pluas su lossis noj hmo, ua ke noj su nrog noj su lossis noj ob peb cov khoom noj txom ncauj, hauv qhov no. ib qho me me ntxiv ntawm cov tshuaj insulin tshwm ntawm qhov nkhaus.

Rov qab mus rau txheem

Ib koob txhaj ntawm insulin ntev lossis nruab nrab

Ib qho tshuaj txhaj yog vim yog qhov qhia txog cov tshuaj insulin txhua hnub thaum sawv ntxov ua ntej noj tshais.

Qhov kev nqis tes ua ntawm cov txheej txheem no yog nkhaus uas los ntawm lub sijhawm kev tswj hwm tshuaj, ncav lub ncov thaum lub sijhawm noj su thiab nqis los noj hmo (teeb duab 2)

Cov txheej txheem yog ib qho yooj yim, muaj ntau yam tsis zoo:

Qhov nkhaus ib leeg yog qhov tsis tshua zoo ib yam li lub ntuj nkhaus rau cov tshuaj insulin zais cia.
Daim ntawv thov ntawm cov txheej txheem no suav nrog kev noj ntau zaus nyob rau ib hnub - noj tshais me ntsis hloov los ntawm pluas su cov pluas su, cov pluas su tsis tshua qab thiab noj hmo me.
Qhov ntau thiab tsawg npaum li cas ntawm cov zaub mov yuav tsum sib txheeb nrog cov txiaj ntsig ntawm kev nqis tes ua ntawm insulin thaum lub sij hawm thiab qib ntawm lub cev ua si.

Qhov tsis zoo ntawm cov qauv no suav qhov feem pua ntawm qhov pheej hmoo ntawm lub qog ntshav qab zib, ob leeg nruab hnub thiab hmo ntuj. Qhov tshwm sim ntawm nocturnal hypoglycemia, nrog rau kev nce ntxiv ntawm cov tshuaj insulin thaum sawv ntxov, nce qhov kev pheej hmoo ntawm hypoglycemia thaum lub sijhawm ua haujlwm siab tshaj plaws ntawm cov tshuaj

Cov lus qhia ntawm qhov tseem ceeb ntawm cov tshuaj insulin ua rau cuam tshuam lub cev kev rog hauv lub cev, uas tuaj yeem ua rau cov kab mob concomitant.

Cov txheej txheem no tsis pom zoo rau cov neeg muaj ntshav qab zib hom 1, ntshav qab zib hom 2, kev kho mob yog siv nrog cov tshuaj uas muaj suab thaj ua rau noj thaum noj hmo.

Rov qab mus rau txheem

Ob zaug txhaj ntawm cov insulin nruab nrab

Cov txheej txheem ntawm kev siv tshuaj insulin no vim yog qhov qhia ntawm cov tshuaj thaum sawv ntxov ua ntej noj tshais thiab yav tsaus ntuj ua ntej noj hmo. Qhov koob tshuaj txhua hnub ntawm insulin raug muab faib rau thaum sawv ntxov thiab yav tsaus ntuj hauv qhov sib piv ntawm 2: 1, raws feem (daim duab 3).

Qhov zoo ntawm cov txheej txheem yog tias txoj kev pheej hmoo ntawm hypoglycemia yog txo qis, thiab kev sib cais ntawm cov tshuaj insulin nyob rau hauv ob txoj kev koom tes ua rau txo qis koob tshuaj mus rau hauv tib neeg lub cev.
Qhov tsis zoo ntawm cov txheej txheem suav nrog kev ua kom nruj rau kev tswj hwm thiab kev noj haus - ntshav qab zib yuav tsum noj tsawg dua 6 zaug hauv ib hnub. Tsis tas li ntawd, qhov nkhaus ntawm cov tshuaj insulin, zoo li hauv thawj cov phiaj xwm, deb ntawm qhov nkhaus ntawm ntuj insulin zais cia.

Vim li cas cov kab mob fungal tau tshwm sim ntawm cov mob ntshav qab zib? Yuav ua li cas nrog lawv?

Kev kho mob ntshav qab zib hom 2 - kho nrog tshuaj hypoglycemic. Nyeem ntxiv hauv qhov ntawv.

Almonds rau cov ntshav qab zib - cov txiaj ntsig thiab kev puas tsuaj

Rov qab mus rau txheem

Ob zaug txhaj ntawm qhov nruab nrab thiab luv ua yeeb yam insulin

Ib qho ntawm cov kev tswj hwm zoo tshaj plaws tau txiav txim siab ua ob zaug kev txhaj tshuaj ntawm kev cuam tshuam hauv nruab nrab thiab lub cev luv luv.Cov txheej txheem no pom tus cwj pwm los ntawm kev qhia ntawm cov tshuaj thaum sawv ntxov thiab yav tsaus ntuj, tab sis tsis zoo li cov phiaj xwm dhau los, nws muaj peev xwm hloov cov tshuaj insulin txhua hnub nyob ntawm seb cov kev tawm dag zog yav dhau los lossis kev noj zaub mov.

Hauv cov ntshav qab zib, vim kev siv dag zog ntawm cov tshuaj insulin, nws thiaj li muaj peev xwm ua kom cov neeg tuaj yeem noj cov zaub mov uas muaj ntau hom ntshav qab zib los ntawm kev siv cov khoom uas muaj cov piam thaj siab lossis nce qhov khoom noj ntau dhau (daim duab 4).

Yog tias thaum nruab hnub koj npaj lub pastime nquag (taug kev, ntxuav, kho) thaum ntxov cov tshuaj insulin thaum sawv ntxov yuav nce li 2 ntu, thiab cov tshuaj nruab nrab txo qis li 4 - 6 units, vim tias kev tawm dag zog yuav pab txo qis qab zib,
Yog tias qhov xwm txheej loj tshaj plaws nrog noj hmo kom muaj zog ntau tau npaj rau yav tsaus ntuj, qhov koob tshuaj tiv thaiv luv luv yuav tsum tau nce ntxiv ntawm 4 units, thiab cov tshuaj nruab nrab yuav tsum tau tso rau hauv tib tus nqi.

Vim tias muaj qhov sib faib ntawm qhov sib txawv ntawm qhov tshuaj txhua hnub, qhov nkhaus ntawm ob zaug txhaj ntawm cov tshuaj nruab nrab thiab luv-luv cov insulin yog qhov ze tshaj plaws rau cov nkhaus ntawm ntuj tsis pub, uas ua rau nws zoo tshaj plaws thiab haum rau kev kho mob ntshav qab zib hom 1. Tus nqi ntawm cov insulin txhaj ntxiv rau hauv cov ntshav, uas ua rau muaj kev pheej hmoo ntawm hypoglycemia.

Txawm hais tias muaj qhov ua tau zoo, cov txheej txheem tsis yog tsis muaj qhov tsis zoo, ib qho yog txuam nrog kev noj zaub mov tawv. Yog hais tias kho ob zaug insulin tso cai rau koj los ua kom muaj kev sib txawv ntawm cov khoom noj khoom noj coj los noj, ces kev cais tawm ntawm cov khoom noj khoom haus yog qhov txwv tsis pub muaj. Kev sib txawv ntawm lub sijhawm tau ib nrab ntawm ib teev ua rau muaj qhov tshwm sim ntawm cov ntshav qog ntshav qab zib.

Kev niaj hnub noj cov vitamins rau ntshav qab zib. Nta rau ntshav qab zib

Kev kuaj ntshav qab zib thawj zaug txhais tau li cas?

Cov tsos mob ntshav qab zib hauv cov txiv neej. Nyeem ntxiv hauv qhov ntawv.

Rov qab mus rau txheem

Triple txhaj ntawm luv luv thiab lub caij ntev insulin

Qhov peb-lub sij hawm txhaj tshuaj ntawm insulin thaum sawv ntxov thiab yav tav su ua ke nrog cov txheej txheem dhau los ntawm kev kho ob npaug, tab sis nws yoog raws yav tsaus ntuj, uas ua rau nws zoo dua.Cov phiaj xwm cuam tshuam nrog kev qhia txog kev sib xyaw ntawm cov tshuaj insulin luv luv thiab lub caij ntev thaum sawv ntxov ua ntej noj tshais, noj cov insulin luv ua ntej noj su thiab noj me ntsis ntawm cov tshuaj insulin ua ntej noj hmo (Daim Duab 5). Qhov nkhaus ntawm qhov kev txhaj tshuaj triple yog qhov ze tshaj plaws rau qhov nkhaus ntawm ntuj tso cai ntawm insulin thaum yav tsaus ntuj.

Rov qab mus rau txheem

Cov hauv paus - Bolus Scheme

Cov hauv paus - ib qho bolus regimen ntawm insulin txoj kev kho lossis ib txoj kev ntxim nyiam tshaj plaws ib qho, vim tias nws yog qhov ze ze rau qhov nkhaus ntawm ntuj insulin zais cia.

Nrog lub hauv paus bolus regimen rau insulin tswj hwm, ib nrab ntawm tag nrho cov koob tshuaj ntog ntawm insulin ntev ntev, thiab ib nrab ntawm luv. Ob feem peb ntawm cov tshuaj insulin ntev yog txhaj rau hauv thawj ib nrab thiab thib ob ntawm lub hnub, tus so thaum yav tsaus ntuj. Qhov koob tshuaj ntawm "insulin" luv luv yog nyob ntawm qhov ntau thiab cov khoom noj ntawm cov zaub mov noj. Cov tshuaj insulin me me tsis ua rau muaj kev pheej hmoo ntawm cov ntshav qog ntshav qab zib, muab cov tshuaj uas tsim nyog ntawm cov tshuaj hauv cov ntshav.