Kev qhia rau kev siv thiab cov yam ntxwv ntawm cov insulin Detemir
Niaj hnub siv DNA thev naus laus zis tau txhim kho qhov profile ntawm kev ua ntawm kev yooj yim (ib txwm) insulin. Detemir insulin yog tsim los ntawm kev tsim cov kab mob DNA biotechnology uas siv txoj siv sia lim Saccharomyces cerevisiae, yog soluble basal analog ntawm tib neeg cov kua dej los ua ntev nrog qhov kev txiav txim siab tsis kawg. Kev txiav txim qhov profile yog qhov tsawg dua li qhov sib txawv piv nrog isofan-insulin thiab insulin glargine. Lub sijhawm ua haujlwm ntev yog vim qhov tshaj tawm tus kheej kev koom tes ntawm detemir insulin cov tshuaj tua ntawm qhov chaw txhaj tshuaj thiab qhov khi ntawm cov molecules rau albumin los ntawm kev sib txuas nrog ib qho kev sib xyaw ua ke nrog fatty fatty chain. Piv nrog isofan-insulin, detemir insulin muab faib qeeb dua hauv cov phom sij lub hom phiaj. Cov kev sib koom ua ke ntawm cov khoom faib ncua tau muab ntau qhov kev rov qab ua haujlwm dua thiab cov insulin kev txiav txim siab profile ntawm detemir. Detemir insulin yog tus yam ntxwv ua rau ntau ntxiv ntawm kev cia siab ua ntej ntawm kev ua hauv cov neeg mob piv nrog insulin NPH lossis insulin glargine. Qhov qhia tau hais tias xav tau ntawm kev ua yog vim muaj ob yam: insulin detemir tseem nyob hauv lub xeev yaj nyob rau txhua theem ntawm nws daim ntawv noj tshuaj mus rau qhov khi rau cov insulin receptor thiab qhov cuam tshuam ntawm kev khi rau kom cov ntshiab albumin.
Los ntawm kev sib cuam tshuam nrog lub receptor tshwj xeeb ntawm sab cytoplasmic membrane ntawm cov hlwb, nws tsim cov txheej txheem insulin-receptor complex uas txhawb cov txheej txheem intracellular, suav nrog cov synthesis ntawm ntau cov enzymes tseem ceeb (hexokinase, pyruvate kinase, glycogen synthetase, thiab lwm yam). Kev txo qis hauv cov ntshav qabzib yog vim muaj kev nce ntxiv hauv nws txoj kev thauj mus los ntawm qhov tsis txaus, kev nce siab ntawm cov nqaij mos, kev ua kom cov lipogenesis, glycogenogenesis, qhov txo qis ntawm cov piam thaj ntau dhau los ntawm lub siab, thiab lwm yam. 4 teev txog 14 teev tom qab kev tswj hwm. Tom qab kev coj ua subcutaneous, qhov lus teb pharmacodynamic tau faib rau cov koob tshuaj uas tau siv (cov txiaj ntsig siab tshaj plaws, sijhawm ua haujlwm, cov nyhuv dav dav). Tom qab SC txhaj tshuaj, detemir khi rau albumin los ntawm nws cov fatty acid saw. Yog li, nyob rau hauv lub xeev qhov kev txiav txim ruaj khov, qhov kev kub siab ntawm tsis pub dawb insulin yog qhov txo qis, uas ua rau cov qib glycemia ruaj khov. Lub sijhawm ntawm kev ua ntawm detemir ntawm ib koob ntawm 0.4 IU / kg yog li ntawm 20 teev, yog li cov tshuaj tau sau tseg ob zaug ib hnub rau feem ntau cov neeg mob. Hauv kev tshawb fawb mus ntev (6 lub hlis), yoo cov plasma ntshav qab zib hauv cov neeg mob ntshav qab zib hom I zoo dua piv nrog isofan-insulin, raws li kev kho / bolus kho mob. Kev tswj glycemic (glycosylated hemoglobin - HbA1c) thaum lub sij hawm kho nrog insulin detemir tau muab piv rau qhov ntawd hauv kev kho mob nrog isofan-insulin, nrog rau kev pheej hmoo tsawg ntawm kev txhim kho nocturnal hypoglycemia thiab qhov tsis muaj qhov nce hauv lub cev hnyav thaum nws siv. Cov ntaub ntawv ntawm hmo ntuj ua kom tsis muaj qab zib tswj tau yog nthuav thiab ntau heev tshaj dua rau qhov ua kom insulin piv nrog isofan insulin, uas yog qhov cuam tshuam txog kev pheej hmoo hmo ntuj tsis zoo.
Qhov siab tshaj plaws ntawm kev tshem tawm cov insulin hauv cov ntshav cov ntshav tau mus txog 6-8 teev tom qab kev tswj hwm. Nrog rau kev coj noj coj ua ob hnub ib zaug, kev ruaj khov ruaj khov ntawm cov tshuaj hauv ntshav cov dej yog ua tiav tom qab 2-3 hno.
Kev tsis ua haujlwm zoo ib yam li cov tib neeg cov tshuaj insulin, txhua yam kev tsim tawm yog tsis ua haujlwm. Kev Tsim Kev Tsim Protein hauv vitro thiab hauv vivo qhia qhov tsis muaj chaw kho mob sib cuam tshuam tseem ceeb ntawm insulin detemir thiab cov roj ntsha lossis lwm yam tshuaj uas cuam tshuam rau cov ntshav protein.
Ib nrab-lub neej tom qab sc txhaj tshuaj yog txiav txim siab los ntawm cov degree ntawm nqus ntawm daim ntaub subcutaneous thiab yog 5-7 teev, nyob ntawm qhov koob tshuaj.
Thaum s / rau kev qhia ntawm cov concentration hauv cov ntshav cov ntshav tau sib npaug nrog cov koob tshuaj tau muab tshuaj (qhov siab tshaj plaws, kev nqus ntawm kev nqus).
Cov pab pawg neeg tshwj xeeb
Cov chaw muaj tshuaj Pharmacokinetic tau kawm hauv cov menyuam yaus (6–12 xyoo) thiab cov neeg hluas (13-17 xyoo) thiab muab piv nrog cov neeg laus muaj ntshav qab zib hom ntshav siab hom ntshav qab zib. Tsis muaj qhov sib txawv hauv cov chaw kho mob ntawm cov tshuaj tua kab mob ntawm insemir insulin ntawm cov neeg laus thiab cov neeg mob hluas, lossis ntawm cov neeg mob uas tsis muaj mob raum thiab mob siab thiab cov neeg mob noj qab nyob zoo.
Kev siv cov tshuaj insulin detemir
Tsim qauv rau kev coj ua subcutaneous. Cov koob tshuaj yog txiav txim siab ntawm tus kheej hauv txhua kis. Detemir insulin yuav tsum tau siv tshuaj 1 lossis 2 zaug nyob rau ib hnub raws li qhov xav tau ntawm tus neeg mob. Cov neeg mob uas yuav tsum tau siv ob zaug ib hnub rau kev tswj hwm kev noj qab haus huv hauv cov ntshav tuaj yeem nkag rau qhov kev noj tshuaj yav tsaus ntuj thaum noj hmo, lossis ua ntej mus pw, lossis 12 teev tom qab noj thaum sawv ntxov. Detemir insulin yog txhaj sc hauv tus ncej puab, sab hauv plab phab ntsa lossis xub pwg. qhov chaw txhaj tshuaj yuav tsum tau hloov txawm tias thaum txhaj rau hauv tib thaj chaw. Ib yam li lwm cov insulins, hauv cov neeg laus thiab cov neeg mob lub raum lossis mob ntshav siab tsis txaus, cov ntshav qabzib feem ntau yuav tsum tau saib xyuas ntau ntxiv thiab cov tshuaj txhaj pom ib qho zuj zus. Kev hloov koob tshuaj kuj tseem ceeb thaum txhim kho tus neeg mob lub cev kev ua si, hloov nws kev noj zaub mov li qub, lossis nrog lub zog tsis xis nyob.
Phiv cov tshuaj insulin detemir
Cov kev phiv tshuaj pom nyob rau hauv cov neeg mob siv insemir insulin yog feem ntau koob tshuaj thiab tsim vim muaj cov tshuaj pharmacological ntawm cov tshuaj insulin. Kev mob ntshav qab zib feem ntau yog cov kev mob tshwm sim feem ntau. Kev mob ntshav qab zib yog nce zuj zus yog tias noj tshuaj ntau dhau yog siv rau ntawm lub cev xav tau cov tshuaj insulin.
Cov kev tawm ntawm qhov chaw txhaj tshuaj tuaj yeem pom nrog kev kho mob kwv yees li ntawm 2% ntawm cov neeg mob. Qhov feem ntawm cov neeg mob uas tau txais kev kho mob thiab uas cia siab tias yuav muaj kev mob tshwm sim yog kwv yees li 12%. Qhov xwm txheej ntawm qhov tshwm sim tsis zoo thaum lub sij hawm soj ntsuam sim qhia hauv qab no.
Kev ntshaib plab thiab zaub mov tsis haum: nquag (1/100, ≤1 / 10).
Kev Hypoglycemia: Cov tsos mob ntawm kev ua qog ntshav feem ntau pib dheev. Cov no suav nrog "tawm hws txias", pallor ntawm daim tawv nqaij, ua rau qaug zog, tshee lossis tshee tshee, ntxhov siab, nkees nkees lossis tsis muaj zog, tsis meej pem, qis zuj zus, nkees nkees, tshaib plab, tsis pom kev, mob taub hau, xeev siab. Kev mob ntshav nce siab ntau tuaj yeem ua rau tsis nco qab thiab / lossis rov huam, ib ntus lossis tsis tuaj yeem ua haujlwm ntawm lub hlwb kev ua haujlwm, txawm tias tuag.
Kev ntshawv siab thiab kev tsis haum ntawm qhov chaw txhaj tshuaj: nquag (1/100, ≤1 / 10).
Cov tshuaj tiv thaiv ntawm qhov chaw txhaj tshuaj: Qhov tshuaj tiv thaiv tsis haum hws nyob hauv zos (liab, o thiab khaus ntawm qhov chaw txhaj tshuaj) yuav tsim tau thaum kho cov tshuaj insulin. Cov kev tsis haum no feem ntau ua rau lub sijhawm luv luv thiab ploj nrog kev kho txuas ntxiv.
Tsis tshua muaj nqi (1/1000, ≤1 / 100).
Lipodystrophy: tuaj yeem txhim kho ntawm qhov chaw txhaj tshuaj vim qhov tsis ua raws li txoj cai ntawm kev hloov chaw txhaj tshuaj nyob hauv tib thaj chaw. Edema: tej zaum yuav tshwm sim thaum pib ntawm kev siv tshuaj insulin. Cov tsos mob no feem ntau yog ib ntus.
Lub cev tsis muaj zog tiv thaiv kab mob: tsis tshua muaj (1/1000, ≤1 / 100).
Kev tsis haum tshuaj: urticaria, tawv nqaij pob khaus tuaj yeem tsim vim muaj qhov tsis nco qab. Cov tsos mob ntawm tus mob lub cev tsis muaj qab hau yuav suav nrog khaus, tawm hws, mob plab, mob caj pas, mob caj pas, mob ua pa nyuaj, txhaws ntswg, poob ntshav siab. Kev txhim kho ntawm cov tshuaj tiv thaiv hypersensitivity tuaj yeem ua rau muaj kev phom sij rau lub neej.
Pom kev tsis txaus ntseeg: tsis tshua muaj (1/1000, ≤1 / 100).
Kev tsis sib haum: Cov teeb meem tsis haum yuav tshwm sim thaum pib theem ntawm kev siv tshuaj insulin. Cov tsos mob no feem ntau yog ib ntus. Mob ntshav qab zib retinopathyCov. Kev txhim kho mus sij hawm ntev hauv glycemic tswj txo qhov kev pheej hmoo ntawm kev kho mob ntshav qab zib retinopathy. Txawm li cas los xij, kev sib zog ntawm kev siv tshuaj insulin nrog kev txhim kho ntse hauv kev tswj kev noj cov khoom noj uas ua rau cov pluas mov yuav ua rau muaj kev cuam tshuam ib ntus rau cov cim ntawm tus mob ntshav qab zib retinopathy.
Qhov tsis zoo ntawm lub paj hlwb: tsawg tsawg (1/10000, ≤1 / 1000).
Mob paj hlwb peripheral: Kev txhim kho sai ntawm glycemic tswj tuaj yeem ua rau lub xeev ntawm mob neuropathy, uas feem ntau thim rov qab.
Cov lus qhia tshwj xeeb rau kev siv cov tshuaj Insulin detemir
Detemir insulin muab cov tshuaj glycemic zoo dua (raws li kev ntsuas ntshav ntawm ntshav lub ntsej muag) piv nrog isofan-insulin. Qhov tsis txaus noj ntawm insulin lossis ncua kev kho mob, tshwj xeeb tshaj yog nrog hom I mob ntshav qab zib mellitus, tuaj yeem ua rau kev loj hlob ntawm hyperglycemia lossis ntshav qab zib ketoacidosis. Raws li txoj cai, thawj cov tsos mob ntawm hyperglycemia tshwm sim maj, dhau ob peb teev lossis hnub. Cov tsos mob no suav nrog kev nqhis dej, tso zis sai, xeev siab, ntuav, nkees, liab thiab tawv nqaij ntawm daim tawv nqaij, lub qhov ncauj qhuav, tsis qab los noj mov, tsis hnov ntxhiab ntawm cov acetone hauv kev ua pa. Hauv hom I mob ntshav qab zib mellitus, tsis muaj kev kho mob kom tsim nyog, hyperglycemia ua rau kev txhim kho mob ntshav qab zib ketoacidosis thiab tuaj yeem ua rau tuag taus. Hypoglycemia tuaj yeem tsim yog tias qhov koob tshuaj insulin muaj zog heev txog kev siv tshuaj insulin hauv tus neeg mob tshwj xeeb. Noj zaub mov zoo los yog kev tawm dag zog ntau yuav ua rau lub qog ntshav qab zib. Tom qab them nyiaj rau cov pluas noj carbohydrate, piv txwv li, nrog kev siv tshuaj insulin ntau dua, cov neeg mob yuav muaj cov tsos mob tshwm sim ua ntej ntawm hypoglycemia, uas cov neeg mob yuav tsum tau ceeb toom. Cov paib ceeb toom ib txwm yuav ploj thaum muaj ntshav qab zib ntev. Cov kab mob tsis haum, tshwj xeeb tshaj yog kis thiab nrog kub taub hau, feem ntau ua rau lub cev xav tau cov tshuaj insulin.
Hloov los ntawm lwm hom insulin
Hloov chaw ntawm tus neeg mob mus rau ib hom tshiab ntawm insulin lossis insulin los ntawm lwm qhov chaw tsim khoom yuav tsum tshwm sim nyob rau hauv kev saib xyuas mob nkeeg nruj. Yog tias koj hloov lub siab, cov chaw tsim khoom, hom, hom (tsiaj, tib neeg, analogues ntawm tib neeg cov tshuaj insulin) thiab / los yog cov qauv ntawm nws cov khoom siv (tsim kho los yog cov tshuaj insulin ntawm cov tsiaj keeb kwm), yuav tsum tau txhaj tshuaj kho. Cov neeg mob uas tau hloov mus rau txoj kev kho tus mob insulin yuav tsum tau hloov cov koob tshuaj piv rau cov koob tshuaj ntawm kev siv insulin yav dhau los. Qhov xav tau ntawm kev hloov kho ntau ntau tuaj yeem tshwm sim tom qab kev qhia thawj thawj koob lossis thawj ob peb lub lis piam lossis ob hlis. Detemir insulin yuav tsum tsis txhob siv cov tshuaj iv, vim tias qhov no tuaj yeem ua rau ua rau ntshav muaj ntshav qab zib siab heev. Kev rho tawm nrog i / m tswj hwm tau nrawm dua thiab ua rau ntau dua piv nrog kev tswj hwm subcutaneous. Yog tias cov tshuaj insulin sib xyaw nrog lwm hom insulin, qhov profile ntawm ib qho lossis ob qho tib si yuav hloov pauv. Kev sib xyaw ua ke ntawm detemir insulin nrog kev ua kom sai ntawm insulin analogue, xws li insulin aspart, ua rau cov yeeb yam muaj kev txiav txim siab nrog qhov txo qis thiab qeeb tshaj qhov cuam tshuam piv rau lawv cov kev tswj hwm cais.
Hloov los ntawm cov insulins nruab nrab thiab ntev ntev insulin rau levemir insulin yuav xav tau koob tshuaj thiab lub sijhawm hloov kho. Ib yam li lwm cov insulins, ua tib zoo saib xyuas cov ntshav qabzib thaum lub sijhawm txhais lus thiab hauv thawj lub lis piam ntawm cov tshuaj insulin tshiab. Nws yuav tsim nyog los kho qhov mob hypoglycemic concomitant (koob thiab lub sijhawm ntawm kev tswj hwm ntawm cov yeeb yam luv luv ntawm insulin lossis koob tshuaj ntawm qhov ncauj hypoglycemic).
Detemir insulin tsis yog siv rau kev siv tshuaj insulin.
Siv thaum cev xeeb tub thiab lactation. Tam sim no tsis muaj ntaub ntawv qhia txog kev siv tshuaj insulin detemir thaum cev xeeb tub thiab lactation. Kev kawm txog kev ua haujlwm ntawm kev ua me nyuam hauv cov tsiaj tsis tau qhia tawm qhov sib txawv ntawm detemir insulin thiab insulin tib neeg qhov kev xav ntawm embryotoxicity thiab teratogenicity. Feem ntau, ua tib zoo saib xyuas cov poj niam cev xeeb tub uas muaj ntshav qab zib lub sijhawm tag nrho lub sijhawm cev xeeb tub, nrog rau kev npaj thaum cev xeeb tub, yog qhov tsim nyog. Qhov kev xav tau rau insulin hauv thawj peb lub hlis thaum cev xeeb tub feem ntau poob qis, tom qab ntawd zaum ob thiab peb feem plaub nws nce ntxiv. Tsis ntev tom qab yug los, xav tau cov tshuaj insulin sai sai rau qib uas yog ua ntej cev xeeb tub. Rau cov poj niam uas pub mis niam, yuav tsum tau txhaj tshuaj ntau dua ntawm cov tshuaj inulin thiab zaub mov noj.
Cuam tshuam rau kev muaj peev xwm tsav lub tsheb thiab ua haujlwm nrog kev ua haujlwm. Lub peev xwm ntawm cov neeg mob kom pom tseeb thiab tus nqi tshuaj tiv thaiv tej zaum yuav raug mob thaum lub sijhawm hypoglycemia lossis hyperglycemia, uas tuaj yeem tsim kev phom sij rau cov xwm txheej uas cov peev xwm no tsim nyog tshwj xeeb (piv txwv li, thaum tsav tsheb lossis ua haujlwm nrog cov tshuab thiab tshuab). Cov neeg mob yuav tsum tau qhia rau kev ntsuas kom tiv thaiv kev txhim kho hypoglycemia thiab hyperglycemia thaum tsav tsheb thiab ua haujlwm nrog cov txheej txheem. Qhov no tseem ceeb tshwj xeeb tshaj yog rau cov neeg mob uas tsis muaj los yog tsawg dua cov tsos mob tshwm sim ntawm kev tsim kho tus mob hypoglycemia lossis cov kev mob ntshav tsis txaus ua kom tsis txhob poob qis. Hauv cov xwm txheej no, kev tsim nyog ntawm kev tsav tsheb los yog kev ua haujlwm zoo li no yuav tsum raug txiav txim siab.
Kev sib cuam tshuam yeeb tshuaj Insulin detemir
Muaj ntau tus yeeb tshuaj uas cuam tshuam rau kev xav tau cov tshuaj insulin.
Cov nyhuv hypoglycemic ntawm insulin yog kho los ntawm: qhov ncauj hypoglycemic tshuaj, Mao inhibitors, ACE inhibitors, carbonic anhydrase inhibitors, uas tsis yog-xim β-blockers, bromocriptine, sulfonamides, anabolic steroids, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lithium, tshuaj muaj ethanol.
Cov nyhuv hypoglycemic ntawm insulin tsis muaj zog: cov tshuaj tiv thaiv tsis haum, corticosteroids, cov thyroid hormones, thiazide diuretics, heparin, tricyclic antidepressants, sympathomimetics, danazole, clonidine, qeeb calcium channel blockers, diazoxide, morphine, phenytoin, nicotine. Nyob rau hauv kev cuam tshuam ntawm reserpine thiab salicylates, nws muaj peev xwm ua kom tsis muaj zog lossis txhim kho qhov kev ua ntawm cov tshuaj Octreotide / lanreotide, uas tuaj yeem ua rau ob leeg nce thiab txo qhov xav tau ntawm lub cev. Ers-adrenergic blockers tuaj yeem npog cov tsos mob ntawm kev mob hypoglycemia thiab ncua sijhawm rov qab los tom qab muaj ntshav qab zib tsawg. Cov cawv yuav pab txhim kho thiab ua kom ntev li ntawm cov nyhuv hypoglycemic ntawm insulin.
Incompatibility
Qee cov tshuaj, piv txwv li, muaj cov thiol lossis sulfite, thaum detemir ntxiv rau cov tshuaj insulin, tuaj yeem ua rau nws rhuav tshem. Yog li, tsis txhob ntxiv cov tshuaj insulin nyob rau hauv kev daws teeb meem.
Kev noj tshuaj ntau dhau ntawm cov tshuaj Insulin detemir, cov tsos mob thiab kev kho mob
Ib koob tshuaj tshwj xeeb uas ua rau tham txog kev siv tshuaj ntau dhau ntawm cov tshuaj insulin tsis tau tsim, txawm li cas los xij, ntshav qab zib hauv lub siab tuaj yeem tsim muaj maj mam yog tias qhov tshuaj loj heev tau qhia rau tus neeg mob tshwj xeeb. Cov tsos mob ntshav qog.
Kev Kho Mob: tus neeg mob tuaj yeem tshem tawm qhov mob ntshav qab zib me me los ntawm kev noj cov piam thaj, piam thaj lossis zaub mov muaj carbohydrate. Yog li, nws raug nquahu kom cov neeg mob ntshav qab zib kom noj qab zib, qab zib, ncuav qab zib los yog kua txiv ua kua qab zib tas li.Yog tias qhov mob ntshav nce siab ntau, thaum tus neeg mob tsis nco qab lawm, 0.5-1 mg ntawm glucagon v / m lossis s / c, (tuaj yeem ua haujlwm los ntawm tus neeg kawm tiav), lossis iv dextrose (piam thaj), yuav tsum raug tswj hwm.
INSERT INTO `info` (` ID `,` Npe `,` NameBase`, `TEXT`, `IsUsed`,` Cov lus piav qhia, `KeyWords`) VALUES (tsuas yog nkag los ntawm tus kws kho mob). Kev siv tshuaj kom zoo ntawm dextrose kuj tsim nyog yog tias tus neeg mob tsis rov qab nco qab txog 10-15 feeb tom qab kev tswj hwm ntawm glucagon. Tom qab nws rov qab nco qab, tus neeg mob tau qhia kom noj zaub mov ntau nyob rau hauv carbohydrates thiaj li tiv thaiv kom tsis txhob rov qab ua dua ntawm tus mob ntshav qab zib tsawg.
Sau cov chaw muag tsuaj uas koj tuaj yeem yuav Insulin detemir:
Tso tawm daim ntawv, muaj pes tsawg leeg thiab ntim khoom
Kev daws rau sc administration pob tshab, tsis muaj xim.
| 1 ml | 1 rab koob xaum qhuav | |
| tshuaj insulin | 100 DAIM DUAB * | 300 PIECES * |
Cov muaj tswv yim: glycerol, phenol, metacresol, zinc acetate, sodium chloride, sodium dihydrogen phosphate dihydrate, hydrochloric acid los yog sodium hydroxide, dej d / i.
* 1 koog muaj 142 μg ntsev tsis muaj tshuaj tua kab mob insulin, uas sib haum rau 1 chav tsev. tib neeg cov insulin (IU).
3 ml - iav daim cartridges (1) - tshuaj ntsuab ntau lub taub tes uas siv cov tshuaj lim kom siv tas mus li (5) - pob ntawv los qhia.
Pharmacological kev txiav txim
Kev siv tshuaj hypoglycemic. Nws yog cov soluble basal analogue ntawm tib neeg ntev-ua yeeb yam insulin nrog ib tiaj tiaj kev ua ub no. Ua los ntawm recombinant DNA biotechnology siv hom tshuaj Saccharomyces cerevisiae.
Kev txiav txim ntawm qhov tshuaj ntawm Levemir ® FlexPen ® yog qhov tsawg dua qhov sib txawv hauv qhov sib piv nrog insulin-isophan thiab insulin glargine.
Lub sijhawm ua haujlwm ntev ntev ntawm cov tshuaj Levemir ® FlexPen ® yog vim qhov tshaj tawm tus kheej kev koom tes ntawm detemir insulin lwg me me ntawm qhov chaw txhaj tshuaj thiab qhov khi ntawm cov tshuaj molecules rau albumin los ntawm kev sib txuas nrog cov hlua sab. Piv nrog tshuaj insulin-isophan, insulin detemir yuav qeeb me ntsis rau qhov phom sij lub hom phiaj. Cov kev sib koom ua ke ntawm kev faib khoom ncua tau muab ntau qhov kev nqus tau ntau dua thiab muaj peev xwm ua kom zoo dua qub ntawm Levemir ® FlexPen ® piv rau insulin-isophan.
Nws cuam tshuam nrog ib qho kev tshwj xeeb ntawm sab cytoplasmic membrane ntawm cov hlwb thiab tsim cov txheej txheem insulin-receptor complex uas txhawb cov txheej txheem intracellular, suav nrog synthesis ntawm cov naj npawb ntawm cov enzymes tseem ceeb (hexokinase, pyruvate kinase, glycogen synthetase).
Cov thawj coj hauv cov ntshav nyob rau hauv lub cev vim qhov nce ntxiv hauv nws txoj kev thauj neeg mus los, kev nqus ntawm cov nqaij mos ntau dua, kev txhawb nqa lipogenesis, glycogenogenesis, thiab txo tus nqi ntawm cov piam thaj los ntawm lub siab.
Rau kev txhaj tshuaj ntawm 0.2-0.4 U / kg 50%, cov nyhuv siab tshaj plaws ntawm cov tshuaj tshwm sim hauv thaj tsam li ntawm 3-4 teev mus rau 14 teev tom qab kev tswj hwm. Lub sijhawm tiv thaiv yog txog li 24 teev, nyob ntawm seb lub koob tshuaj, uas ua rau nws muaj peev xwm tswj hwm 1 zaug / hnub lossis 2 zaug / hnub.
Tom qab kev tswj hwm sc, ib qho kev siv tshuaj pharmacodynamic tau muab faib rau cov koob tshuaj uas tau siv (cov txiaj ntsig siab tshaj plaws, sijhawm ua haujlwm, cov nyhuv dav dav).
Hauv kev tshawb fawb mus ntev hauv cov neeg mob ntshav qab zib hom 2 uas tau txais kev kho mob ntshav qab zib nyob rau hauv kev sib xyaw nrog cov tshuaj tiv thaiv ntshav qab zib hauv qhov ncauj, nws tau pom tias glycemic tswj (nyob rau hauv glycosylated hemoglobin - АbА1s) tiv thaiv keeb kwm ntawm kev kho mob nrog Levemir ® FlexPen ®, nws tau piv nrog cov tshuaj insulin-isophan thiab insulin glargine nrog qhov hnyav nce.
Hloov hauv lub cev qhov hnyav nrog kev kho mob insulin
| Kawm ntev | Insulin detemir ib zaug | Insulin detemir ob zaug | Isulin cov kua dej | Cov tshuaj insulin glargine |
| 20 lub lis piam | + 0.7 kg | + 1.6 kg | ||
| 26 lub lis piam | + 1.2 kg | + 2.8 kg | ||
| 52 lub lim tiam | + 2.3 kg | + 3.7 kg | + 4 kg |
Hauv cov kev tshawb fawb, kev siv tshuaj sib xyaw ua ke nrog Levemir en FlexPen ® thiab qhov ncauj tshuaj hypoglycemic nyob rau hauv 61-65% ntawm cov neeg mob txo qhov kev pheej hmoo ntawm kev tsim tsaus ntuj nti hypoglycemia, hauv kev sib piv rau insulin-isophan.
Hauv kev tshawb fawb ntev (months6 hlis), yoo plasma ntshav qab zib hauv cov neeg mob ntshav qab zib hom ntshav qab zib tau zoo dua piv nrog kev kho mob nrog Levemir ® FlexPen ® piv nrog insulin-isophan tshuaj kho mob hauv paus / bolus txoj kev kho, nrog rau kev tshawb fawb nrog cov menyuam yaus thiab tub ntxhais hluas hnub nyoog 6 txog 17 xyoo. Glycemic tswj (HbA1s) thaum kho nrog Levemir ® FlexPen ® piv rau cov kev kho mob insulin-isophan, muaj kev pheej hmoo hmo ntuj tsawg thiab tsis muaj kev hnyav hauv lub cev nrog Levemir ® FlexPen ®.
Cov ntaub ntawv ntawm hmo ntuj glycemic tswj yog flatter thiab ntau heev tshaj dua nrog Levemir ® FlexPen ® piv nrog insulin-isophan, uas yog cuam tshuam los ntawm kev pheej hmoo tsawg ntawm kev tsim hmo ntuj hypoglycemia.
Thaum siv Levemir ® FlexPen ®, tiv thaiv kev tsim tshuaj tiv thaiv kab mob. Txawm li cas los xij, qhov tseeb no tsis cuam tshuam nrog kev tswj glycemic.
Cov Tshuaj Pharmacokinetics
Nrog kev tswj hwm sc, cov tshuaj ntau ntau yog ib feem ntawm cov koob tau muab tshuaj (Cmax, degree ntawm kev nqus).
Cmax ua tiav 6-8 teev tom qab kev tswj hwm. Nrog rau kev tswj hwm ob hnub ntawm kev tswj hwm ntawm Css tiav tom qab 2-3 hno.
Kev nkag mus rau sab hauv lub cev yog qhov qis dua rau Levemir ® FlexPen ® piv rau lwm cov kev npaj tshuaj insulin uas nyob puag ncig.
Nruab Nrab Vd detemir insulin (kwv yees li 0.1 l / kg) qhia tias muaj ntau ntawm detemir insulin khiav hauv cov ntshav.
Hauv kev tshawb pom nyob hauv vitro thiab hauv vivo cov protein txuas qhia txog qhov tsis muaj kev sib cuam tshuam hauv chaw kho mob ntawm detemir insulin thiab fatty acids lossis lwm yam tshuaj tiv thaiv protein.
Lub biotransformation ntawm insulin detemir zoo ib yam li tib neeg cov kev npaj insulin, tag nrho cov metabolites tsim tawm tsis ua haujlwm.
Davhlau ya nyob twg T1/2 tom qab sc txhaj tshuaj, nws yog txiav txim siab los ntawm cov degree ntawm nqus ntawm cov nqaij subcutaneous thiab yog 5-7 teev, nyob ntawm qhov koob tshuaj.
Pharmacokinetics hauv cov chaw kuaj mob tshwj xeeb
Muaj tsis muaj kev sib kis tseem ceeb hauv kev sib deev sib txawv hauv cov chaw muag tshuaj ntawm Levemir ® FlexPen ®.
Cov chaw muag tshuaj ntawm cov tshuaj Levemir ® FlexPen ® tau kawm hauv cov menyuam yaus (6-12 xyoo) thiab cov hluas (13-17 xyoo) thiab piv. Tsis muaj qhov sib txawv ntawm cov khoom lag luam pharmacokinetic piv nrog cov neeg mob cov neeg mob ntshav qab zib hom 1.
Tsis muaj qhov sib txawv hauv qhov chaw kho mob ntawm Levemir ® FlexPen ® ntawm cov neeg laus thiab cov neeg hluas, lossis ntawm cov neeg mob uas tsis muaj mob raum thiab mob hlwb thiab cov neeg mob noj qab nyob zoo.
Kev Kawm Kev Nyab Xeeb Preclinical
Kev tshawb nrhiav hauv vitro nyob rau hauv tib neeg cov kab, nrog rau kev tshawb fawb txog kev khi rau cov kab mob insulin thiab IGF-1 (insulin-zoo li qhov kev loj hlob), pom tias insemir insulin muaj kev cuam tshuam tsawg rau ob qho tib si receptors thiab muaj cov nyhuv me rau kev loj hlob ntawm tes piv rau tib neeg cov insulin.
Cov ntaub ntawv tshaj tawm raws li kev tshawb fawb niaj hnub ntawm kev nyab xeeb ntawm pharmacological, rov qab siv tshuaj ntau dua tshuaj lom neeg, genotoxicity, lub cev muaj zog, cov tshuaj lom neeg muaj peev xwm ntawm kev ua me nyuam, tsis qhia txog kev phom sij rau tib neeg.
Kev noj tshuaj ntxiv
Levemir ® FlexPen ® yog npaj rau kev tswj hwm sc.
Qhov ntau thiab tsawg zaus ntawm kev tswj hwm ntawm cov tshuaj Levemir ® FlexPen ® tau txiav txim siab ntawm tus kheej hauv txhua kis.
Kev Kho Mob nrog Levemir ® FlexPen ® ua ke nrog tshuaj ntawm qhov ncauj hypoglycemic, nws pom zoo kom pib nrog 1 zaug / hnub ntawm koob ntawm 10 PIECES lossis 0.1-0.2 PIECES / kg. Cov koob tshuaj ntawm Levemir ® FlexPen ® yuav tsum tau xaiv ib tus zuj zus raws li cov ntshav qabzib muaj nuj nqis. Raws li cov txiaj ntsig ntawm cov kev tshawb fawb, cov hauv qab no yog cov lus qhia rau koob tshuaj titration:
| Qhov Ntsuas Plasma Ntsuas qhov nruab nrab ntsuas nws tus kheej ua ntej noj tshais | Kuaj tshuaj ntawm Levemir ® FlexPen ED (ED) |
| > 10 mmol / L (180 mg / dL) | +8 |
| 9.1-10 mmol / L (163-180 mg / dl) | +6 |
| 8.1-9 mmol / L (145-162 mg / dl) | +4 |
| 7.1-8 mmol / L (127-144 mg / dl) | +2 |
| 6.1-7 mmol / L (109-126 mg / dl) | +2 |
| Yog tias ib qho txiaj ntsig ntshav qabzib: | |
| 3.1-4 mmol / L (56-72 mg / dl) | -2 |
| Yog tias Levemir ® FlexPen ® siv raws li cov txheej txheem pib / bolus, nws yuav tsum siv tshuaj 1 lossis 2 zaug ib hnub raws li tus neeg mob xav tau. Cov neeg mob uas yuav tsum tau siv cov tshuaj 2 zaug / hnub rau kev tswj hwm zoo ntawm glycemia tuaj yeem nkag rau thaum yav tsaus ntuj tsis hais thaum noj hmo, lossis ua ntej mus pw, lossis 12 teev tom qab noj thaum sawv ntxov. Levemir ® FlexPen ® muab rau tus ncej puab, sab xub ntiag ntawm phab ntsa lossis xub pwg. Qhov chaw txhaj tshuaj yuav tsum tau hloov txawm tias thaum nkag mus rau thaj chaw qub. Ntawm ntawm cov neeg moblaus lawmxyab ntawv thiab cov neeg mob raum lossis lub siab tsis ua haujlwm cov ntshav qabzib nyob rau qib yuav tsum tau saib xyuas dua thiab txhaj tshuaj kho kom haum. Kuj tseem yuav tsum tau kho dua thaum ua kom tus neeg mob lub cev ua ub no, hloov nws li kev noj zaub mov kom zoo dua qub, lossis muaj mob hnyav. Ntawm hloov los ntawm cov yeeb yam nruab nrab thiab insulin ntev mus rau Levemir ® FlexPen ® insulin koob tshuaj thiab lub sijhawm hloov kho yuav tsum tau ua. Ua tib zoo saib xyuas cov ntshav qabzib hauv lub sijhawm hloov pauv thiab hauv thawj lub limtiam ntawm cov tshuaj tshiab pom zoo. Yuav tsum kho cov kev kho cov ntshav qog ntshav kom ntshav (koob thiab sijhawm uas tswj cov tshuaj insulin sai li sai tau lossis siv tshuaj ntawm qhov ncauj hypoglycemic). Hnub nyoog ntawm kev siv cov tshuaj Levemir ® FlexPen ® Levemir ® FlexPen ® koob txhaj tshuaj nrog dispenser. Muab koob tshuaj ntawm cov tshuaj insulin nyob rau hauv thaj tsam ntawm 1 txog 60 units tuaj yeem hloov pauv hauv nce 1 ntu. NovoFine ® thiab NovoTvist ® koob mus txog 8 hli ntev yog tsim los rau kev siv nrog Levemir ® FlexPen ®. Yuav kom ua raws li kev tiv thaiv kev nyab xeeb, koj yuav tsum nco ntsoov nqa lub cuab yeej hloov pauv rau kev tswj hwm insulin thaum muaj poob lossis puas rau FlexPen ®. Ua ntej siv Levemir ® FlexPen ®, nco ntsoov tias cov hom tshuaj insulin raug xaiv tau. Npaj rau kev txhaj tshuaj: hle lub hau, tua cov roj hmab membrane nrog daim nplawm dej rau hauv dej cawv kho mob, tshem tawm daim ntawv nplaum tiv thaiv los ntawm rab koob pov tseg, ua tib zoo thiab zawm lub hau mus rau ntawm Levemir ® FlexPen ®, tshem lub sab loj (tsis pov tseg) thiab sab hauv (muab pov tseg) lub hau los ntawm rab koob Cov. Ib rab koob tshiab yuav tsum tau siv rau txhua txoj kev txhaj tshuaj. Tsis txhob khoov lossis ua kom puas lub koob. Txhawm rau kom tsis txhob lam tau lam ua, tsis txhob muab lub hau sab hauv khi rau ntawm rab koob. Qhov ua ntej tshem tawm ntawm huab cua los ntawm daim cartridge. Hauv kev siv ib txwm, kua xaum xaum yuav tuaj yeem nqus cov pa hauv rab koob thiab dej phwj ua ntej kev txhaj tshuaj. Txhawm rau kom tsis txhob tau txais huab cua npuas thiab qhia cov tshuaj ntawm cov tshuaj, yuav tsum ua raws li cov lus qhia hauv qab no: - Hu rau 2 pawg ntawm cov tshuaj, - muab Levemir ® FlexPen ® feem ntsug nrog lub koob thiab ntau zaus maj mam kov lub taub dej nrog koj lub ntsis ntiv tes kom cov cua npuas txav mus rau sab saud ntawm daim cartridge, - thaum tuav Levemir ® FlexPen ® nrog rab koob sawv, nias lub pob pib rau txhua txoj kev, xaiv tshuaj yuav rov qab mus rau xoom, - Ib qho kev poob ntawm insulin yuav tsum tshwm sim thaum kawg ntawm rab koob, yog tias qhov no tsis tshwm sim, tom qab ntawd rov ua qhov txheej txheem, tab sis tsis tshaj 6 zaug. Yog tias cov tshuaj insulin tsis tuaj los ntawm rab koob, qhov no qhia tau tias tus cwj mem tsis haum lawm thiab yuav tsum tsis txhob siv ntxiv. Koob chaw. Nco ntsoov tias txoj kev xaiv ntau npaum li tau teem rau "0". Nkag mus rau qhov nyiaj tau ntawm UNIT xav tau rau kev txhaj tshuaj. Cov koob tshuaj tuaj yeem hloov kho los ntawm kev hloov cov tshuaj xaiv tshuaj hauv ib qho kev taw qhia. Thaum tig qhov ntsuas ntau npaum li cas, kev saib xyuas yuav tsum ua kom tsis txhob yuam kev nias lub khawm pib kom tiv thaiv txoj kev tso tawm ntawm koob tshuaj insulin. Nws tsis tuaj yeem tsim kom tau ib koob tshuaj ntau dua qhov nyiaj ntawm UNITS tseem tshuav hauv daim cartridge. Tsis txhob siv cov nplai seem los ntsuas cov tshuaj insulin. Cov qhia ntawm cov tshuaj. Ntxig lub koob subcutaneously. Txhawm rau txhawm rau txhaj tshuaj, nias lub pob pib rau txhua txoj kev kom txog rau thaum "0" tshwm nyob rau hauv pem hauv ntej ntawm qhov ntsuas cov koob tshuaj. Thaum tswj hwm cov tshuaj, tsuas yog pib khawm yuav tsum nias. Thaum qhov kev xaiv ntau npaum li cas tig lawm, kev tswj hwm tshuaj yuav tsis tshwm sim. Tom qab txhaj koob, rab koob yuav tsum nyob hauv qab daim tawv nqaij 6 feeb (qhov no yuav ua kom paub meej ntawm kev txhaj tshuaj ntawm cov tshuaj insulin). Thaum tshem tawm rab koob, khaws lub khawm pib nias tag nrho, qhov no yuav ua kom paub meej ntawm kev qhia ntawm qhov tshuaj tag nrho. Koob tshem tawm. Kaw lub koob nrog lub hau sab nraud thiab unscrew nws los ntawm cov xaum xaum qhuav. Pov tseg hauv rab koob, kev tshuaj xyuas kev nyab xeeb. Tom qab txhaj txhua, koob yuav tsum tau muab tshem tawm. Txwv tsis pub, kua yuav xau tawm ntawm tus cwj mem, uas yuav ua rau qhov ntsuas tsis yog. Cov neeg kho mob, cov neeg txheeb ze, thiab lwm cov neeg saib xyuas yuav tsum ua raws li cov kev tiv thaiv ib txwm thaum tshem thiab pov tawm cov koob kom tsis txhob muaj qhov phom sij tsis zoo. Siv Levemir ® FlexPen ® yuav tsum tau muab pov tseg nrog rab koob txiav tawm. Cia khoom thiab kev saib xyuas. Qhov saum npoo ntawm cov tes tsho xaum tuaj yeem raug muab ntxuav nrog paj rwb pas nrig ntuav hauv cawv cawv. Tsis txhob tso dej hauv cov xwj qhwv hauv dej cawv, ntxuav los yog ntub nws. nws tuaj yeem tsim kev puas tsuaj rau lub cuab yeej. Kev puas tsuaj rau tus xaum xaum nrog lub Levemir ® FlexPen ® dispenser yuav tsum zam. Txwv tsis pub rov ntim syringe cwj mem. Sab sij huamCov kev tsis zoo tshwm sim pom hauv cov neeg mob uas siv Levemir ® FlexPen ® feem ntau yog qhov koob tshuaj-tsim thiab kev txhim kho vim yog cov txiaj ntsig pharmacological ntawm cov tshuaj insulin. Cov kev mob tshwm sim feem ntau yog hypoglycemia, uas tshwm sim thaum uas cov tshuaj ntau dhau los siv rau ntawm tus neeg lub cev xav tau cov tshuaj insulin. Los ntawm cov kev tshawb fawb hauv chav kho mob nws tau paub tias mob ntshav qab zib ntau, txhais tau tias yog qhov xav tau ntawm kev cuam tshuam thib peb, muaj ntau li thaj tsam 6% ntawm cov neeg mob uas tau txais Levemir ir FlexPen ®. Cov tshuaj tiv thaiv ntawm qhov chaw txhaj tshuaj tuaj yeem pom ntau zaus nrog Levemir ® FlexPen ® tshaj li kev qhia ntawm tib neeg insulin. Cov kev cuam tshuam no suav nrog liab, o, ua pob, ua pob, thiab khaus ntawm qhov chaw txhaj tshuaj. Feem ntau qhov tshwm sim ntawm qhov chaw txhaj tshuaj yog qhov me me thiab ib ntus ntawm qhov xwm txheej, i.e. ploj nrog kev kho mob txuas mus ob peb hnub mus rau ntau lub lis piam. Qhov feem ntawm cov neeg mob uas tau txais kev kho mob nrog Levemir ® FlexPen ®, uas xav tias yuav muaj kev mob tshwm sim, kwv yees li 12%. Qhov tshwm sim ntawm cov kev mob tshwm sim, uas feem ntau kwv yees muaj feem cuam tshuam nrog Levemir ® FlexPen ® thaum kuaj mob, muaj qhia hauv qab no. Cov kev phiv tsis cuam tshuam nrog kev cuam tshuam rau cov metabolism hauv carbohydrate: feem ntau (> 1/100, 1/100, 1/1000, 1/1000, 1/1000, 1/10 000, contraindications rau kev siv yeeb tshuaj - nce ib tug neeg rhiab heev rau cov tshuaj ntawm cov tshuaj. Nws tsis raug nquahu kom siv cov tshuaj Levemir ® FlexPen ® hauv cov menyuam yaus hnub nyoog qis dua 6 xyoo, vim tias kev tshawb fawb soj ntsuam hauv pab pawg neeg ntawm cov neeg mob tsis tau ua. Kev siv cov tshuaj thaum cev xeeb tub thiab lactationCov kev paub txog kev kho mob nrog kev siv cov insulin detemir thaum cev xeeb tub thiab thaum pub mis niam yog tsawg. Kev tshawb nrhiav ntawm kev ua me nyuam hauv cov tsiaj tsis qhia tawm qhov sib txawv ntawm insulin detemir thiab tib neeg cov insulin nyob rau hauv cov lus ntawm embryotoxicity thiab teratogenicity. Feem ntau, ua tib zoo saib xyuas cov poj niam cev xeeb tub uas muaj ntshav qab zib lub sijhawm tag nrho lub sijhawm cev xeeb tub, nrog rau kev npaj thaum cev xeeb tub, yog qhov tsim nyog. Qhov kev xav tau rau insulin hauv thawj peb lub hlis thaum cev xeeb tub feem ntau poob qis, tom qab ntawd zaum ob thiab peb feem plaub nws nce ntxiv. Tsis ntev tom qab yug los, xav tau cov tshuaj insulin sai sai rau qib uas yog ua ntej cev xeeb tub. Hauv cov pojniam muaj menyuam, kev txhaj tshuaj thiab noj zaub mov kom haum. Yeeb tshuaj sib cuam tshuamHypoglycemic nyhuv ntawm insulin txhim khu qhov ncauj hypoglycemic tshuaj, Mao inhibitors, ACE inhibitors, carbonic anhydrase inhibitors, xim beta-blockers, bromocriptine, sulfonamides, anabolic steroids, tetracyclines, clofibrate, ketoconazole, mebendazole, pyridoxine, theophylline, cyclophosphamide, fenfluramine, lithium, tshuaj, muaj ethanol. Cov nyhuv hauv cov ntshav insulin tsis muaj zog txaus los ntawm kev tiv thaiv kab mob hauv lub qhov ncauj, corticosteroids, iodine-muaj cov thyroid hormones, somatotropin, thiazide diuretics, heparin, tricyclic antidepressants, sympathomimetics, danazole, clonidine, qeeb calcium calcium blockers, diazoxide, morphine, phenin, thiab pheny. Nyob rau hauv kev cuam tshuam ntawm reserpine thiab salicylates, ob qho tib si ua kom tsis muaj zog thiab nce ntxiv hauv kev ua ntawm cov tshuaj muaj peev xwm ua tau. Octreotide, lanreotide tuaj yeem ob leeg nce thiab txo qis lub cev xav tau cov tshuaj insulin. Beta-blockers tuaj yeem npog cov tsos mob ntawm kev mob ntshav qab zib thiab ncua sijhawm rov qab tom qab muaj ntshav qab zib tsawg. Ethanol tuaj yeem txhim kho thiab ua kom ntev ntev ntawm cov qog ntshav hypoglycemic ntawm insulin. Qee cov tshuaj, piv txwv li, muaj cov thiol lossis sulfite pawg, thaum ntxiv rau cov tshuaj Levemir ® FlexPen ®, tuaj yeem ua rau kev puas tsuaj ntawm insulin detemir. Levemir ® FlexPen ® yuav tsum tsis txhob ntxiv rau kev daws teeb meem. Cov lus thiab cov xwm txheej ntawm kev ciaSau npe B. Cov tshuaj yuav tsum muab cia rau hauv tub yees li ntawm 2 ° txog 8 ° C (hauv tub yees, tab sis kom deb ntawm lub taub yees txias), tsis txhob khov. Txee lub neej - 30 lub hlis. Txhawm rau tiv thaiv los ntawm lub teeb, cov xaum xaum xaj yuav tsum cia nrog lub hau ntawm. Tom qab siv thawj zaug, Levemir ® FlexPen ® yuav tsum tsis txhob cia rau hauv lub tub yees. Siv lossis nqa raws li tus cwj mem tsis txaus siv nrog Levemir ® FlexPen ® yuav tsum cia nyob rau qhov kub tshaj li 30 ° C rau txog 6 lub lis piam. Cov tshuaj yuav tsum muab khaws cia kom deb ntawm cov menyuam yaus. Dosage daim ntawvKev daws rau subcutaneous saib xyuas ntawm 100 PIECES / ml 1 ml ntawm kev daws cov tshuaj heev - insulin detemir 100 IU (2400 nmol = 14.2000 mg), tus zam: zinc, glycerol, phenol, metacresol, sodium hydrogen phosphate dihydrate, sodium chloride, 2 M hydrochloric acid lossis sodium hydroxide (2 M tov) (los kho pH), dej rau kev txhaj tshuaj. Ib qho cartridge muaj 3 ml ntawm kev daws, sib npaug rau 300 daim PIECES. Ib chav tsev ntawm insulin detemir muaj 0.142 mg ntawm cov ntsev tsis muaj tshuaj tua kab mob insulin. Ib ntu ntawm insulin detemir (IU) sib raug rau ib chav ntawm tib neeg cov tshuaj insulin (IU). Pob tshab, tsis muaj xim ua kua. Thaum lub sij hawm cia, cov khoom siv zoo heev ntawm cov zeem cia yuav poob tawm.
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