Tresiba® Penfill® Insulin degludec

Txhaj Tshuaj 100 U / ml

1 ml ntawm kev daws

cov tshuaj nquag - tshuaj insulin degludec * - 100 PIECES (3.66 mg),

zam txim: phenol, metacresol, glycerol, zinc, hydrochloric acid / sodium hydroxide (rau pH kho), dej rau kev txhaj tshuaj.

* tsim los ntawm recombinant DNA biotechnology siv lim siv Saccharomycescerevisiae

Ib qho cartridge muaj 3 ml ntawm kev daws, sib npaug rau 300 daim PIECES.

Pob tshab tsis muaj xim.

Cov chaw muag tshuaj

Cov Tshuaj Pharmacokinetics

Tom qab txhaj tshuaj subcutaneous, kev tsim cov tshuaj soluble ruaj khov insulin degludec multhexamers cov ntaub ntawv, uas tsim cov insulin depot hauv subcutaneous adipose cov ntaub so ntswg. Multihexamers maj mam sib cais, tso tawm degludec insulin monomers, uas ua rau lub qeeb txuas ntxiv ntawm cov tshuaj mus rau hauv cov ntshav.

Kev sib luag ntawm Tresiba® hauv plasma sib luag yog tau mus txog tom qab 2-3 hnub ntawm kev siv txhua hnub.

Kev ua ntawm insulin degludec rau 24 teev nrog nws cov thawj coj ib hnub ib hnub yog tusyees faib nruab nrab ntawm thawj thiab thib 12 12 teev sib nrug (AUCGIR, 0-12h, SS / AUCGIR, τ, SS = 0.5).

Qhov sib koom ua ke ntawm degludec insulin rau cov ntshiab albumin sib raug rau lub peev xwm khi ntawm plasma protein> 99% hauv tib neeg cov ntshav ntshav.

Kab Zuag

Nrog kev tswj hwm hauv subcutaneous, tag nrho cov ntshav plasma ntau ntau yog cov sib npaug ntawm cov koob tshuaj uas tau siv hauv cov tshuaj kho tau.

Cov pab pawg neeg tshwj xeeb

Cov neeg laus, cov neeg mob ntawm ntau haiv neeg, cov neeg mob sib txawv, cov neeg mob uas lub raum tsis ua haujlwm lossis lub siab ua haujlwm

Tsis muaj qhov sib txawv hauv tsev kho mob ntawm Tresiba Penfill® ntawm cov neeg laus thiab cov neeg mob hluas, ntawm cov neeg mob ntawm cov pab pawg sib txawv, ntawm cov neeg mob uas tsis zoo los yog mob hlwb thiab cov neeg mob noj qab nyob zoo.

Muaj kuj tsis muaj qhov sib txawv ntawm cov yam ntxwv pharmacokinetic ntawm cov tshuaj nyob ntawm poj niam txiv neej tus neeg mob.

Menyuam yaus thiab tub ntxhais hluas

Cov chaw muag tshuaj ntawm Tresiba Penfill® hauv txoj kev tshawb fawb hauv cov menyuam yaus (1–11 xyoo) thiab cov neeg hluas (12-18 xyoo) uas muaj ntshav qab zib hom 1 yog piv rau cov neeg mob hauv cov neeg laus uas tau txhaj ib koob.

Tag nrho cov txiaj ntsig ntawm kev txhaj tshuaj ntawm degludec insulin hauv cov menyuam yaus thiab cov tub ntxhais hluas yog qhov siab dua piv rau cov neeg mob hauv cov neeg laus nrog kev tswj hwm ib leeg ntawm cov tshuaj rau cov neeg mob ntshav qab zib hom 1.

Cov Tshuaj Hauv Tshuaj

Tresiba® Penfill® yog ib qho khoom noj ntawm cov neeg ua haujlwm ntev insulin uas ua los ntawm kev siv cov DNA biotechnology siv cov tshuaj Saccharomyces cerevisiae hom.

Treciba® Penfill ® yog qhov yooj yim sib txig ntawm tib neeg cov roj ntsha ua haujlwm ntev. Tom qab txhaj tshuaj subcutaneous, qhov sib xyaw ua haujlwm ntawm cov tshuaj (insulin degludec) ua cov kuab tshuaj lom neeg nyob rau hauv cov subcutaneous depot, los ntawm qhov muaj qhov qeeb qeeb txuas ntxiv ntawm cov tshuaj insulin degludec rau hauv cov ncig, muab ib daim ntawv tiaj tus ntawm kev ua thiab ruaj khov hypoglycemic nyhuv ntawm cov tshuaj.

Hauv lub sijhawm 24-teev lub sijhawm saib xyuas qhov hypoglycemic nyhuv ntawm cov tshuaj hauv cov neeg mob rau tus neeg ntawm koob tshuaj degludec insulin raug tswj ib zaug ib hnub, Tresiba Penfill® tshuaj, nyob rau hauv kev sib piv rau cov insulin glargine, pom ib qho kev faib sib luag ntawm cov kev ua hauv thawj thiab thawj 12-teev sijhawm (AUCGIR, 0-12h, SS / AUCGIR, tag nrho, SS = 0.5)

Daim duab. 1. 24-teev rau nruab nrab lub suab thaj infusion rate profile - equilibrium degludec insulin concentration ntawm 100 PIECES / ml 0.6 PIECES / kg (1987 kawm)

Lub sijhawm sijhawm ntawm cov tshuaj Tresiba Penfill® yog ntau dua 42 teev nyob rau ntawm txoj kev kho mob ntau npaum li cas. Kev sib xyaw ua ke ntawm cov tshuaj hauv cov ntshav ntshav tau tiav 2-3 hnub tom qab kev tswj hwm ntawm cov tshuaj.

Insulin degludec nyob rau hauv kev sib xyaw ua kom pom tseeb pom tsawg dua (4 zaug) piv nrog insulin glargin txhua hnub kev hloov pauv ntawm hypoglycemic kev ua, uas tau kwv yees los ntawm tus nqi ntawm cov sib npaug ntawm cov kev hloov pauv (CV) rau txoj kev kawm ntawm cov nyhuv hypoglycemic ntawm cov tshuaj dhau ib zaug tshuaj ntau npaum li cas los ntawm 0 txog 24 teev ( AUCGIR, τ, SS) thiab tsis pub dhau lub sijhawm ntawm 2 txog 24 teev (AUCGIR, 2-24h, SS) (Cov Lus 1).

Tab. 1. Kev hloov pauv ntawm cov ntawv qhia niaj hnub ntawm cov nyhuv hypoglycemic ntawm cov tshuaj Tresiba thiab insulin glargine nyob hauv lub xeev qhov sib luag hauv cov neeg mob uas muaj hom 1 ntshav qab zib mellitus.

Kev hloov pauv ntawm cov ncauj lus niaj hnub ntawm hypoglycemic kev txiav txim thaum lub sij hawm ib koob dosing (AUCGIR, τ, SS)

Kev hloov pauv ntawm cov ntaub ntawv txhua hnub ntawm hypoglycemic kev txiav txim siab thaum lub sijhawm sib nrug ntawm 2 txog 24 teev (AUCGIR, 2-24 h, SS)

CV: coefficient ntawm intraindype hloov pauv hauv%

SS: tshuaj muaj yees nyob rau hauv sib npaug

AUCGIR, 2-24h: cov nyhuv hauv lub cev hauv 22 xuaj moos kawg ntawm kev noj tshuaj ntau zaus (i.e., nws tsis muaj qhov cuam tshuam rau nws ntawm kev tso tshuaj insulin thaum lub sijhawm ua kev qhia clamp).

Txoj kab sib txuas ntawm qhov nce ntxiv ntawm koob tshuaj Tresiba Penfill® thiab nws cov txiaj ntsig hypoglycemic dav tau raug pom.

Cov kev tshawb fawb tsis qhia tawm qhov sib txawv hauv tsev kho mob hauv cov chaw muag tshuaj ntawm cov tshuaj Tresiba ntawm cov neeg laus thiab cov neeg laus cov hluas.

Cov chaw kuaj mob tau zoo thiab Kev Nyab Xeeb

11 kev kho mob thoob ntiaj teb qhib kev soj ntsuam tau ua nyob rau hauv kev tsim "Kev Kho Mob rau lub hom phiaj" kav ntev li 26 thiab 52 lub lis piam, ua cov pab pawg sib txuas, uas muaj tag nrho 4275 cov neeg mob ntshav qab zib mellitus (1102 cov neeg mob ntshav qab zib hom 1 thiab 3173 cov neeg mob ntshav qab zib ntshav qab zib hom 2) kho nrog Tresiba®.

Kev ua tau zoo ntawm Tresiba® tau kawm rau cov neeg mob ntshav qab zib hom 1 (kab 3), hauv cov neeg mob ntshav qab zib hom 2 uas tsis tau txais tshuaj insulin ua ntej (pib siv tshuaj tua kab mob insulin, Rooj 4), thiab leej twg tau txais kev kho mob insulin (kev ua kom zoo ntxiv ntawm kev siv tshuaj insulin, Rooj 5 ) hauv kev hloov pauv lossis rov qab noj tshuaj ntau dua ntawm cov tshuaj Tresiba® (Cov Lus 6).

Qhaj ntawv tsis zoo tshaj plaws ntawm cov tshuaj sib piv (insulin detemir thiab insulin glargine) dhau ntawm cov tshuaj Tresiba nrog rau kev txo qis hauv glycated hemoglobin (HbA1c) los ntawm lub sijhawm ntawm kev suav rau thaum kawg ntawm kev tshawb fawb tau ua pov thawj. Ib qho kev zam tsuas yog siv cov tshuaj sitagliptin, thaum sib piv nrog qhov uas cov tshuaj Tresiba® tau qhia txog nws qhov kev muaj nuj nqis tseem ceeb nrog rau kev txo qis hauv HbA1c (Cov Lus 5).

Cov txiaj ntsig ntawm kev hloov pauv kev ntsuas ntawm cov ntaub ntawv tau txais thaum lub sij hawm 7 cov kev sim kho mob tau npaj los ntawm "kev kho mus rau lub hom phiaj" nrog kev koom tes ntawm cov neeg mob uas muaj hom 1 thiab hom 2 mob ntshav qab zib mellitus qhia tau qhov zoo ntawm Tresiba txoj kev kho nrog txoj kev txo qis piv rau kev kho mob insulin glargine , qhov ntau zaus ntawm kev txhim kho hauv cov neeg mob uas muaj mob ntu ntawm nocturnal hypoglycemia (Cov Lus 2). Kev txo qis qhov tshwm sim ntawm hypoglycemia thaum kho mob Tresib® tau ua tiav nrog qhov qis qis nruab nrab ntawm cov ntshav txhauv ntau dua nrog insulin glargine.

Rooj ntawv 2. Xov xwm tsom xam ntawm cov ntaub ntawv rov ua haujlwm ntshav qog

Lub sijhawm pkev pom zooennoyntshav qogthiabtab sis

Kwv yees Txoj Kev Phom Sij

(insulin degludec / insulin glargine)

Tag Nrho

Hmo ntujs

Type 1 diabetes mellitus + type 2 mob ntshav qab zib (cov ntaub ntawv dav dav)

Qhia txog ntawm cov tshuaj

Cov tshuaj Insulin degludec * (Insulin degludec *) - Cov tshuaj Insulin degludec * (Insulin degludec *) ® Penfill ® - tib neeg lub cev ntev insulin ua los ntawm cov tshuaj DNA DNA biotechnology siv Saccharomyces cerevisiae hom.

Insulin degludec tshwj xeeb khi rau tib neeg cov tshuaj insulin endogenous thiab, cuam tshuam nrog nws, paub txog nws cov tshuaj pharmacological zoo ib yam li cov nyhuv ntawm tib neeg insulin.

Cov nyhuv hypoglycemic ntawm degludec insulin yog vim muaj kev siv ntau dua ntawm cov suab thaj los ntawm cov ntaub so ntswg tom qab khi ntawm cov insulin rau cov leeg nqaij thiab cov roj ntsha ua kom lub cev thiab ib txhij txo qis hauv cov nqi ntawm cov piam thaj los ntawm lub siab.

Cov tshuaj Tresiba Penfill ® yog qhov sib piv ntawm tib neeg lub cev ntawm cov tshuaj insulin ntawm lub sijhawm ntev, tom qab txhaj tshuaj subcutaneous nws tsim cov tshuaj soluble multhexamers nyob rau hauv cov subcutaneous depot, los ntawm qhov uas muaj kev txuas ntxiv thiab ntev ntev ntawm kev nqus ntawm degludec insulin mus rau hauv cov ntshav, uas muab qhov ntev ntev, tiaj tus kheej ntawm kev txiav txim siab thiab ruaj khov hypoglycemic cov tshuaj. Hauv lub sijhawm 24-teev lub sijhawm soj ntsuam hypoglycemic cov tshuaj nyob rau hauv cov neeg mob rau tus neeg ntawm koob tshuaj degludec insulin raug tswj ib zaug ib hnub, Tresiba Penfill® tshuaj, tsis zoo li cov tshuaj insulin glargine, qhia txog kev sib faib ntim ntawm cov kev ua hauv thawj thiab thawj 12-teev sijhawm ( Auc_{GiR, 0-12h, SS}/ Auc_{GiR, tag nrho, SS} = 0.5).

Cov tshuaj insulin degludec hauv kev sib xyaw ua kom pom tseeb pom tsawg dua (4 npaug) piv nrog insulin glargin txhua hnub kev hloov pauv ntawm hypoglycemic kev ua, uas tau kwv yees los ntawm tus nqi ntawm qhov sib npaug ntawm qhov hloov pauv (CV) rau txoj kev kawm ntawm cov nyhuv hypoglycemic ntawm cov tshuaj thaum lub sijhawm ib koob (AUC)_{GiR, t, SS}) thiab hauv lub sijhawm ncua sijhawm ntawm 2 txog 24 teev (AUC_{GiR, 2-24h, SS}), saib ຕາ ntawv 1.

Cov lus 1. Cov hloov pauv ntawm cov ntawv qhia niaj hnub ntawm kev cuam tshuam hypoglycemic ntawm yeeb tshuaj Tresiba thiab insulin glargine nyob rau hauv lub xeev ntawm qhov sib npaug siab hauv cov neeg mob uas muaj hom 1 ntshav qab zib mellitus.

Insulin degludec (N26) (CV%)	Cov tshuaj insulin glargine (N27) (CV%)
Kev hloov pauv ntawm txhua hnub hypoglycemic kawg profiles dhau ib zaug kev noj tshuaj ib zaug (AUC_{GiR, t, SS}).	20	82
Kev hloov pauv ntawm cov ncauj lus niaj hnub ntawm kev ntsuas hypoglycemic nyob rau lub sijhawm sib nrug ntawm 2 txog 24 teev (AUC_{GiR, 2-24h, SS}).	22	92

CV yog qhov coefficient ntawm intraindype hloov pauv hauv%,

SS yog qhov cia siab ntawm cov tshuaj hauv equilibrium,

Auc_{GiR, 2-24h, SS} - cov nyhuv hauv lub cev hauv 22 xuaj moos tom qab lub sijhawm noj tshuaj (yog li, nws tsis muaj qhov cuam tshuam rau nws ntawm kev tso ntshav insulin thaum lub sijhawm qhia pib ntawm kev kawm clamp).

Txoj kev sib raug zoo ntawm kev nce ntxiv ntawm koob tshuaj Tresiba Penfill® thiab nws cov txiaj ntsig hypoglycemic dav tau ua pov thawj.

Cov kev tshawb fawb tsis qhia tawm qhov sib txawv hauv tsev kho mob ntawm cov chaw muag tshuaj ntawm cov tshuaj Tresib® ntawm cov neeg laus thiab cov neeg laus cov hluas.

Cov chaw kuaj mob tau zoo thiab Kev Nyab Xeeb

Ua 11 lub sijhawm muaj kev sim kho nyob thoob ntiaj teb ntawm Kev Kho-Rau-Lub Hom Phiaj ("kho mus rau lub hom phiaj") lub sijhawm 26 thiab 52 lub lis piam, ua cov pab pawg sib law liag, uas suav tag nrho 4275 tus neeg mob (1102 cov neeg mob ntshav qab zib hom 1 thiab 3173 tus neeg mob nrog hom 2 mob ntshav qab zib mellitus) kho nrog Tresiba®.

Qhov ua tau zoo ntawm Tresiba® tau kawm rau cov neeg mob ntshav qab zib hom 1 uas tsis tau txais tshuaj insulin ua ntej, thiab nrog hom 2 mob ntshav qab zib mellitus uas tau txais kev kho mob insulin, nyob rau hauv thaj chaw kho mob uas tau kho lossis hloov kho rau Tresiba®. Qhov uas tsis muaj qhov zoo tshaj ntawm kev sib piv cov tshuaj (insulin detemir thiab insulin glargia) hla Tresiba® hauv kev sib piv rau qhov txo qis hauv HbA Performance index tau raug pov thawj_1C txij lub sijhawm suav nrog rau qhov kawg ntawm txoj kev tshawb no. Qhov kev zam yog sitagliptin, thaum lub sijhawm Tresiba® qhia tau tias nws muaj kev muaj nuj nqi zoo dua li kev txo HbA_{_1C}.

Cov txiaj ntsig ntawm kev kawm soj ntsuam ("kho rau lub hom phiaj" lub tswv yim) rau kev pib kho cov tshuaj insulin rau cov neeg mob ntshav qab zib hom 2 mob ntshav qab zib tau qhia tias muaj 36% tsawg dua ntawm qhov tshwm sim ntawm nocturnal hypoglycemia phaum mob (txhais tau tias yog ntu kev mob ntshav qab zib uas tshwm sim thaum tav su thiab 6 teev sawv ntxov paub tseeb los ntawm kev ntsuas ntshav ntshav qabzib concentration b0.84*0.68* Cov neeg laus laus ≥ 65 xyoo0.820.65* Yam 1 ntshav qab zib1.10.83 Koob tshuaj txij nkawm sijhawm b1.020.75* Mob ntshav qab zib Hom 20.83*0.68* Koob tshuaj txij nkawm sijhawm b0.75*0.62* Tsuas yog kho nyob rau hauv cov neeg mob yav dhau los tsis tau txais insulin0.83*0.64*

* cov lus tseem ceeb
a - g-lees paub cov ntshav hypoglycemia yog ib qho kev tshwm sim ntawm hypoglycemia, paub tseeb los ntawm kev ntsuas ntshav ntshav ntshav qabzib concentration b - lub sijhawm mob ntshav qab zib tsawg tom qab 16 lub lim tiam ntawm kev kho.

Tsis muaj chaw txhaj tshuaj tseem ceeb rau cov tshuaj insulin tau kuaj pom tom qab kho nrog Tresiba Penfill® rau ncua sijhawm.

Tom ntej Tiam Tuaj Ntev Ua yeeb yam ntev ntev

Rau cov mob ntshav qab zib, tib neeg NPH insulin thiab nws cov yeeb yam ntev (analogues) kuj tseem muaj. Cov lus hauv qab no qhia cov kev sib txawv tseem ceeb ntawm cov tshuaj no.

Thaum lub Cuaj Hlis 2015, qhov tshiab ntawm Abasaglar ua yeeb yam ntev ntev tau tshaj tawm, uas yuav luag zoo tib yam rau Lantus ubiquitous.

Cov insulin ntev ntev

Thoob ntiaj teb lub npe / cov tshuaj muaj zog	Lub npe lag luam ntawm cov tshuaj	Kev txiav txim hom	Lub sijhawm siv sijhawm
Cov tshuaj insulin glargine glargine	Xantus Lantus	Ntev insulin - ib qho tshuaj noj	24 h
Glargin	Aplas	Ntev insulin - ib qho tshuaj noj	24 h
Cov tshuaj Insulin Detemir	Levemir Levemir	Ntev insulin - ib qho tshuaj noj	≤ 24 h
Cov tshuaj insulin glargine	Toujeo Tojo	Ua dab tsi ntev ntxiv ua cov roj ntsha basal insulin	> 35 teev
Degludec	Tresiba tresiba	Cov tshuaj insulin ntev heev - ib qho tshuaj txig	> 48 h
NPH	Humulnin N, Insulatard, Insuman Basal, Polhumin N	Nruab Nrab Sijhawm Insulin	18 - 20 h

Chaw Tswj Xyuas Khoom Noj thiab Tshuaj (FDA, Asmeskas FDA) - Lub koomhaum tseemfwv qib siab rau Meskas Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv hauv xyoo 2016 tau pom zoo ntxiv lwm cov tshuaj insulin ntev, Toujeo. Cov khoom no muaj nyob rau hauv cov lag luam hauv tsev thiab ua pov thawj nws cov hauj lwm zoo hauv kev kho mob ntshav qab zib.

Cov tshuaj NPH insulin (NPH Tsis Nruab Nrab Protamine Hagedorn)

Qhov no yog ib hom qauv ntawm cov hluavtaws insulin qauv ntawm tus qauv tsim ntawm tib neeg insulin, tab sis enriched nrog protamine (ntses protein) kom qeeb nws. NPH tau pos huab. Yog li ntawd, ua ntej tswj hwm, nws yuav tsum tau ua tib zoo tig los sib tov kom zoo.

NPH yog daim ntawv qis tshaj plaws ntawm kev siv tshuaj insulin. Hmoov tsis zoo, nws ua rau muaj kev pheej hmoo siab ntau ntawm hypoglycemia thiab qhov hnyav nce, vim tias nws muaj qhov tshaj tawm hauv kev ua si (txawm hais tias nws cov nyhuv yog maj mam thiab tsis nrawm li ntawm cov tshuaj insulin hauv ib lub bolus).

Cov neeg mob ntshav qab zib hom 1 feem ntau yog txhaj ob zaug tshuaj NPH insulin rau ib hnub. Thiab cov neeg mob uas muaj ntshav qab zib hom 2 tuaj yeem txhaj ib hnub ib zaug. Txhua yam nws yog nyob ntawm theem ntawm cov piam thaj hauv cov ntshav thiab cov lus pom zoo los ntawm tus kws kho mob.

Lub Sij Hawm Rau Insulin Sij Hawm Ntev

Insulin, cov tshuaj lom neeg hauv cov tshuaj uas tau hloov kho kom lawv maj mam nqus thiab cuam tshuam ntawm cov tshuaj, yog suav tias yog hluavtaws analogue ntawm tib neeg cov tshuaj insulin.

Lantus, Abasaglar, Tujeo thiab Tresiba muaj cov yeeb yam zoo sib xws - lub sijhawm ua haujlwm ntev dua thiab tsis tshua pom lub ncov ntawm kev ua dua NPH. Hauv qhov no, lawv qhov kev nkag tsawg txo kev pheej hmoo ntawm hypoglycemia thiab lub cev qhov hnyav. Txawm li cas los xij, tus nqi ntawm analogues yog siab dua.

Abasaglar, Lantus, thiab Tresiba cov tshuaj insulin yog ib zaug ib hnub. Qee tus neeg mob tseem siv tshuaj Levemir ib hnub ib zaug. Qhov no tsis siv rau cov neeg muaj ntshav qab zib hom 1 rau cov neeg uas ua yeeb tshuaj tsawg dua 24 teev.

Tresiba yog qhov tshiab tshaj plaws thiab tam sim no kim tshaj plaws ntawm daim ntawv insulin muaj nyob rau ntawm kev ua lag luam. Txawm li cas los xij, nws muaj qhov tseem ceeb tseem ceeb - txoj kev pheej hmoo ntawm ntshav qog ntshav, tshwj xeeb tshaj yog thaum tsaus ntuj, yog qhov qis tshaj.

Tshuaj insulin ntev npaum li cas

Lub luag haujlwm ntawm cov tshuaj insulin ntev yog sawv cev rau lub zais qhov tseem ceeb ntawm cov kua dej los ntawm cov kua txiav ntshav. Yog li, qib sib luag ntawm cov tshuaj no hauv cov ntshav tau paub meej hauv nws cov haujlwm. Qhov no tso cai rau peb lub cev siv cov piam thaj hauv cov ntshav hauv 24 teev.

Yuav ua li cas txhaj tshuaj insulin

Txhua qhov kev tawm tsam ntev ntev yog txhaj rau hauv qab daim tawv nqaij mus rau qhov chaw uas muaj cov rog ua rog. Lub cev tom qab ntawm tus ncej puab yog qhov zoo tshaj plaws rau cov laj thawj no. Qhov chaw no tso cai rau kom qeeb qeeb, kev nqus ntawm cov dej ntawm cov tshuaj. Nyob ntawm qhov teem caij mus los ntawm tus kws kho mob endocrinologist, koj yuav tsum tau txhaj ib lossis ob zaug ib hnub.

Kev txhaj tshuaj zaus

Yog tias koj lub hom phiaj xav kom muaj cov tshuaj insulin tsawg li tsawg tau, siv Abasaglar, Lantus, Toujeo, lossis Tresiba analogues. Ib qho kev txhaj tshuaj (sawv ntxov lossis yav tsaus ntuj, tab sis nco ntsoov nyob rau tib lub sijhawm ntawm nruab hnub) tuaj yeem muab cov tshuaj pleev xim txawv ib ncig ntawm lub moos.

Koj yuav tsum tau txhaj ob zaug nyob rau ib hnub txhawm rau tswj cov qib ntshav ntshav zoo thaum xaiv NPH. Qhov no, txawm li cas los xij, tso cai rau koj los kho lub koob tshuaj nyob ntawm lub sijhawm ntawm hnub thiab kev ua si - siab dua thaum nruab hnub thiab tsawg dua thaum mus pw.

Txoj kev pheej hmoo ntawm kev ua qog ntshav ntshav hauv kev siv tshuaj insulin basal

Nws tau muaj pov thawj tias kev ua haujlwm ntev ntev ntawm cov tshuaj insulin kuj tsis tshua muaj peev xwm ua rau muaj ntshav txhaws (tshwj xeeb tshaj yog muaj ntshav qab zib tsawg thaum hmo ntuj) piv rau NPH. Thaum siv lawv, lub hom phiaj qhov tseem ceeb ntawm glycated hemoglobin HbA1c yog qhov ua tau.

Kuj tseem muaj pov thawj pom tias kev siv cov tshuaj insulin ntev ntev ua piv rau isoflan NPH ua rau lub cev hnyav dua (thiab vim li ntawd, kev txo tshuaj thiab kev xav rau tag nrho cov tshuaj).

Mob ntshav qab zib hom kuv hom ntshav qab zib ntev

Yog tias koj raug mob los ntawm mob ntshav qab zib hom 1, koj tus txiav tsis muaj peev xwm tsim cov insulin txaus. Yog li, tom qab txhua pluas noj, koj yuav tsum siv tshuaj kho mob uas ua haujlwm ntev uas ua yam ntxwv ntawm cov tshuaj insulin los ntawm beta hlwb. Yog tias koj tsis mus txhaj tshuaj, muaj qhov pheej hmoo tias yuav ua kab mob ntshav qab zib ketoacidosis.

Thaum xaiv los ntawm Abasaglar, Lantus, Levemir thiab Tresiba, koj yuav tsum paub qee yam ntawm cov yam ntxwv ntawm insulin.

Lantus thiab Abasaglar muaj qhov sib tw me ntsis dua li Levemir, thiab rau cov neeg mob feem ntau, lawv nquag ua haujlwm 24 teev.
Levemir tej zaum yuav tsum tau noj ob zaug ib hnub.
Siv Levemir, koob tshuaj tuaj yeem xav tau raws li lub sijhawm nruab hnub, yog li txo qhov pheej hmoo ntawm nocturnal hypoglycemia thiab txhim kho hnub nruab hnub.
Toujeo, Tresibia tshuaj zoo dua txo cov tsos mob saum toj no piv rau Lantus.
Koj kuj yuav tsum xav txog kev phiv los ntawm cov tshuaj xws li ua pob. Cov kev tsis haum no muaj tsawg, tab sis lawv tuaj yeem tshwm sim.
Yog tias koj xav hloov los ntawm kev ua yeeb yaj kiab ntev ntev mus rau NPH, nco ntsoov tias cov koob tshuaj tom qab noj mov tas yuav xav kom txo qis.

Ntev insulin rau hom ntshav qab zib hom II

Kev kho mob ntshav qab zib hom II feem ntau pib nrog kev qhia txog kev noj zaub mov kom zoo thiab tshuaj noj qhov ncauj (Metformin, Siofor, Diabeton, thiab lwm yam ..). Txawm li cas los xij, muaj qee yam xwm txheej thaum cov kws kho mob yuam kom siv cov tshuaj insulin.

Feem ntau muaj nyob rau hauv qab no:

Tsis muaj txiaj ntsig ntawm cov tshuaj ntawm qhov ncauj, tsis muaj peev xwm ua tiav ib txwm glycemia thiab glycated hemoglobin
Cov txheej txheem ua kom zoo rau txoj kev tswj hwm qhov ncauj
Kev kuaj mob ntshav qab zib nrog cov ntshav siab glycemic, nce ntxiv cov tsos mob hauv tsev kho mob
Myocardial infarction, mob hlab ntsha hlwb, mob stroke, mob hnyav, phais mob
Cev xeeb tub

Ntev-ntev insulin profile

Thawj qhov tshuaj feem ntau yog 0.2 units / kg lub cev hnyav. Lub tshuab xam zauv no siv tau rau cov neeg tsis muaj tshuaj tiv thaiv insulin, nrog lub siab ua haujlwm thiab lub raum. Qhov ntau npaum li cas ntawm cov insulin yog tshuaj tshwj xeeb los ntawm koj tus kws kho mob (!)

Ntxiv rau qhov kev ncua sijhawm (qhov ntev tshaj plaws yog degludec, qhov luv tshaj yog tib neeg cov caj ces engineering insulin-isophan), cov tshuaj no kuj txawv hauv qhov pom. Hauv cov tshuaj insulin NPH, qhov siab tshaj ntawm kev kis tau faib tawm nyob rau lub sijhawm thiab tshwm sim ntawm 4 mus rau 14 teev tom qab txhaj tshuaj. Kev nquag piav qhia ntawm ntev ua yeeb yam insulin detemir ncav cuag nws qhov siab kawg ntawm 6 thiab 8 teev tom qab txhaj, tab sis nws kav ntev dua thiab tsawg tshaj tawm tau hais.

Cov tshuaj insulin glargine yog li ntawd hu ua insulin basal. Nws cov peev xim hauv cov ntshav yog tsawg heev, yog li qhov kev pheej hmoo ntawm kev mob ntshav qab zib yog tsawg dua.

Sau cov analogues

Daim ntawv tso tawm (los ntawm qhov nrov)	Nqe, tshiav.
*Cov tshuaj Insulin degludec (Insulin degludec )*
Tresiba
FlexTouch 100ED / ml 3ml Tsis yog. 1 koob txhaj-cwj mem (Novo Nordisk A / S (Denmark)	7093.20

Ib tus qhua qhua tau tshaj tawm cov khoom noj txhua hnub

Kuv yuav tsum tau noj tshuaj Insulin degludec ntau npaum li cas * (Insulin degludec *)?
Cov neeg teb feem ntau yuav tau haus cov tshuaj no ib hnub 3 zaug. Daim ntawv tshaj tawm qhia tias pes tsawg tus neeg teb ntxiv siv cov tshuaj no.

Cov Tswv Cuab	%
3 zaug ib hnub	1	Pharmacological kev txiav txim Kev mob siab. Cov nyhuv pharmacological ntawm degludec insulin yog pom zoo ib yam li cov nyhuv ntawm tib neeg insulin los ntawm kev khi tshwj xeeb thiab cuam tshuam nrog tib neeg endogenous insulin receptors. Qhov ua rau lub ntsej muag ntawm insulin degludec yog vim muaj kev nce ntxiv ntawm kev siv cov kua nplaum los ntawm cov nqaij ua tom qab khi rau cov leeg thiab cov roj ntsha ua kom lub cev thiab ib lub zog txo tsawg dua rau ntawm cov piam thaj los ntawm lub siab. Txoj kev ntawm daim ntawv thov Rau cov laus: Subcutaneously 1 lub sijhawm nyob rau ib hnub, nyiam dua tib lub sijhawm. Qhov tshuaj tau raug muab xam ib leeg zuj zus raws li cov ntsiab lus qabzib nyob hauv cov ntshav ntshav. Cov neeg mob uas muaj ntshav qab zib hom I xav tau ntxiv kev txhaj tshuaj tiv thaiv insulin npaj sai kom ntseeg tau tias muaj kev xav paub txog ua ntej (ua ntej noj mov) insulin. - mob ntshav qab zib rau cov neeg laus. Sab sij huam - Nyob rau ib feem ntawm lub cev tiv thaiv kab mob: tsis tshua - muaj lub cev tsis haum lub cev (nrog rau o ntawm daim nplaig lossis daim di ncauj, raws plab, xeev siab, nkees thiab tawv nqaij), urticaria. - Los ntawm ib sab ntawm cov metabolism thiab khoom noj khoom haus: feem ntau - hypoglycemia (hypoglycemia tuaj yeem txhim kho yog tias cov koob tshuaj insulin tseem ceeb ntau dua li cov neeg mob xav tau cov tshuaj insulin. Kev mob ntshav qab zib tsawg tuaj yeem ua rau tsis nco qab thiab / lossis rov huam, ib ntus lossis tsis tuaj yeem cuam tshuam ntawm lub hlwb kev ua haujlwm txog thaum tuag. Cov tsos mob ntawm lub qog ntshav qab zib feem ntau pib dheev, nrog rau kev tawm hws txias, pallor ntawm daim tawv nqaij, nce qaug zog, tshee lossis tshee tshee, ntxhov siab, txawv txawv lossis qaug zog, kev ua kom tsis zoo, txo qhov xim ntawm lub ntsej muag, kev tsaug zog, kev tshaib kev nqhis, qhov muag plooj, mob taub hau, xeev siab, palpitations). - Ntawm ib feem ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: ua tsis xws luag - lipodystrophy (suav nrog lipohypertrophy, lipoatrophy tuaj yeem txhim kho ntawm qhov chaw txhaj tshuaj. Ua raws li cov cai rau hloov thaj chaw txhaj tshuaj hauv tib thaj chaw pabcuam kom txo tau txoj kev pheej hmoo ntawm kev tsim cov tshuaj tiv thaiv no). - Kev mob siab thiab tsis meej ntawm qhov chaw txhaj tshuaj: feem ntau muaj kev cuam tshuam ntawm qhov chaw txhaj tshuaj (hematoma, mob, mob ntshav hauv zos, erythema, cov nqaij txuas pob txha tsis sib haum, o, mob ntawm daim tawv nqaij, khaus, ua pa thiab ua kom nruj ntawm qhov chaw txhaj tshuaj), ua rau tsis tuaj yeem - peripheral edema. Feem ntau qhov tshwm sim ntawm qhov chaw txhaj tshuaj yog qhov me me thiab ib ntus thiab feem ntau ploj nrog kev kho txuas ntxiv. Daim ntawv tso tawm Kev daws d / p / rau qhov kev taw qhia ntawm 100 PIECES / 1 ml: cartridges 3 ml 5 pcs. Kev daws rau sc tswj hwm yog pob tshab, xim tsis muaj zog. 1 ml: kev sib xyaw ntawm cov tshuaj insulin degludec thiab cov tshuaj insulin aspart hauv qhov sib piv ntawm 70/30 (sib npaug rau 2.56 mg ntawm cov tshuaj insulin degludec thiab 1.05 mg ntawm cov tshuaj insulin aspart) 100 IU * Cov neeg siv: glycerol - 19 mg, phenol - 1.5 mg, metacresol - 1.72 mg, zinc 27.4 μg (xws li zinc acetate 92 μg), sodium chloride 0.58 mg, hydrochloric acid los yog sodium hydroxide (rau pH hloov kho), dej d / thiab - txog li 1 ml. 3 ml (300 PIECES) - Penfill® iav daim cartridges (5) - Al / PVC cov hlwv (1) - pob cov duab los qhia. pH ntawm kev daws 7.4. * 1 PIECE muaj 0.0256 mg ntawm anhydrous saltless insulin degludec thiab 0.0105 mg ntawm anhydrous saltless insulin aspart, uas sib raug rau 1 IU ntawm tib neeg insulin, 1 chav tsev ntawm insulin detemir, insulin glargine lossis biphasic insulin aspart. Cov ntaub ntawv ntawm nplooj ntawv koj tab tom saib yog tsim rau cov ntaub ntawv lub hom phiaj nkaus xwb thiab tsis txhawb nqa nws tus kheej kev noj tshuaj hauv ib txoj kev twg. Cov peev txheej yog npaj los ua kom paub cov kws kho mob nrog cov lus qhia ntxiv txog qee yam tshuaj, yog li nce lawv qib kev tshaj lij. Siv cov tshuaj "Insulin degludec"tsis muaj qhov tsis ua tiav muab kev sab laj nrog ib tus kws tshaj lij, nrog rau nws cov lus pom zoo ntawm txoj kev siv thiab kev noj tshuaj uas koj xaiv. Cov khoom txaus nyiam Yuav ua li cas xaiv txoj cai piv rau Hauv khw muag tshuaj, tshuaj feem ntau muab faib ua cov lus ua kom sib piv thiab cov duab analogues. Cov txheej txheem ntawm cov lus txhais suav nrog ib los yog ntau qhov kev dhia tshuaj qub uas muaj kev kho lub cev. Los ntawm cov qauv piv txwv yog cov tshuaj uas muaj cov tshuaj sib txawv, tab sis npaj rau kev kho mob ntawm tib cov kab mob. Qhov sib txawv ntawm cov kis thiab kab mob Cov kab mob kis tau yog tshwm sim los ntawm cov kab mob, kab mob, hu ua fungi thiab protozoa. Cov chav kawm ntawm kab mob tshwm sim los ntawm cov kab mob thiab cov kab mob feem ntau zoo sib xws. Txawm li cas los xij, kom paub qhov txawv ntawm qhov ua rau tus kab mob txhais tau tias xaiv qhov kev kho mob uas yuav pab tau sai sai nrog qhov malaise thiab yuav tsis ua mob rau tus menyuam. Kev ua xua yog qhov ua rau mob khaub thuas Qee tus neeg tau paub txog qhov xwm txheej uas tus menyuam yaus nyob ntev thiab ntau lub sijhawm muaj tus mob khaub thuas. Cov niam txiv coj nws mus rau cov kws kho mob, ua cov kev xeem, siv tshuaj, thiab vim li ntawd, tus me nyuam twb sau npe nrog kws kho mob raws li feem ntau mob. Qhov tseeb uas ua rau mob ntsws ua pa heev tsis txheeb xyuas. Txoj hlab zis: kho mob chlamydial urethritis Chlamydial urethritis feem ntau pom muaj nyob ntawm txoj kev siv ntawm urologist. Nws tshwm sim los ntawm tus kab mob intracellular parasite Chlamidia trachomatis, uas muaj cov yam ntxwv ntawm ob qho kab mob thiab kab mob, uas feem ntau xav tau cov tshuaj tua kab mob mus ntev ntev rau cov tshuaj tua kab mob. Nws muaj peev xwm ua rau tsis muaj qhov mob tshwj xeeb ntawm txoj hlab zis rau txiv neej thiab poj niam. Pom Zoo Finlepsin ® qeeb qeeb (Finlepsin® retard) Qhob noom xim kasfes rau pancreatitis Cov qib piam thaj uas tso cai tau hauv neeg cov ntshav yog dab tsi? Cia Koj Saib Nrov Khoom Cov hom berries txwv tsis pub thiab tso cai rau ntshav qab zib Noj qab zib rau cov ntshav qab zib Lorista thiab Amlodipine Kev khomob thiab kev tiv thaiv Cov zaub twg muaj suab thaj ntau tshaj? Noj qab zib rau cov ntshav qab zib Nrov Posts Tshuaj ntsuab kho mob Yuav ua li cas noj omez nrog pancreatitis rau txiav Tshuaj ntsuab kho mob 2018 Puas yog kev kho tus mob pancreatitis, Omez yeej muab tau txiaj ntsig zoo? ... Minirin® (Minirin) Kev khomob thiab kev tiv thaiv Tshuaj Lozap Ntxiv (12 Kev khomob thiab kev tiv thaiv Dab tsi yog glycated qab zib decryption tsom xam thiab ntsuas Mob ntshav qab zib Qeb Noj qab zib rau cov ntshav qab zib Mob ntshav qab zib kab mob Lawj xeeb ntshav qab zib Ntshav qab zib metres Saib xyuas Kev khomob thiab kev tiv thaiv Cov lus nug Mob ntshav qab zib hauv cov menyuam yaus thiab cov hluas Cov khoom lag luam rau cov ntshav qab zib Kev tsom xam Editor Tus Xaiv Kev txiav tawm pancreatic thiab qhov tshwm sim ntawm rov qab Kev khomob thiab kev tiv thaiv, 2018 Cov kev kho mob ntshav qab zib tshiab: kev nrhav thiab tshuaj tshiab nyob hauv kev kho Kev khomob thiab kev tiv thaiv, 2018 Cov ntshav piam thaj li ib txwm: yuav ua li cas los txiav txim (cov lus) Kev tsom xam, 2018 Nrov Posts Kuv puas tuaj yeem noj qos yaj ywm nrog mob ntshav qab zib? Noj qab zib rau cov ntshav qab zib, 2018 Nws puas tuaj yeem noj yaj nrog cov rog hauv siab? Noj qab zib rau cov ntshav qab zib, 2018 Noj hom 2 mob ntshav qab zib Noj qab zib rau cov ntshav qab zib, 2018 pobedidijabetes.org © Copyright 2024. All Rights Reserved. \| Tiv Thaiv Mob Ntshav Qab Zib!

Cov Tswv Cuab

3 zaug ib hnub

Pharmacological kev txiav txim

Kev mob siab. Cov nyhuv pharmacological ntawm degludec insulin yog pom zoo ib yam li cov nyhuv ntawm tib neeg insulin los ntawm kev khi tshwj xeeb thiab cuam tshuam nrog tib neeg endogenous insulin receptors. Qhov ua rau lub ntsej muag ntawm insulin degludec yog vim muaj kev nce ntxiv ntawm kev siv cov kua nplaum los ntawm cov nqaij ua tom qab khi rau cov leeg thiab cov roj ntsha ua kom lub cev thiab ib lub zog txo tsawg dua rau ntawm cov piam thaj los ntawm lub siab.

Txoj kev ntawm daim ntawv thov

Rau cov laus: Subcutaneously 1 lub sijhawm nyob rau ib hnub, nyiam dua tib lub sijhawm. Qhov tshuaj tau raug muab xam ib leeg zuj zus raws li cov ntsiab lus qabzib nyob hauv cov ntshav ntshav. Cov neeg mob uas muaj ntshav qab zib hom I xav tau ntxiv kev txhaj tshuaj tiv thaiv insulin npaj sai kom ntseeg tau tias muaj kev xav paub txog ua ntej (ua ntej noj mov) insulin.

- mob ntshav qab zib rau cov neeg laus.

Sab sij huam

- Nyob rau ib feem ntawm lub cev tiv thaiv kab mob: tsis tshua - muaj lub cev tsis haum lub cev (nrog rau o ntawm daim nplaig lossis daim di ncauj, raws plab, xeev siab, nkees thiab tawv nqaij), urticaria.
- Los ntawm ib sab ntawm cov metabolism thiab khoom noj khoom haus: feem ntau - hypoglycemia (hypoglycemia tuaj yeem txhim kho yog tias cov koob tshuaj insulin tseem ceeb ntau dua li cov neeg mob xav tau cov tshuaj insulin. Kev mob ntshav qab zib tsawg tuaj yeem ua rau tsis nco qab thiab / lossis rov huam, ib ntus lossis tsis tuaj yeem cuam tshuam ntawm lub hlwb kev ua haujlwm txog thaum tuag. Cov tsos mob ntawm lub qog ntshav qab zib feem ntau pib dheev, nrog rau kev tawm hws txias, pallor ntawm daim tawv nqaij, nce qaug zog, tshee lossis tshee tshee, ntxhov siab, txawv txawv lossis qaug zog, kev ua kom tsis zoo, txo qhov xim ntawm lub ntsej muag, kev tsaug zog, kev tshaib kev nqhis, qhov muag plooj, mob taub hau, xeev siab, palpitations).
- Ntawm ib feem ntawm daim tawv nqaij thiab cov nqaij mos subcutaneous: ua tsis xws luag - lipodystrophy (suav nrog lipohypertrophy, lipoatrophy tuaj yeem txhim kho ntawm qhov chaw txhaj tshuaj. Ua raws li cov cai rau hloov thaj chaw txhaj tshuaj hauv tib thaj chaw pabcuam kom txo tau txoj kev pheej hmoo ntawm kev tsim cov tshuaj tiv thaiv no).
- Kev mob siab thiab tsis meej ntawm qhov chaw txhaj tshuaj: feem ntau muaj kev cuam tshuam ntawm qhov chaw txhaj tshuaj (hematoma, mob, mob ntshav hauv zos, erythema, cov nqaij txuas pob txha tsis sib haum, o, mob ntawm daim tawv nqaij, khaus, ua pa thiab ua kom nruj ntawm qhov chaw txhaj tshuaj), ua rau tsis tuaj yeem - peripheral edema. Feem ntau qhov tshwm sim ntawm qhov chaw txhaj tshuaj yog qhov me me thiab ib ntus thiab feem ntau ploj nrog kev kho txuas ntxiv.

Daim ntawv tso tawm

Kev daws d / p / rau qhov kev taw qhia ntawm 100 PIECES / 1 ml: cartridges 3 ml 5 pcs.
Kev daws rau sc tswj hwm yog pob tshab, xim tsis muaj zog.
1 ml:
kev sib xyaw ntawm cov tshuaj insulin degludec thiab cov tshuaj insulin aspart hauv qhov sib piv ntawm 70/30
(sib npaug rau 2.56 mg ntawm cov tshuaj insulin degludec thiab 1.05 mg ntawm cov tshuaj insulin aspart) 100 IU *
Cov neeg siv: glycerol - 19 mg, phenol - 1.5 mg, metacresol - 1.72 mg, zinc 27.4 μg (xws li zinc acetate 92 μg), sodium chloride 0.58 mg, hydrochloric acid los yog sodium hydroxide (rau pH hloov kho), dej d / thiab - txog li 1 ml.

3 ml (300 PIECES) - Penfill® iav daim cartridges (5) - Al / PVC cov hlwv (1) - pob cov duab los qhia.
pH ntawm kev daws 7.4.
* 1 PIECE muaj 0.0256 mg ntawm anhydrous saltless insulin degludec thiab 0.0105 mg ntawm anhydrous saltless insulin aspart, uas sib raug rau 1 IU ntawm tib neeg insulin, 1 chav tsev ntawm insulin detemir, insulin glargine lossis biphasic insulin aspart.

Cov ntaub ntawv ntawm nplooj ntawv koj tab tom saib yog tsim rau cov ntaub ntawv lub hom phiaj nkaus xwb thiab tsis txhawb nqa nws tus kheej kev noj tshuaj hauv ib txoj kev twg. Cov peev txheej yog npaj los ua kom paub cov kws kho mob nrog cov lus qhia ntxiv txog qee yam tshuaj, yog li nce lawv qib kev tshaj lij. Siv cov tshuaj "Insulin degludec"tsis muaj qhov tsis ua tiav muab kev sab laj nrog ib tus kws tshaj lij, nrog rau nws cov lus pom zoo ntawm txoj kev siv thiab kev noj tshuaj uas koj xaiv.

Cov khoom txaus nyiam

Yuav ua li cas xaiv txoj cai piv rau
Hauv khw muag tshuaj, tshuaj feem ntau muab faib ua cov lus ua kom sib piv thiab cov duab analogues. Cov txheej txheem ntawm cov lus txhais suav nrog ib los yog ntau qhov kev dhia tshuaj qub uas muaj kev kho lub cev. Los ntawm cov qauv piv txwv yog cov tshuaj uas muaj cov tshuaj sib txawv, tab sis npaj rau kev kho mob ntawm tib cov kab mob.

Qhov sib txawv ntawm cov kis thiab kab mob
Cov kab mob kis tau yog tshwm sim los ntawm cov kab mob, kab mob, hu ua fungi thiab protozoa. Cov chav kawm ntawm kab mob tshwm sim los ntawm cov kab mob thiab cov kab mob feem ntau zoo sib xws. Txawm li cas los xij, kom paub qhov txawv ntawm qhov ua rau tus kab mob txhais tau tias xaiv qhov kev kho mob uas yuav pab tau sai sai nrog qhov malaise thiab yuav tsis ua mob rau tus menyuam.

Kev ua xua yog qhov ua rau mob khaub thuas
Qee tus neeg tau paub txog qhov xwm txheej uas tus menyuam yaus nyob ntev thiab ntau lub sijhawm muaj tus mob khaub thuas. Cov niam txiv coj nws mus rau cov kws kho mob, ua cov kev xeem, siv tshuaj, thiab vim li ntawd, tus me nyuam twb sau npe nrog kws kho mob raws li feem ntau mob. Qhov tseeb uas ua rau mob ntsws ua pa heev tsis txheeb xyuas.

Txoj hlab zis: kho mob chlamydial urethritis
Chlamydial urethritis feem ntau pom muaj nyob ntawm txoj kev siv ntawm urologist. Nws tshwm sim los ntawm tus kab mob intracellular parasite Chlamidia trachomatis, uas muaj cov yam ntxwv ntawm ob qho kab mob thiab kab mob, uas feem ntau xav tau cov tshuaj tua kab mob mus ntev ntev rau cov tshuaj tua kab mob. Nws muaj peev xwm ua rau tsis muaj qhov mob tshwj xeeb ntawm txoj hlab zis rau txiv neej thiab poj niam.