Soluble tib neeg cov roj ntsha muaj peev xwm ntxiv cov tshuaj insulin thiab txhua yam txog nws

Cov tshuaj hormones thiab lawv luv luv ua yeeb yam / insulins.

100ME / ml-5ml D.t.d.№5 nyob rau hauv flac.

S .: subcutaneously 30 feeb ua ntej noj mov 4 zaug hauv ib hnub

Rp.: Insulini 40 ME (5 ml)

S. Txhaj tshuaj subcutaneously ntawm 0.5 ml 3 zaug hauv ib hnub 30 feeb ua ntej noj mov.

Sib cuam tshuam nrog ib qhov tshwj xeeb receptor rau ntawm sab nraud ntawm cov leeg, tsim ib qho insulin receptor complex

Hom 1, 2 mob ntshav qab zib mellitus, mob ntshav qab zib ketoacidosis, ketoacidotic thiab hyperosmolar coma, ntshav qab zib mellitus ntawm cov poj niam cev xeeb tub, ua ntej hloov mus rau kev kho mob nrog kev siv tshuaj insulin ntev.

Kev tsis haum tshuaj, ntshav qog ntshav qab zib, hypoglycemic coma, pom kev tsis pom kev zoo (feem ntau thaum pib kho), hyperemia, mob pruritus, thiab lipodystrophy (ntawm qhov chaw txhaj tshuaj).

50 Insulin-Isophan (Tib Neeg Kev Tshawb Fawb Hauv Tshuab)

Nruab Nrab Sijhawm Insulin

S .: txhaj tshuaj ncua ncua 2 zaug hauv ib hnub

Rp.: Insulini-isophani 40 ME (5 ml)

S. Txhaj tshuaj subcutaneously ntawm 0.5 ml 2 zaug hauv ib hnub 30 feeb ua ntej noj mov.

Nws cuam tshuam nrog cov receptors tshwj xeeb sab nraud ntawm cytoplasmic membrane ntawm lub cell thiab tsim cov txheej txheem insulin-receptor complex uas txhawb cov txheej txheem intracellular.

Type 1.2 diabetes mellitus, hom 2 mob ntshav qab zib mellitus hauv cov poj niam cev xeeb tub.

hypoglycemic tej yam kev mob hypoglycemic coma. o, tsis hloov chaw uas siv

51 ipratropium bromide

Rp.: Sol.Atroventi 0.25% -20ml pro inh.

S.: 0.5 mg (40 tee) 3-4 zaug hauv ib hnub los ntawm lub tshuab tshuaj tua kab mob, yav dhau los diluted nyob rau hauv 4 ml ntawm dej qab ntsev.

Rp .: Sol. Ipratropiibromidi 0.25% - 20ml

D.S .: 2 ml (40 tee) yaj hauv 2 ml ntawm 0.9% sodium tshuaj dawb tov, nchuav rau hauv lub khob haus dej. 1 inhalation 3 zaug ib hnub.

Mob ntsws ob leeg mob ntsws (mob ntsws tsis ua kom mob ntsws, mob ntsws txhaws ntswg), mob hawb pob (mob me thiab mob me).

Kev tsis haum xeeb rau atropine thiab nws cov lus qhia, thiab lwm yam tshuaj, tshuaj cev xeeb tub (kuv plaub hlis), cov menyuam yaus hnub nyoog qis dua 6 xyoos

mob taub hau, xeev siab, lub qhov ncauj qhuav, tachycardia, palpitations, ntxhov siab ntawm kev pab, tsis muaj kev zais cia cov hws qog, ua rau lub plab zom mov tsis tuaj yeem, tso zis, rov qab ua xua.

52 Itracanazole. Antifungal tus neeg sawv cev ntawm pawg triazole derivative

Rp .: Intraconazoli 0.1

S .: sab hauv 1 tshuaj ntsiav 1 zaug hauv ib hnub.

inhibits cytochrome-P450-dependent synthesis of ergosterol - ib qho tseem ceeb ntawm cov fungal cell membrane.

Mycoses ntawm daim tawv nqaij, qhov ncauj ntawm qhov ncauj thiab qhov muag, onychomycosis tshwm sim los ntawm dermatophytes, poov xab thiab pwm, candidiasis nrog kev puas tsuaj ntawm daim tawv nqaij thiab cov leeg nqaij, nrog rau vulvovaginal candidiasis, pityriasis versicolor, muaj zog mycoses

dyspepsia, mob plab, nce kev ua haujlwm ntawm daim siab hloov pauv, mob taub hau, kiv taub hau, mob peripheral neuropathy, nkees, tsaug zog.

Dab tsi yog qhov sib txawv ntawm kev npaj tshuaj insulin los ntawm ib leeg

1. Qib kev huv huv.
2. Qhov chaw txais nyiaj yog nqaij npuas, nqaij hlav, tib neeg insulin.
3. Cov khoom siv ntxiv muaj nyob hauv kev daws tshuaj yog cov tshuaj khaws cia, kev tiv thaiv lub sijhawm ntev, thiab lwm tus.
4. Kev Sau Ntawv.
5. pH ntawm kev daws.
6. Lub peev xwm los sib xyaw cov tshuaj siv tau ntev thiab ntev.

Qhov tshuaj insulin yog ib yam tshuaj uas tsim los ntawm cov hlwb tshwj xeeb hauv kev txiav Nws yog tus muaj protein ntau xa ob npaug, uas suav nrog 51 amino acids.

Txog 6 billion units ntawm insulin yog noj txhua xyoo hauv ntiaj teb (1 chav tsev yog 42 micrograms ntawm yam khoom). Kev tsim tawm ntawm cov tshuaj insulin yog cov thev naus laus zis ntau thiab tau coj los ntawm cov txheej txheem kev lag luam nkaus xwb.

Qhov chaw ntawm insulin

Tam sim no, nyob ntawm cov peev txheej ntawm cov ntau lawm, cov roj ntsha insulin thiab tib neeg cov tshuaj insulin npaj raug rho tawm.

Nqaij npuas nqaij npuas tam sim no muaj qhov ua kom huv siab, muaj qhov ua tau zoo hypoglycemic, thiab muaj kev xyaum tsis muaj kev fab tshuaj rau nws.

Txoj kev npaj tshuaj insulin tib neeg ua tiav hlo hauv cov qauv tshuaj lom neeg nrog tib neeg cov tshuaj hormones. Lawv feem ntau yog tsim los ntawm kev siv biosynthesis siv cov thev naus laus zis kev tsim kho tshuab.

Cov neeg tsim khoom loj siv cov qauv kev tsim khoom uas tau lees tias lawv cov khoom ua tau raws li txhua tus qauv ua tau zoo. Tsis muaj qhov sib txawv tseem ceeb hauv kev ua ntawm tib neeg thiab porcine monocomponent insulin (i.e., purified) tau pom; hauv kev cuam tshuam nrog kev tiv thaiv kab mob, raws li kev tshawb fawb ntau, qhov sib txawv yog tsawg heev.

Ntu ntu siv nyob rau hauv kev tsim cov tshuaj insulin

Hauv lub raj mis nrog cov tshuaj muaj ib qho kev daws uas tsis tsuas yog cov tshuaj insulin, tab sis kuj tseem muaj lwm qhov sib txuas. Lawv txhua tus muaj lub luag haujlwm tshwj xeeb:

• lub caij nyoog ntawm kev ua ntawm cov tshuaj,
• daws kev ua kom huv
• muaj qhov tsis xws luag ntawm kev daws thiab tswj hwm qhov nruab nrab pH (acid-base balance).

Kev txuas ntxiv ntawm cov kua dej

Txhawm rau tsim cov tshuaj insulin txuas ntxiv, ib qho ntawm ob lub tebchaw, zinc lossis protamine, ntxiv rau txoj kev daws teeb meem ntawm cov tshuaj insulin. Raws li qhov no, tag nrho cov insulins tuaj yeem faib ua ob pawg:

• cov tshuaj tiv thaiv insulin - protafan, insuman basal, NPH, humulin N,
• zinc-insulins - insulin-zinc-ncua kev kawm ntawm mono-tard, daim kab xev, humulin-zinc.

Cov tshuaj tiv thaiv yog cov protein, tab sis muaj kev phiv tshuaj nyob rau hauv daim ntawv ntawm kev fab tshuaj rau nws yog qhov tsis tshua muaj.

Txhawm rau tsim cov nruab nrab ntawm ib puag ncig ntawm kev daws, phosphate tsis ntxiv rau nws. Nws yuav tsum nco ntsoov tias cov tshuaj insulin muaj phosphates yog nruj me ntsis txwv tsis pub los ua ke nrog insulin-zinc ncua (ICS), txij li zinc phosphate precipitates nyob rau hauv cov ntaub ntawv no, thiab qhov kev ua ntawm zinc-insulin yog qhov luv luv hauv txoj kev tsis paub tshaj plaws.

Tshuaj tua kab mob Cheebtsam

Qee lub tebchaw tias, raws li pharmacological thiab thev naus laus zis, yuav tsum tau qhia rau hauv kev npaj, muaj cov nyhuv tsis haum. Cov no suav nrog cresol thiab phenol (ob qho tib si lawv muaj ib tus ntxhiab tsw tshwj xeeb), nrog rau methyl parabenzoate (methyl paraben), uas tsis muaj ntxhiab tsw.

Cov lus qhia ntawm ib qho ntawm cov khaws cia thiab ua rau muaj kev ntxhiab tsw txawv ntawm qee qhov kev npaj insulin. Txhua qhov kev khaws cia hauv cov nyiaj uas lawv pom hauv insulin npaj tsis muaj qhov cuam tshuam zoo.

Protamine insulins feem ntau suav nrog cresol lossis phenol. Phenol tsis tuaj yeem raug ntxiv rau ICS cov kev daws teeb meem vim tias nws hloov pauv qhov ua rau lub cev ntawm cov keeb yam ntxwv. Cov tshuaj no suav nrog methyl paraben. Tsis tas li, zinc ions hauv kev daws muaj cov nyhuv antimicrobial.

Ua tsaug rau qhov kev tiv thaiv ntau theem kev tiv thaiv kab mob, kev tiv thaiv tau txais kev tiv thaiv los ntawm kev txhim kho cov teeb meem uas tuaj yeem tshwm sim los ntawm cov kab mob sib kis tau thaum lub koob tau rov qab tso rau hauv qhov kev daws teeb meem.

Vim tias muaj cov tshuaj tiv thaiv zoo li no, tus neeg mob tuaj yeem siv tib lub koob txhaj tshuaj subcutaneous txhaj tshuaj ntawm 5 mus rau 7 hnub (muab tsuas yog nws siv cov koob txhaj tshuaj). Ntxiv mus, cov tshuaj muaj peev xwm ua rau nws tuaj yeem tsis siv cawv siv tshuaj kho cov tawv nqaij ua ntej txhaj tshuaj, tab sis ib zaug ntxiv tsuas yog tus neeg mob txhaj nws tus kheej nrog cov koob txhaj tshuaj nrog daim nyias nyias (insulin).

Insulin Syringe Calibration

Hauv kev npaj tshuaj insulin thawj zaug, tsuas yog ib chav ntawm cov tshuaj hormones tsuas muaj nyob hauv ib ml ntawm qhov kev daws teeb meem. Tom qab ntawd, cov ntsiab lus tau nce siab. Feem ntau ntawm cov tshuaj insulin hauv cov hwj tau siv hauv Russia muaj 40 units hauv 1 ml ntawm kev daws. Vials feem ntau yog cim nrog lub cim U-40 lossis 40 units / ml.

Lawv yog npaj rau kev siv dav, tsuas yog rau cov insulin zoo li no thiab lawv cov calibration tau ua raws li lub hauv paus ntsiab lus: thaum lub koob txhaj puv nrog 0.5 ml ntawm cov tshuaj, ib tug neeg tau nce 20 units, 0.35 ml sib raug rau 10 units thiab lwm yam.

Txhua lub cim ntawm cov koob txhaj tshuaj yog sib npaug nrog qee qhov ntim, thiab tus neeg mob twb paub lawm tias muaj pes tsawg qhov ntsuas nyob hauv cov ntim no. Yog li, qhov ntsuas lub zog ntawm cov koob txhaj tshuaj yog qhov kev ntsuas hluav taws xob los ntawm qhov ntim ntawm cov tshuaj, xam rau kev siv tshuaj insulin U-40.4 koog ntawm cov tshuaj insulin muaj nyob hauv 0.1 ml, 6 units - hauv 0.15 ml ntawm cov tshuaj, thiab yog li ntawm mus txog 40 units, uas sib haum rau 1 ml ntawm kev daws.

Qee cov mills siv cov tshuaj insulin, 1 ml ntawm cov muaj 100 units (U-100). Rau cov tshuaj no, cov tshuaj insulin tshwj xeeb raug tsim tawm, uas zoo ib yam li cov tshuaj uas tau hais los saum no, tab sis lawv muaj qhov ntsuas txawv.

Nws yuav siv mus rau hauv tus account no cov kev xav tshwj xeeb (nws yog 2,5 zaug siab dua li cov qauv). Hauv qhov no, cov koob tshuaj insulin rau tus neeg mob, tau kawg, tseem nyob li qub, vim nws txaus siab rau lub cev xav tau cov tshuaj insulin tshwj xeeb.

Ntawd yog, yog tias tus neeg mob yav dhau los siv tshuaj U-40 thiab tau txhaj 40 yam ntawm cov tshuaj hormones ib hnub, tom qab ntawd nws yuav tsum tau txais tib 40 yam thaum txhaj tshuaj insulin U-100, tab sis txhaj nws ntau npaum li 2.5 zaug tsawg dua. Ntawd yog, tib 40 units yuav muaj nyob rau hauv 0.4 ml ntawm kev daws.

Hmoov tsis zoo, tsis yog txhua tus kws kho mob thiab tshwj xeeb tshaj yog cov neeg mob ntshav qab zib paub txog qhov no. Thawj qhov kev nyuaj pib thaum qee tus neeg mob hloov mus rau kev siv cov insulin injectors (koob txhaj tshuaj), uas siv cov roj av (tshwj xeeb pob) muaj cov insulin U-40.

Yog tias koj sau cov koob txhaj nrog cov kev daws teeb meem sau npe U-100, piv txwv li, mus txog lub cim ntawm 20 units (i.e. 0.5 ml), tom qab ntawd cov ntim no yuav muaj ntau txog li 50 units ntawm cov tshuaj.

Txhua lub sijhawm, txhaws cov tshuaj insulin U-100 nrog cov koob txhaj tshuaj thiab saib cov chaw txiav, ib tus neeg yuav tau txais qhov koob tshuaj 2.5 zaug ntau dua li cov uas tau pom nyob rau theem ntawm lub cim no. Yog hais tias tsis yog tus kws kho mob lossis tus neeg mob tsis tau ceeb toom txog qhov ua yuam kev no, tom qab ntawv qhov kev pheej hmoo ntawm kev muaj ntshav siab ntau yog qhov muaj txiaj ntsig vim muaj cov tshuaj ntau dhau hwv, uas nyob hauv kev coj ua feem ntau tshwm sim.

Ntawm qhov tod tes, qee zaum muaj cov tshuaj insulin ua kom zoo rau cov tshuaj U-100. Yog tias qhov koob txhaj tshuaj no yog qhov yuam kev puv nrog qhov niaj zaus muaj ntau yam U-40 tov, tom qab ntawd cov koob tshuaj tiv thaiv kab mob hauv lub koob txhaj tshuaj yuav tsawg dua 2.5 npaug dua li qhov uas tau sau ze rau qhov sib txuam ntawm lub koob txhaj tshuaj.

Raws li qhov txiaj ntsig ntawm qhov no, qhov kev piav qhia tsis meej ntxiv hauv cov ntshav qabzib yog tau thaum xub thawj siab. Qhov tseeb, tau kawg, txhua yam yog qhov tsim nyog - rau txhua qhov tshuaj ntawm cov tshuaj nws yog qhov tsim nyog los siv cov koob txhaj tshuaj kom haum.

Hauv qee lub tebchaws, piv txwv li, Switzerland, txoj kev npaj tau ua tib zoo xav, raws li qhov muaj kev hloov pauv tau ua rau cov tshuaj insulin npaj sau npe U-100. Tab sis qhov no yuav tsum muaj kev sib txuas lus ntawm txhua tus neeg txaus siab: cov kws kho mob ntawm ntau qhov tshwj xeeb, cov neeg mob, cov neeg tu mob los ntawm txhua lub tuam tsev, kws muag tshuaj, cov tsim khoom, cov tub ceev xwm.

Hauv peb lub tebchaws, nws yog qhov nyuaj heev kom hloov txhua tus neeg mob rau kev siv tshuaj insulin U-100 nkaus xwb, vim tias, feem ntau yuav ua rau, qhov no yuav ua rau muaj qhov yuam kev ntau ntxiv hauv kev txiav txim qhov koob tshuaj.

Kev sib xyaw ua ke siv luv luv thiab ntev ntev ntawm lub cev insulin

Hauv cov tshuaj niaj hnub, kev kho mob ntshav qab zib, tshwj xeeb yog thawj hom, feem ntau tshwm sim siv kev sib xyaw ntawm ob hom tshuaj insulin - kev txiav txim siab luv thiab ntev.

Nws yuav yooj yim dua rau cov neeg mob yog tias cov tshuaj nrog ntau lub sijhawm ua ke tuaj yeem sib koom ua ke hauv ib qho koob tshuaj thiab muab ua ke kom tsis txhob ua rau tawv nqaij ob npaug.

Ntau tus kws kho mob tsis paub dab tsi txiav txim siab qhov muaj peev xwm los sib xyaw ua ke ntawm cov insulins. Lub hauv paus ntawm qhov no yog tshuaj lom neeg thiab galenic (txiav txim los ntawm cov muaj pes tsawg leeg) kev sib xyaw ntawm kev ncua ntev thiab luv ua yeeb yam insulins.

Nws yog qhov tseem ceeb heev uas thaum tov ob hom tshuaj, kev pib sai ntawm kev ua ntawm luv luv insulin tsis ncab lossis ploj.

Nws tau muaj pov thawj tias kev ua yeeb yaj kiab luv luv tuaj yeem ua ke nyob rau hauv ib qho kev txhaj nrog tshuaj tiv thaiv kab mob, thaum lub sijhawm pib lub cev luv luv insulin tsis qeeb, vim hais tias cov kua dej tsis txaus rau cov tshuaj tiv thaiv.

Hauv qhov no, cov chaw tsim tshuaj paus tsis muaj teeb meem.Piv txwv li, tuaj yeem ua ke nrog humulin H lossis protafan. Ntxiv mus, kev sib xyaw ntawm cov kev npaj no tuaj yeem khaws cia.

Hais txog kev npaj tshuaj zinc-insulin, nws tau ntev tau tsim tsa hais tias insulin-zinc-ncua kev kawm (crystalline) tsis tuaj yeem ua ke nrog cov insulin luv, vim nws khi rau cov zinc ions ntau dhau thiab hloov mus rau cov insulin ntev ntev, qee zaum qee.

Qee tus neeg mob ua ntej siv tshuaj yeeb-luv luv, tom qab ntawd, tsis tas yuav tshem rab koob tawm hauv qab daim tawv, hloov me ntsis nws kev taw qhia, thiab zinc-insulin yog txhaj los ntawm nws.

Raws li cov txheej txheem ntawm kev tswj hwm no, ob peb txoj kev tshawb fawb txog kev tshawb fawb tau ua, yog li nws tsis tuaj yeem txiav txim siab tias qee qhov nrog txoj kev txhaj tshuaj no ua rau cov tshuaj tiv thaiv zinc-insulin thiab cov yeeb tshuaj luv luv tuaj yeem tsim nyob rau hauv daim tawv nqaij, uas ua rau lub cev tsis muaj zog ntawm qhov tom kawg.

Yog li, nws yog qhov zoo dua rau kev siv cov tshuaj insulin luv luv sib cais los ntawm zinc-insulin, ua ob qho kev txhaj tshuaj sib kis rau thaj tsam ntawm daim tawv nqaij uas nyob deb tsawg kawg 1 cm nrug sib nrug. Qhov no tsis yooj yim, tsis txhob hais txog kev siv tshuaj.

Siv cov tshuaj insulin

Tam sim no cov tshuaj kev lag luam tsim cov kev sib xyaw ua ke uas muaj cov tshuaj insulin ua ke nrog cov tshuaj tiv thaiv kab mob-insulin hauv txoj cai sib piv txwv nruj. Cov tshuaj no suav nrog:

Kev sib xyaw ua ke tau zoo tshaj yog cov uas qhov feem ntawm luv luv mus rau ntev ntev ntawm cov tshuaj insulin yog 30:70 lossis 25:75. Qhov sib piv no yog ib txwm qhia hauv cov lus qhia rau kev siv txhua cov tshuaj.

Cov tshuaj no zoo tshaj rau cov neeg uas ua raws cov zaub mov tsis tu ncua, nrog kev tawm dag zog. Piv txwv, lawv feem ntau siv los ntawm cov neeg laus cov neeg mob ntshav qab zib hom 2.

Cov tshuaj insulins sib xyaw ua ke tsis tsim nyog rau kev coj ua ntawm kev hloov kho "insulin", thaum nws yuav tsum tau hloov tas li ntau npaum li cas cov tshuaj ntawm luv luv ua yeeb yam insulin.

Piv txwv li, qhov no yuav tsum tau ua thaum hloov cov nyiaj ntawm cov carbohydrates hauv cov zaub mov, txo qis lossis nce ntau lub cev, thiab lwm yam. Hauv qhov no, qhov koob tshuaj ntawm basal insulin (lub caij nyoog ntev) yog xyaum tsis pauv.

Cov mis, tshuaj lub npe: tsis muaj ntaub ntawv.
Pharmacological pawg: cov tshuaj hormones thiab lawv cov antagonists / insulins.
Pharmacological kev txiav txim: tshuaj qog ntshav.

Cov chaw muag tshuaj

Tib neeg cov kua dej yog ib txoj kev npaj insulin thaum nruab nrab uas tau los ntawm cov qauv ntawm thev naus laus zis DNA thev naus laus zis. Tib neeg cov kua dej tswj kev ua kom cov kua qab zib hauv cov ntshav, ua rau lub cev thiab cov metabolism ntawm cov carbohydrates, cov rog, cov protein nyob hauv cov plab hnyuv siab raum (pob txha leeg, mob siab, ntaub so ntswg adipose). Tib neeg cov kua dej muaj cov khoom ntawm anabolic thiab anti-catabolic effect. Hauv cov leeg nqaij, muaj qhov nce ntawm cov ntsiab lus ntawm glycerol, glycogen, fatty acids, kev nce ntawm synthesis protein thiab nce ntxiv ntawm kev noj cov amino acids, tab sis muaj ib qho txo ​​qis ntawm gluconeogenesis, lipolysis, glycogenolysis, ketogenesis, protein catabolism thiab kev tso tawm ntawm cov amino acids. Tib neeg cov tshuaj insulin khi rau daim nyias nyias receptor (ib qho tetramer, uas muaj 4 ntu, 2 ntawm qhov (beta) tau tso rau hauv cytoplasmic membrane thiab yog tus nqa khoom ntawm tyrosine kinase kev ua si, thiab lwm 2 (alpha) yog extramembrane thiab lub luag haujlwm rau kev sib txuas ntawm cov tshuaj hormones), tsim cov tshuaj insulin receptor complex, uas undergoes autophosphorylation. Qhov cuam tshuam hauv cov hlwb zoo li phosphorylates threonine thiab serine xaus ntawm protein kinases, uas ua rau kev tsim cov phosphatidylinositol glycan thiab ua phosphorylation, uas ua kom cov dej num enzymatic hauv cov phiaj hlwb. Hauv cov leeg nqaij thiab lwm cov nqaij (tshwj tsis yog lub hlwb), nws txhawb nqa kev hloov pauv hauv qabzib thiab cov amino acids, txo qis catabolism protein, thiab txhawb cov txheej txheem hluavtaws.Tib neeg cov insulin txhawb kev tsub zuj zuj ntawm cov piam thaj hauv daim siab ua glycogen thiab inhibits glycogenolysis (gluconeogenesis). Cov kev sib txawv hauv cov tshuaj insulin nyob ntawm tus koob tshuaj, thaj chaw txhaj tshuaj, kev qoj ib ce ntawm tus neeg mob, kev noj haus thiab lwm yam.
Qhov nqus ntawm tib neeg cov tshuaj insulin nyob ntawm tus qauv thiab qhov chaw ntawm kev coj ua (ncej puab, plab, pob tw), insulin concentration, txhaj tshuaj ntim. Tib neeg cov kua dej raug faib tawm tsis txaus ntseeg thoob plaws cov ntaub so ntswg, tsis nkag rau hauv niam mis thiab los ntawm qhov tsis pub tso cov menyuam tawm. Qhov kev ua tsis tau zoo ntawm cov tshuaj tshwm sim hauv daim siab nyob rau hauv kev ua ntawm insulinase (glutathione-insulin transhydrogenase), uas hydrolyzes cov disulfide sib khi ntawm cov saw A thiab B thiab ua rau lawv muaj rau cov proteolytic enzymes. Tib neeg cov kua dej tawm sab nraud los ntawm lub raum (30 - 80%).

Hom 1 thiab hom 2 mob ntshav qab zib mellitus xav tau kev kho tshuaj insulin (nrog kev tawm tsam tshuaj rau qhov ncauj hypoglycemic lossis nrog kev kho mob ua ke, mob cuam tshuam), mob ntshav qab zib mellitus thaum cev xeeb tub.

Kev noj tshuaj thiab kev tswj hwm ntawm tib neeg cov tshuaj insulin

Cov txheej txheem ntawm kev tswj hwm tshuaj yog nyob ntawm hom tshuaj insulin. Tus kws kho mob teeb tsa cov koob tshuaj ib lub zuj zus, nyob ntawm theem ntawm glycemia.
Kev txhaj tshuaj subcutaneous tau nqa tawm hauv thaj av ntawm sab xub ntiag phab ntsa, ncej puab, xub pwg, pob tw. Qhov chaw txhaj tshuaj yuav tsum tau hloov chaw kom qhov chaw qub siv tsis ntau tshaj li ib zaug ib hlis. Nrog kev tswj hwm ntawm cov ntshav dej, yuav tsum tau saib xyuas kom tsis txhob nkag rau cov ntshav thaum lub sijhawm txhaj. Cov neeg mob yuav tsum tau kawm paub txog kev siv tshuaj insulin kom zoo. Tsis txhob zaws tom qab txhaj tshuaj. Qhov ntsuas kub ntawm cov tshuaj tso cai yuav tsum nyob ntawm chav sov.
Txo cov naj npawb ntawm cov kev txhaj tshuaj txhua hnub yog ua tiav los ntawm kev sib xyaw ntawm cov kua dej ntawm cov kev ua kom sib txawv.
Nrog rau kev txhim kho kev ua xua, kev mus pw hauv tsev kho mob ntawm tus neeg mob, kev txheeb xyuas qhov tshwm sim ntawm cov tshuaj uas yog cov ua xua, kev teem caij ntawm kev kho kom tsim nyog thiab kev hloov pauv tshuaj insulin yog qhov tsim nyog.
Kev txiav tawm ntawm kev kho lossis kev siv tshuaj tsis txaus ntawm cov tshuaj insulin, tshwj xeeb tshaj yog nyob rau cov neeg mob uas muaj ntshav qab zib hom 1 mob ntshav qab zib, tuaj yeem ua rau tus mob hyperetcemia thiab ntshav qab zib ketoacidosis (mob uas yuav tsim kev phom sij rau tus neeg mob lub neej).
Kev txhim kho ntawm hypoglycemia nrog kev siv cov tshuaj muaj txiaj ntsig ua rau ib qho kev noj ntau dhau, ua si lub cev, ua txhaum cai ntawm kev noj zaub mov noj, ua kom lub raum piam organic, lub siab rog.
Qhov koob tshuaj insulin yuav tsum tau kho yog tias lub xeev ua haujlwm ntawm lub caj pas pituitary, qog adrenal, cov thyroid caj pas, lub raum thiab / lossis mob siab tsis zoo, Addison's disease, hypopituitarism, thiab ntshav qab zib mellitus hauv cov neeg mob uas muaj hnub nyoog 65 xyoos. Tsis tas li, kev hloov pauv ntawm cov tshuaj insulin tej zaum yuav tsum tau ua nrog qhov nce ntawm kev siv dag zog ntawm lub cev lossis kev hloov pauv ntawm cov zaub mov ib txwm muaj. Kev noj tshuaj Ethanol (suav nrog kev haus dej haus cawv tsawg tsawg) tuaj yeem ua rau lub ntsej muag ntshav qis. Tsis txhob noj cov tshuaj ethanol ntawm ib qho kev mob plab. Nrog rau qee cov kab mob kis tau yooj yim (tshwj xeeb yog kis tau tus mob), cov xwm txheej uas muaj nrog kub taub hau, ntxhov siab ntxhov siab, qhov xav tau cov tshuaj insulin yuav nce ntxiv.
Cov tsos mob ntawm cov ua ntej ntawm hypoglycemia thaum siv insulin tib neeg hauv qee cov neeg mob yuav tsis tshua pom los yog txawv ntawm cov uas tau pom nrog siv insulin ntawm cov tsiaj keeb kwm. Nrog rau kev kho ntshav qabzib hauv cov ntshav li qub, piv txwv li, nrog kev kho mob hnyav nrog insulin, tag nrho lossis qee qhov tsos mob tshwm sim ua rau muaj ntshav qab zib yuav ploj, hais txog qhov twg cov neeg mob yuav tsum tau ceeb toom. Cov tsos mob ua ntej ntawm hypoglycemia yuav dhau los tsis hais tawm los yog hloov nrog lub caij nyoog ntev ntawm mob ntshav qab zib mellitus, mob ntshav qab zib neuropathy, thiab siv cov beta-blockers.
Rau qee tus neeg mob, yuav tau kho kom tau cov koob tshuaj thaum hloov los ntawm tsiaj los ntawm insulin los rau tib neeg insulin. Qhov no tuaj yeem tshwm sim twb tau dhau los ntawm thawj zaug kev tswj hwm ntawm tib neeg li kev npaj tshuaj insulin lossis maj mam li ntawm ob peb lub lis piam lossis hli tom qab hloov mus.
Txoj kev hloov ntawm ib hom tshuaj insulin mus rau lwm qhov yuav tsum tau ua nyob rau hauv kev saib xyuas mob nkeeg thiab tswj ntshav qabzib. Cov kev hloov hauv kev ua, hom (tus tsim khoom), hom, hom (tib neeg, tsiaj, tib neeg cov roj ntsha insulin) thiab / lossis cov qauv kev tsim tawm (DNA recombinant insulin lossis insulin ntawm cov tsiaj keeb kwm) yuav tsum tau hloov kho koob tshuaj.
Thaum siv cov tshuaj insulin npaj ib txhij nrog cov tshuaj ntawm thiazolidinedione pab pawg, qhov kev pheej hmoo ntawm kev txhim kho edema thiab mob plawv tsis ua haujlwm nce, tshwj xeeb tshaj yog nyob rau cov neeg mob mob ntshav ncig ntawm cov kab mob thiab muaj cov kev pheej hmoo ua rau mob plawv tsis ua haujlwm.
Nrog hypoglycemia hauv tus neeg mob, qhov ceev ntawm psychomotor cov tshuaj tiv thaiv thiab kev mloog zoo tuaj yeem txo qis. Qhov no tuaj yeem txaus ntshai thaum cov peev xwm no tsim nyog tshwj xeeb (piv txwv li, tswj kev siv tshuab, tsav tsheb thiab lwm yam). Cov neeg mob yuav tsum tau qhia rau kev ceev faj kom tiv thaiv kev txhim kho hypoglycemia thaum ua cov haujlwm uas muaj kev phom sij uas yuav tsum muaj kev cuam tshuam psychomotor ceev thiab muaj kev saib xyuas ntau ntxiv (suav nrog kev tsav tsheb, ua haujlwm nrog cov tshuab). Qhov no tseem ceeb tshwj xeeb tshaj yog rau cov neeg mob tsis tuaj lossis cov tsos mob me me ua ntej ntawm lub qog ntshav qab zib, nrog rau kev txhim kho ntshav nquag. Hauv cov xwm txheej zoo li no, tus kws kho mob yuav tsum soj ntsuam qhov ua tau ntawm tus neeg mob los ua qhov haujlwm ntawd.

Cev xeeb tub thiab lactation

Thaum cev xeeb tub, nws yog qhov tseem ceeb heev kom tswj tau glycemic zoo hauv cov poj niam uas tau txais kev kho mob insulin. Thaum cev xeeb tub thiab lactation, nws yog ib qho tsim nyog yuav tau kho cov koob tshuaj insulin kom them nyiaj rau ntshav qab zib. Qhov kev xav tau rau cov tshuaj insulin feem ntau poob qis hauv thawj peb lub hlis thaum cev xeeb tub thiab nce hauv lub hlis thib ob thiab zaum thib peb ntawm cev xeeb tub. Qhov xav tau rau insulin tuaj yeem txo qis heev thaum yug menyuam thiab tam sim ntawd. Cov poj niam uas mob ntshav qab zib yuav tsum ceeb toom lawv tus kws kho mob txog kev xeeb tub los yog nws cov phiaj xwm. Rau cov poj niam uas mob ntshav qab zib mellitus, yuav tau txhaj tshuaj insulin thiab / lossis noj zaub mov kom haum lub sijhawm pub niam mis. Tib neeg cov kua dej tsis yog mutagenic nyob rau hauv vitro thiab hauv vivo series hauv kev tshawb fawb ntawm kev tshuaj lom neeg caj ces.

Vim li cas cov tshuaj insulin hu ua "txhob kaw ntau ntxiv"

Qee cov neeg mob ntshai ntawm lub sijhawm "tsim kho txhob kaw," lawv hais txog "GMOs siab phem."

Qhov tseeb, nws yog qhov tsim muaj ntawm cov tshuaj no uas cawm ntau lab tus tib neeg ntawm cov neeg mob ntshav qab zib.

Thaum pib, cov kws kho mob siv cov tshuaj insulin cais tawm ntawm cov tsiaj (feem ntau yog npua thiab nyuj). Txawm li cas los xij, qhov kev loj hlob no tsis tsuas yog txawv teb chaws rau tib neeg, tab sis kuj tseem nkag rau hauv cov hlab ntshav, ua rau cov ntshav qabzib thiab ua ntau yam teeb meem.

Cov tshuaj insulin tau tsim kho rau hauv txhua qhov kev xav tau ntawm tus neeg mob ntshav qab zib, tshem tawm cov kev tsis haum tshuaj. Tom qab qhov kawg ntawm nws qhov kev txiav txim, nws tawg cia rau hauv cov amino acids zoo tib yam thiab nws tau tawm ntawm lub cev.

Cov khoom siv yooj yim

Solulin tib neeg cov kua dej yog hais txog luv luv ua yeeb yam insulin hloov yeeb tshuaj.

Ua ke nrog cov xovtooj ntawm phab ntsa receptor, cov tshuaj tsim cov tshuaj insulin receptor complex uas ua rau cov txheej txheem ua haujlwm:

1. Kev rho tawm ntawm cov enzymes rau kev ua tiav thiab nqus tau cov piam thaj los ntawm cov ntaub so ntswg,
2. Kev nce nyob rau hauv kev thauj thiab tso ntshav qab zib,
3. Tsawg tus nqi ntawm glycogen tsim nyob rau hauv daim siab,
4. Txhawb kev tsim cov protein thiab cov rog.

Nrog kev tswj hwm ntawm subcutaneous, cov tshuaj pib ua tom qab 20-30 feeb, mus txog nws qhov siab tshaj plaws hauv 1-3 teev, kav ntev txog 5-8 teev.

Cov tshuaj no tau muab faib rau qhov sib txawv ntawm cov ntaub so ntswg: piv txwv li, nws tsis nkag rau hauv qhov chaw tiv thaiv kab mob thiab tsis kis mus rau niam mis. Tom qab qhov kawg ntawm nws txoj kev txiav txim, tib neeg cov kua dej tawm sab nraud los ntawm lub raum (li 80%) tom qab nws rhuav tshem los ntawm insulinase.

Kev ntsuas rau siv

Feem ntau, cov kws kho mob tshaj tawm cov tshuaj insulin thaum muaj:

• Kev kho tus kheej lossis kev sib txuas ua ke los kho ntshav qab zib mellitus hom 1 thiab 2,
• Yuav tiv thaiv tag nrho lossis ib nrab ntawm kev tawm tsam (tawm tsam) ntawm lub cev mus rau qhov ncauj (noj ntawm qhov ncauj) tshuaj tiv thaiv kab mob,
• Mob ntshav qab zib mellitus thaum cev xeeb tub (yog tias cov khoom noj tsis zoo)
• Teeb meem ntawm ntshav qab zib mellitus (ketoacidosis, hypersmolar lossis ketoacidotic coma),
• Txoj kev kho mob ntshav qab zib tiv thaiv keeb kwm ntawm ntau yam kab mob,
• Cov teeb meem kev hem thawj hauv cov neeg mob ntshav qab zib uas tau noj ntawm qhov ncauj noj cov tshuaj muaj suab thaj (lub sijhawm ua ntej, mob hnyav, nrog rau raug mob lossis frostbites, ua ntej yug menyuam, thiab lwm yam),
• Ntshav qab zib nephropathy lossis mob rau pob khaus siab,
• Qhov txhab tawv nqaij tawv nqaij (tawv nqaij daj, mob carbuncles, mob rwj),
• Kev Hloov pauv rau cov kua dej nrog qhov ntev (ntev ntev).

Kev phiv tshuaj

Txawm hais tias nws ua siab zoo, insulin tuaj yeem muaj cov kev mob tshwm sim thaum siv:

1. Kev txhim kho ntawm hypoglycemia vim kev tsis lees txais cov tshuaj los ntawm lub cev lossis cov tshuaj tiv thaiv kab mob nrog nws tus kheej insulin,
2. Kev tsis haum tshuaj (urticaria, pruritus, lossis ntau dua Quincke edema nrog rau o ntawm lub ntsej muag thiab cov qog ua pa, pallor thiab ua tsis taus pa),
3. Kev paub qab hau ntshav siab,
4. Hnov tsis nco qab (qee zaus ncav cuag tsis nco qab),
5. Hyperglycemia lossis ntshav qab zib acidosis (tawm tsam keeb kwm ntawm kub ib ce lossis kis tus kab mob, noj zaub mov tsis zoo, tom qab kev txhaj tshuaj tsis raws cai lossis koob tsis haum),
6. Deterioration ntawm kev zoo nyob rau hauv daim ntawv ntawm nqhis dej, tsaug zog, tsis qab los, ua ntsej muag liab,
7. Cov kev tawm tsam hauv ib cheeb tsam hauv cov lus qhia ua ke (hlawv, khaus, liab, liab nyob ze lossis atrophy ntawm adipose nqaij).

Ua ke nrog lwm cov tshuaj

Thaum siv tib neeg cov tshuaj insulin nrog qee yam tshuaj, nws cov nyhuv hypoglycemic yog lub zog lossis tsis muaj zog.

Qhov ua kom cov piam thaj txo qis tuaj yeem nce ntxiv thaum noj insulin nrog:

1. Sulfonamides (sulfonamide lossis hypoglycemic agents),
2. MAO inhibitors (furazolidone, thiab lwm yam),
3. ACE inhibitors (captopril, enalapril, thiab lwm yam),
4. NSAIDs (tshuaj aspirin, diclofenac, thiab lwm yam),
5. Androgens thiab anabolic steroids (Anavar, Androxon, thiab lwm yam),
6. Cov tshuaj tiv thaiv kab mob (quinoline, quinidine, thiab lwm yam),
7. Tetracyclines (tetracycline, doxycycline),
8. Lwm yam tshuaj (theophylline, pyridoxine, morphine, thiab lwm yam)

Txhawm rau kom txo cov nyhuv hypoglycemic ntawm cov tshuaj, nws cuam tshuam nrog:

• Glucocorticoids
• Amphetamines
• Estrogens (suav nrog raws li qhov ncauj txwv tsis pub muaj),
• Kev tshuaj ntsuab
• Sympathomimetics
• Cov thyroid hormones
• Cov tshuaj sib cais (triamterone, phenytoin, glucagon).

Tsis tas li ntawd, ua ke nrog cov tshuaj insulin, cov tshuaj tuaj yeem txo qis lossis txhim kho cov nyhuv hypoglycemic:

1. Beta blockers,
2. Reserpine
3. Morphine
4. Octreotide.Dosage thiab xaiv cov ntau npaum

Qhov koob tshuaj thiab cov txheej txheem ntawm kev tswj hwm tib neeg cov tshuaj insulin yog ib txwm txiav txim siab los ntawm tus neeg endocrinologist, coj mus rau hauv tus account tsim nyog ntsuas ntawm cov ntshav qabzib thiab zis ntawm tus neeg mob.

Cov tshuaj no muab rau hauv ntshav qab zib ua ntau txoj hauv kev: subcutaneously (s / c), intramuscularly (i / m) lossis tso ntshav (i / v). Ntau zaus, cov insulin raug tswj xyuas subcutaneously. Ua qhov no, siv thaj chaw:

• Plab
• Lub xub pwg
• Daim tawv nqaij khoov rau hauv lub pob tw.

Cov tshuaj no feem ntau tau txhaj tshuaj rau hauv kev mob hnyav los ntawm kev mob ntshav qab zib: ketoacidosis, mob ntshav qab zib coma.

Nws raug nquahu kom siv cov tshuaj insulin 15-30 feeb ua ntej noj mov, 3 zaug hauv ib hnub. Qee zaum 5-6 ib zaug kev tswj hwm ntawm cov tshuaj raug tso cai.

Cov tshuaj insulin feem ntau yog xam hauv ib qho kev faib tawm ntawm 0.5-1 units rau 1 kg ntawm qhov hnyav. Yog tias cov tshuaj insulin raug tshuaj ntau dua 0.6 mg rau ib kg ntawm lub cev qhov hnyav, ces cov tshuaj yuav tsum raug noj tsawg kawg 2 zaug hauv ib hnub. Qhov nruab nrab, cov tshuaj txhua hnub yog li 30-40 units (hauv cov menyuam yaus, 8 units).

Cov poj niam cev xeeb tub feem ntau yog tshuaj rau 0.6 PIECES ib kg ntawm qhov hnyav. Kev txhaj tshuaj feem ntau tsim 3-5 zaug hauv ib hnub, raws li tus naj npawb ntawm cov zaub mov.

Feem ntau, cov tshuaj insulin sai ua ke nrog cov insulin ntev dua.

Cov kev cai tswj hwm insulin

Txawm tias cov ntshav qab zib ua rau ua yuam kev thaum tswj cov tshuaj insulin.

Txoj cai tseem ceeb tshaj plaws rau kev kho tshuaj insulin yog:

1. Txheeb xyuas cov txee lub neej thiab chaw cia khoom ntawm cov tshuaj: nws yuav tsum tsis txhob nphav mus rau qhov kub ntxhov lossis nce ntshav.
2. Muab tshuaj rau hauv txhab txias kom txias. Nws yog txaus kom khaws lub raj mis pib hauv qhov chaw tsaus thaum chav sov.
3. Rov ua kom zoo ntawm cov ntau npaum ntawm cov tshuaj nrog cov lus qhia thiab kws kho mob pom zoo.
4. Tso cov cua ntawm lub koob txhaj tshuaj ua ntej txhaj tshuaj. Nws tsis yog yuav tsum so cov tawv nqaij nrog cawv. Kev kis mob nrog cov tshuaj insulin yog qhov tsis tshua muaj, thiab haus dej cawv txo cov nyhuv ntawm cov tshuaj.
5. Xaiv qhov chaw zoo coj los qhia. Rau kev ua yeeb yam luv luv, qhov no yog lub plab. Thaum txhaj rau hauv lub xub pwg lossis lub ntsej muag gluteal, cov tshuaj ua haujlwm qeeb dua.
6. Kev tiv thaiv kev cuam tshuam ntawm qhov chaw txhaj tshuaj nyob rau hauv daim ntawv ntawm kev siv tag nrho thaj chaw saum npoo. Rau kev qhia ntawm cov insulin luv luv, tag nrho lub plab hauv plab yog siv: los ntawm sab saum toj ntawm cov npoo nqi mus rau qhov quav, nrog rau thaj chaw tom qab ntawm lub cev. Nws yog ib qho tseem ceeb kom rov qab li 2 cm ntawm qhov chaw txhaj tshuaj qub, qhia cov koob txhaj tshuaj ntawm kaum ntawm 45-60 degrees, kom cov tshuaj tsis xau.
7. Ua ntej muab cov tshuaj, nws yog qhov zoo dua rau daim tawv nqaij nrog tus ntiv tes xoo thiab ntiv tes. Yog tias nws nkag mus rau hauv cov leeg nqaij, cov tshuaj yuav txo nws cov haujlwm. Tom qab tso cov koob, tuav cov koob txhaj tshuaj rau li 5-10 feeb.
8. Hauv plab, tso tshuaj insulin luv luv yog qhov zoo tshaj 20 feeb ua ntej noj mov. Hauv lwm qhov chaw, cov tshuaj tau muab tshuaj rau ib nrab ib teev ua ntej noj mov.

Lub npe kev lag luam ntawm cov tshuaj

Qhov tshuaj insulin yog tsim nyob rau hauv daim ntawv ntawm cov tshuaj rau kev txhaj tshuaj thiab yog muag hauv khw muag tshuaj.

Txhob kaw cov neeg muaj peev xwm tsim cov tshuaj insulin tuaj yeem tsim nyob hauv cov npe lag luam:

Ua tsaug rau niaj hnub kev ua thev naus laus zis, tsim ua kom muaj zog (tsim ua kom rov qab) tib neeg cov kua dej yog tsim. Nws yog nws leej twg yog tus nquag tshuaj ntawm qhov kev npaj: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Cov tshuaj no txawv ntawm thawj zaug hauv qhov rov ua dua ntawm cov amino acids, uas ntxiv cov khoom tshiab rau lawv (piv txwv li, cov txiaj ntsig tau ob-ntu ntev dua), uas yog qhov tseem ceeb heev rau cov neeg mob ntshav qab zib.

Noj ntau dhau

Nws tshwm sim tias kev tswj hwm ntawm insulin hauv qee kis ua rau hyperglycemia.

Cov tsos mob tseem ceeb ntawm hyperglycemia yog cov kev qhia hauv daim ntawv ntawm:

• Tsis muaj zog
• Pallor
• Ua fws hws
• Lub plawv dhia
• Mob taub hau
• Yeeb ncuab rau kev tshaib kev nqhis
• Cov kabmob hauv lub cev
• Loog ntawm tus nplaig, daim di ncauj, nqua.

Thaum pib ntawm cov tsos mob uas zoo sib xws, tus neeg mob yuav tsum noj tam sim ntawd ib qho yooj yim zom cov zaub mov carbohydrate (feem ntau yog khoom qab zib, ib qho qab zib lossis tshuaj yej qab zib).

Teeb meem

Kev kho mob ntev ntev nrog cov tshuaj insulin tuaj yeem ua rau ntau yam mob. Lub ntsiab yog:

1. Qhov tshwm sim ntawm cov ntshav qog ntshav qab zib. Noj zaub mov tsis zoo, noj tshuaj ntau dhau, ua si lub cev ntau dhau, lub raum thiab mob siab tuaj yeem pab txhawb rau qhov no.
2. Kev tshaj xo lipodystrophy. Kev tiv thaiv kab mob yog hloov thaj chaw rau kev txhaj tshuaj, ntxiv cov tshuaj novocaine (0.5-1.5 ml) rau insulin, thiab txhaj cov koob txhaj tshuaj rau hauv Ѕ ntawm cov tuab ntawm daim ntaub adipose.
3. Tshuaj tsis lees paub. Lwm yam (feem ntau ua ke) hom tshuaj muaj suab thaj nyob qis tau xaiv.
4. Kev ua xua tsis haum.Siv txoj hau kev kho mob (antihistamines, glucocorticoids) thiab kev hloov tshuaj txaus.

Solulin tib neeg lub cev yog qhov pab cawm neeg mob ntshav qab zib. Txawm li cas los xij, nws yog ib qho tseem ceeb uas yuav tau siv cov tshuaj no kom muaj txiaj ntsig, coj mus rau txhua tus cai rau nws txoj kev tswj hwm. Nws yog qhov tsim nyog uas tus kws kho mob sau ntawv rau cov tshuaj no, laij nws cov koob tshuaj thiab saib xyuas tus neeg mob lub sijhawm thaum kho tag nrho.

Qauv Khoos Kas-Kho Mob Tshooj 1

Ua liaj ua teb. Luv luv ua yeeb yam insulin npaj. Sib cuam tshuam nrog ib qhov tshwj xeeb receptor rau ntawm sab nraud ntawm lub hlwb, tsim cov txheej txheem insulin. Los ntawm nce cov synthesis ntawm cAMP (hauv cov roj ntsha thiab lub siab hlwb) lossis nkag ncaj qha rau hauv lub cell (leeg), insulin receptor complex stimulates intracellular processes, suav nrog synthesis ntawm cov lej ntawm cov enzymes tseem ceeb (hexokinase, pyruvate kinase, glycogen synthetase, thiab lwm yam). Kev txo qis hauv cov concentration ntawm cov piam thaj hauv cov ntshav yog los ntawm kev nce ntxiv hauv nws txoj kev thauj mus los hauv lub cev, qhov kev nqus thiab pov tseg ntau los ntawm cov ntaub so ntswg, kev kho ntawm lipogenesis, glycogenogenesis, synthesis protein, txo tus nqi ntawm cov piam thaj los ntawm lub siab (txo qis glycogen tawg), thiab lwm yam Tom qab s / c txhaj tshuaj, cov nyhuv tshwm sim tsis pub dhau 20-30 min, nce mus txog qhov siab kawg nkaus tom qab 1-3 teev thiab kav ntev, nyob ntawm qhov koob tshuaj, 5-8 teev. Ntev ntawm cov tshuaj nyob ntawm qhov koob tshuaj, txoj kev, qhov chaw tswj hwm thiab muaj tus yam ntxwv tseem ceeb.

Cov Tshuaj Pharmacokinetics Kev ua tiav ntawm kev nqus tau nyob ntawm tus txheej txheem kev tswj hwm (s / c, i / m), qhov chaw tswj hwm (plab, ncej, pob tw), koob tshuaj, tshuaj insulin tsom hauv tshuaj, thiab lwm yam Nws tau faib tsis ncaj hauv cov ntaub so ntswg. Nws tsis hla tus cwj pwm ntawm lub tso mis thiab nkag rau hauv niam mis. Nws yog rhuav tshem los ntawm insulinase, feem ntau yog nyob hauv daim siab thiab lub raum. T_1/2 - los ntawm ob peb mus rau 10 feeb Nws yog tawm los ntawm ob lub raum (30-80%).

Cov Khoom Qhia. Hom 1 mob ntshav qab zib mellitus, hom 2 mob ntshav qab zib mellitus: theem ntawm kev tawm tsam tshuaj rau qhov ncauj hypoglycemic, ib feem tawm tsam kev kho mob rau qhov ncauj hypoglycemic (kev kho mob sib xyaw), ntshav qab zib ketoacidosis, ketoacidotic thiab hyperosmolar coma, mob ntshav qab zib mellitus uas tau tshwm sim thaum cev xeeb tub (yog tias tsis muaj txiaj ntsig rau kev kho kev noj zaub mov) sib quas ntus siv rau cov neeg mob ntshav qab zib mellitus tiv thaiv kev kis kab mob nrog kub taub hau, nrog kev phais mob tom ntej, kev raug mob, yug menyuam, nrog kev ua txhaum txog txauv cov tshuaj ua ntej hloov mus rau kev kho mob nrog kev siv tshuaj insulin kom ntev.

Cov Yuav Tsum Muaj Kev ua haujlwm tsis txaus siab, kev ua ntshav qab zib.

Tsuas tshuaj Qhov koob tshuaj thiab txoj hauv kev ntawm kev tswj hwm tshuaj yog txiav txim siab ntawm tus kheej hauv txhua kis raws cov ntsiab lus qabzib hauv cov ntshav ua ntej noj mov thiab 1-2 teev tom qab noj mov, thiab tseem nyob ntawm qhov ntsuas ntawm glucosuria thiab cov yam ntxwv ntawm chav kawm ntawm tus kabmob.

Cov tshuaj yog muab s / c, hauv / m, hauv / hauv, 15-30 feeb ua ntej noj mov. Txoj kev sib txawv ntawm kev tswj hwm yog sc. Nrog cov ketoacidosis uas mob ntshav qab zib, mob ntshav qab zib tsis xeev, thaum phais mob kev cuam tshuam - hauv / thiab / m.

Nrog kev kho mob monotherapy, qhov ntau zaus ntawm kev tswj hwm feem ntau yog 3 zaug hauv ib hnub (yog tias tsim nyog, txog li 5-6 zaug hauv ib hnub), qhov chaw txhaj tshuaj tau hloov pauv txhua txhua lub sijhawm kom tsis txhob muaj kev txhim kho ntawm lipodystrophy (atrophy lossis hypertrophy ntawm subcutaneous rog).

Qhov nruab nrab txhua hnub koob tshuaj yog 30-40 PIECES, hauv cov menyuam yaus - 8 PIECES, tom qab ntawd qhov nruab nrab txhua hnub - 0.5-1 PIECES / kg lossis 30-40 PIECES 1-3 zaug hauv ib hnub, yog tias tsim nyog - 5-6 zaug ib hnub Cov. Hauv kev noj tshuaj ib hnub dhau ntawm 0.6 U / kg, insulin yuav tsum tau txhaj rau 2 hauv lossis ntau dua kev txhaj tshuaj hauv ntau qhov chaw ntawm lub cev. Nws yog qhov ua tau los ua ke nrog insulins ntev-coj.

Cov kua tshuaj insulin yog sau los ntawm lub vial los ntawm kev hno nrog rab koob syringe koob txhaj roj hmab nres, so tom qab hle lub hau txhuas nrog ethanol.

Sab sij huam. Kev tsis haum tshuaj (urticaria, angioedema - ua npaws, ua tsis taus pa, ua pa tsis txaus),

hypoglycemia (pallor ntawm daim tawv nqaij, nce tawm hws, tawm hws, palpitations, tshee tshee, tshaib plab, ntxhov siab, ntxhov siab, mob plab hauv lub qhov ncauj, mob taub hau, tsaug zog, pw tsaug zog, ntshai, poob siab, chim siab, coj tus cwj pwm txawv, tsis muaj zog, hais lus thiab hais lus tsis meej thiab qhov pom kev), hypoglycemic coma,

hyperglycemia thiab ntshav qab zib acidosis (thaum qis koob, hla kev txhaj tshuaj, noj zaub mov tsis zoo, tiv thaiv keeb kwm ntawm kub ib ce thiab kis kab mob): tsaug zog, nqhis dej, tsis qab los noj mov, ntsej muag tawm ntsej muag),

hnov tsis nco qab (txog rau kev txhim kho ntawm precomatose thiab coma),

pom kev tsis pom kev tsis zoo (feem ntau thaum pib kho mob),

txhaj tshuaj tiv thaiv kab mob hla nrog tib neeg cov tshuaj insulin, nce ntxiv ntawm lub titer ntawm cov tshuaj tiv thaiv insulin, tom qab los ntawm kev nce glycemia,

hyperemia, khaus thiab lipodystrophy (mob atrophy lossis hypertrophy ntawm subcutaneous rog) ntawm qhov chaw txhaj tshuaj.

Thaum pib ntawm kev kho mob - o thiab tsis hnov ​​mob zoo (yog ib ntus thiab ploj nrog kev kho txuas ntxiv).

Noj ntau dhau. Cov tsos mob: hypoglycemia (tsis muaj zog, tawm hws txias, pallor ntawm daim tawv nqaij, palpitations, tshee tshee, poob siab, kev tshaib plab, nkees nkees hauv tes, ceg, daim di ncauj, nplaig, mob taub hau), hypoglycemic coma, convulsions.

Kev Kho Mob: tus neeg mob tuaj yeem tshem tawm cov ntshav qab zib tsawg ntawm nws tus kheej los ntawm kev noj cov piam thaj lossis zaub mov ntau hauv cov khoom noj uas yooj yim thiab zom tau cov carbohydrates.

Subcutaneous, i / m lossis iv txhaj tshuaj glucagon lossis iv hypertonic dextrose tov. Nrog rau kev txhim kho lub ntsej muag tsis nco qab, 20-40 ml (txog 100 ml) ntawm 40% dextrose kev daws teeb meem yog txhaj tshuaj rau hauv tus dej mus rau hauv tus neeg mob kom txog thaum tus neeg mob tawm ntawm lub cev tsis nco qab.

Kev sib txuam. Cov tshuaj tsis sib haum nrog kev daws teeb meem ntawm lwm cov tshuaj.

Cov nyhuv hypoglycemic yog txhim kho los ntawm sulfonamides (suav nrog qhov ncauj tshuaj hypoglycemic, sulfonamides), MAO inhibitors (suav nrog furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, ACE inhibitors, NSAIDs (suav nrog salicylates), anabolic (suav nrog stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, phenfluramine, Li + kev npaj, pyridoxine, quinidine, quinine, chloroquinine.

Hypoglycemic los ntawm lus glucagon, kev loj hlob lawm, corticosteroids, qhov ncauj contraceptives, estrogens, thiazide thiab voj diuretics, BCCI, thyroid hormones, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclics, clonidine, calcium antagonists, diazoxide, morphine, tshuaj maj, nicotine, phenytoin, epinephrine blockers H₁histamine receptors.

Beta-blockers, reserpine, octreotide, pentamidine tuaj yeem txhim kho ob qho tib si thiab ua rau cov nyhuv tsis muaj zog hypoglycemic ntawm insulin.

Cov lus qhia tshwj xeeb. Ua ntej yuav siv tshuaj insulin los ntawm vial, nws yog qhov tsim nyog los xyuas qhov ntsuas ntawm kev daws. Thaum lub cev txawv teb chaws tshwm sim, nyem lossis nag lossis daus ntawm cov tshuaj ntawm lub khob ntawm lub khob ntim, tsis tuaj yeem siv tshuaj yeeb.

Qhov kub ntawm cov tshuaj insulin yuav tsum nyob ntawm chav sov. Qhov koob tshuaj insulin yuav tsum tau kho nyob rau hauv cov kis mob kis, thaum tsis ua haujlwm ntawm cov thyroid caj pas, Addison's disease, hypopituitarism, mob raum tsis ua haujlwm thiab ntshav qab zib mellitus hauv cov neeg muaj hnub nyoog 65 xyoos.

Cov laj thawj ntawm kev ua ntshav siab tuaj yeem yog: insulin noj ntau dhau, hloov tshuaj, hla zaub mov, ntuav, raws plab, kev ntxhov siab ntawm lub cev, cov kab mob uas txo qis qhov xav tau ntawm insulin (kab mob siab kawg ntawm lub raum thiab mob siab, nrog rau kev ua haujlwm ntawm lub qog adrenal cortex, pituitary lossis thyroid caj pas), hloov chaw kev txhaj tshuaj (piv txwv, daim tawv nqaij ntawm lub plab, xub pwg, ncej puab), ntxiv rau kev sib cuam tshuam nrog lwm yam tshuaj. Nws muaj peev xwm ua kom txo qis ntawm cov piam thaj hauv cov ntshav thaum hloov mus rau tus neeg mob los ntawm tsiaj insulin mus rau tib neeg cov insulin.

Qhov hloov ntawm tus neeg mob mus rau tib neeg cov kua dej yuav tsum tau ua kev tu mob ib txwm muaj thiab tsuas yog ua los ntawm kev saib xyuas ntawm kws kho mob.Kev ntsuam xyuas kev txhim kho hypoglycemia tuaj yeem cuam tshuam cov peev xwm ntawm cov neeg mob koom tes hauv kev khiav tsheb, nrog rau kev saib xyuas cov tshuab thiab tshuab.

Cov neeg mob ntshav qab zib tuaj yeem txwv cov ntshav qab zib tsawg uas lawv xav los ntawm kev noj cov piam thaj lossis zaub mov ntau hauv carbohydrates (Nws raug nquahu kom koj ib txwm muaj tsawg kawg 20 g suab thaj nrog koj). Hais txog qhov hloov ntshav qog ntshav qab zib, nws yog qhov yuav tsum tau qhia rau tus kws kho mob uas tuaj koom nrog daws qhov teeb meem ntawm qhov xav tau ntawm kev kho mob kho.

Hauv kev kho cov tshuaj insulin luv luv hauv qhov mob cais tawm, nws muaj peev xwm kom txo qis lossis nce qhov ntim ntawm adipose nqaij (lipodystrophy) hauv thaj chaw txhaj tshuaj. Txog qhov loj me, cov xwm txheej no tuaj yeem zam tau los ntawm qhov hloov pauv ntawm qhov hloov mus tas li. Thaum cev xeeb tub, nws yog ib qho tsim nyog yuav tsum coj mus rau hauv tus lej txo qis (kuv plaub hlis) lossis nce ntxiv (II - III trimesters) ntawm cov tshuaj insulin. Thaum lub sijhawm thiab yug tom qab yug, insulin yuav tsum poob ntau. Thaum lub sijhawm lactation, kev soj ntsuam txhua hnub yog xav tau rau ntau lub hlis (txog thaum qhov xav tau cov tshuaj insulin yuav ruaj khov).

Cov neeg mob tau txais ntau dua 100 IU ntawm cov tshuaj insulin ib hnub, thaum hloov cov tshuaj, yuav tsum tau mus pw hauv tsev kho mob.

Lub xeev tso npe ntawm cov tshuaj. Daim ntawv tshaj tawm raug cai: hauv 2 ntim. M: Medical Council, 2009. - Feem 2, ntu 1 - 568 s., Tshooj 2 - 560 s.

Npaj tau los ntawm cov ntaub ntawv raw ntawm cov tsiaj keeb kwm

Kev txais cov tshuaj no los ntawm kev mob siab ntawm npua thiab nyuj yog ib yam thev naus laus zis uas niaj hnub no tsis tshua pom muaj. Qhov no yog vim qhov ua tau zoo ntawm cov tshuaj tau txais, nws txoj kev ua kom ua rau kev ua xua thiab tsis txaus ntawm kev ua kom huv. Qhov tseeb yog tias txij li thaum cov tshuaj hormones yog cov tshuaj protein, nws muaj cov qauv ntawm cov amino acids.

Cov insulin tsim tawm hauv tus npua lub cev sib txawv hauv amino acid muaj pes tsawg leeg los ntawm tib neeg cov insulin los ntawm 1 amino acid, thiab insulin bovine los ntawm 3.

Thaum pib thiab nruab nrab ntawm xyoo pua 20, thaum cov tshuaj zoo sib xws tsis muaj, txawm tias cov insulin zoo li no yog qhov kev daws teeb meem hauv cov tshuaj thiab tso cai kho tus mob ntshav qab zib kom txog qib tshiab. Cov tshuaj hormones tau los ntawm hom no txo ​​cov ntshav qab zib, txawm li cas los xij, lawv feem ntau ua rau muaj kev phiv thiab ua xua. Qhov sib txawv ntawm cov muaj pes tsawg leeg ntawm cov amino acids thiab impurities hauv cov tshuaj cuam tshuam rau kev mob ntawm cov neeg mob, tshwj xeeb tshaj yog nyob rau hauv ntau pawg yooj yim ntawm cov neeg mob (cov menyuam yaus thiab cov laus). Lwm qhov laj thawj rau kev ua tsis tau zoo ntawm cov tshuaj insulin yog qhov muaj nws qhov tsis muaj zog nyob rau hauv cov tshuaj (proinsulin), uas tsis yooj yim sua kom tshem tau ntawm qhov kev hloov pauv tshuaj no.

Tam sim no, tseem muaj cov nqaij npuas ua tsis muaj zog ntxiv uas tsis muaj qhov luv ntawm cov luv luv no. Lawv tau los ntawm cov txiav nruab nrab ntawm npua, tab sis tom qab ntawd lawv raug rau kev ua ntxiv thiab ua kom huv. Lawv yog multicomponent thiab muaj excipients.

Hloov cov nqaij npuas insulin yog xyaum tsis txawv ntawm tib neeg cov tshuaj hormones, yog li nws tseem nyob hauv kev siv

Cov tshuaj no tiv thaiv los ntawm cov neeg mob ntau dua zoo dua thiab kev coj ua tsis ua rau muaj kev phiv tshuaj, lawv tsis inhibit tshuaj tiv thaiv kab mob thiab txo cov ntshav qab zib. Bovine insulin tsis siv rau hauv cov tshuaj niaj hnub no, txij li vim nws cov qauv txawv teb chaws nws cuam tshuam tsis zoo rau kev tiv thaiv kab mob thiab lwm yam kab ke ntawm tib neeg lub cev.

Kev Tshawb Fawb Kev Tshawb Fawb Kev Tshawb Fawb

Tib neeg cov tshuaj insulin, uas yog siv rau cov neeg mob ntshav qab zib, ntawm ib qho kev ntsuas lag luam yog tau ntawm ob txoj hauv kev:

• siv enzymatic kho cov kab mob ntawm cov kab mob ntshav qab zib,
• siv hom hloov kab ntawm Escherichia coli lossis poov xab.

Nrog lub cev hloov kho physico-tshuaj, cov molecules ntawm cov kab mob ntshav rau hauv qab ua haujlwm ntawm cov enzymes tshwj xeeb ua tib yam rau tib neeg cov kua dej.Cov amino acid muaj pes tsawg leeg ntawm kev npaj ua tiav tsis txawv ntawm qhov muaj pes tsawg leeg ntawm lub ntuj lawm uas tsim tawm hauv tib neeg lub cev. Thaum lub sij hawm tsim tawm, cov tshuaj yauv yauv ua kom lub siab huv, yog li nws tsis ua rau muaj kev fab tshuaj lossis lwm yam tsis xav ua.

Tab sis feem ntau, cov insulin tau txais los ntawm kev hloov pauv (hloov pauv (hloov pauv)). Siv cov txheej txheem biotechnological, cov kab mob lossis cov poov xab tau hloov kho hauv kev uas lawv tus kheej tuaj yeem tsim cov tshuaj insulin.

Ntxiv rau kev tsim cov tshuaj insulin nws tus kheej, nws txoj kev ua kom huv ua lub luag haujlwm tseem ceeb. Yog li hais tias cov tshuaj tsis ua rau muaj kev tsis haum tshuaj thiab tsis haum, nyob rau txhua theem nws yog qhov yuav tsum tau saib xyuas kev coj huv ntawm cov kab mob sib kis thiab txhua yam kev daws teebmeem, nrog rau cov khoom siv uas siv.

Muaj 2 txoj hauv kev rau cov tshuaj insulin ntau lawm. Thawj zaug ntawm lawv yog nyob ntawm kev siv ntawm ob hom kev sib txawv (hom) ntawm ib qho microorganism. Txhua ntawm lawv coj los ua ke tsuas yog ib txoj saw ntawm cov tshuaj hormones DNA molecule (tsuas yog ob ntawm lawv, thiab lawv muab spirally twisted ua ke). Tom qab ntawd cov saw hlau no tau txuas nrog, thiab hauv kev daws teeb meem nws yog ib qho ua tau los cais cov yam ntxwv nquag ua haujlwm ntawm insulin los ntawm cov uas tsis muaj qhov txheeb raws roj ntsha.

Qhov thib ob kom tau txais cov tshuaj nrog Escherichia coli lossis poov xab yog ua raws li qhov tseeb tias microbe ua ntej tsim cov tshuaj insulin tsis muaj zog (ntawd yog nws cov neeg ua ntej, proinsulin). Tom qab ntawd, siv kev kho mob enzymatic, daim ntawv no tau ua kom tiav thiab siv hauv cov tshuaj.

Cov neeg ua haujlwm tau txais kev nkag mus rau qee lub chaw tsim khoom yuav tsum hnav cov khaub ncaws uas tsis huv, uas tshem tawm qhov kev sib cuag ntawm cov tshuaj nrog tib neeg cov kua nruab nrog cev.

Tag nrho cov txheej txheem no feem ntau yog siv lub tshuab, huab cua thiab txhua qhov chaw nyob hauv kev sib cuag nrog cov ampoules thiab vials tsis huv, thiab cov kab nrog cov khoom siv yog hermetically kaw.

Cov txheej txheem biotechnology ua rau cov kws tshawb fawb xav txog lwm cov kev daws rau cov ntshav qab zib. Piv txwv li, txog rau hnub tim, kev tshawb nrhiav preclinical ntawm kev tsim cov khoom neeg tsim kho kab mob pancreatic beta cells tau ua tiav, uas tuaj yeem tau txais siv cov kev siv engineering caj ces. Tej zaum yav tom ntej lawv yuav siv los txhim kho kev ua haujlwm ntawm cov khoom no hauv cov neeg mob.

Kev tsim cov khoom lag luam niaj hnub no yog cov txheej txheem thev naus laus zis, uas suav nrog kev siv tshuab thiab kev cuam tshuam ntawm tib neeg

Cov khoom siv ntxiv

Kev tsim tawm ntawm cov tshuaj insulin tsis muaj cov neeg hauv lub ntiaj teb niaj hnub no yuav luag tsis pom, vim tias lawv tuaj yeem txhim kho nws cov khoom siv tshuaj lom neeg, txuas ntxiv lub sijhawm ua haujlwm thiab ua tiav qib siab ntawm kev coj dawb huv.

Los ntawm lawv cov khoom, tag nrho cov khoom xyaw ntxiv tuaj yeem faib ua cov hauv qab no:

• rub tawm ntev (cov tshuaj uas siv los muab lub sijhawm ntev dua ntawm kev txiav txim ntawm cov tshuaj),
• tshuaj tua kab mob Cheebtsam
• stabilizers, vim qhov twg cov tshuaj acidity zoo yog tswj tau nyob rau hauv cov tshuaj daws teeb meem.

Ua Luam Tshuaj Ntxiv

Muaj cov insulins ntev ntev uas nws cov kev ua haujlwm lom mus ntev txog 8 rau 42 teev (nyob ntawm pawg ntawm cov tshuaj). Cov nyhuv no tau tiav vim yog ntxiv cov tshuaj tshwj xeeb - prolongators rau cov tshuaj tov. Feem ntau feem ntau, ib qho kev sib txuas hauv qab no yog siv rau lub hom phiaj no:

Cov nqaijrog uas ua kom ntev li qhov kev ua ntawm cov tshuaj yauv ua kom pom tseeb kev ua kom huv thiab muaj cov ua xua tsawg (piv txwv, protamine). Cov ntsev muaj ntsev tsis muaj kev tsis zoo ua rau muaj kev cuam tshuam los ntawm insulin kev ua ub no lossis tib neeg lub neej.

Antimicrobial ntu

Kev rho tawm hauv cov tshuaj tiv thaiv ntawm cov tshuaj insulin yog qhov tsim nyog yog li cov paj microbial tsis muaj ntau thaum lub sij hawm cia thiab siv hauv nws. Cov tshuaj no yog cov khaws cia thiab ua kom paub tseeb tias khaws cia ntawm kev ua tsiaj txhu hauv tshuaj.Ib qho ntxiv, yog tias tus neeg mob tswj cov tshuaj hormones los ntawm ib lub vial rau nws tus kheej xwb, ces cov tshuaj yuav nyob ntev mus ob peb hnub. Vim tias muaj cov tshuaj tiv thaiv zoo tiv thaiv kab mob, nws yuav tsis muaj qhov yuav tsum tau muab pov tseg tsis siv tshuaj tsis zoo vim yog qhov theoretical muaj peev xwm luam tawm nyob rau hauv kev daws cov microbes.

Cov tshuaj yeeb dej hauv qab no tuaj yeem siv los ua tshuaj tua kab mob hauv kev tsim cov tshuaj insulin:

Yog tias cov tshuaj tov ua ke nrog zinc ions, lawv kuj ua raws li kev tiv thaiv ntxiv vim yog lawv cov khoom ua haujlwm antimicrobial

Rau kev tsim txhua yam ntawm cov tshuaj insulin, qee yam tshuaj tua kab mob yog cov haum. Lawv cov kev cuam tshuam nrog cov tshuaj hormones yuav tsum raug kuaj xyuas nyob rau theem ntawm kev coj mus kuaj, vim tias qhov kev khaws cia yuav tsum tsis txhob cuam tshuam cov kev ua haujlwm lom ntawm insulin lossis lwm yam cuam tshuam tsis zoo rau nws lub zog.

Kev siv tshuaj ntau nyob rau hauv feem ntau tso cai rau cov tshuaj los tswj cov tawv nqaij hauv qab daim tawv nqaij yam tsis tau kho ua ntej nrog cawv lossis lwm yam tshuaj tua kab mob (tus tsim khoom lag luam feem ntau hais txog qhov no hauv cov lus qhia). Qhov no yooj yim tswj hwm kev siv tshuaj thiab txo qhov tsawg ntawm cov neeg npaj ua ntej txhaj tshuaj nws tus kheej. Tab sis cov lus pom zoo no tsuas ua haujlwm yog tias cov tshuaj daws tau siv uas siv ib tug kheej insulin koob txhaj nrog ib rab koob nyias.

Lub cev ruaj khov

Kev ruaj khov yog qhov tsim nyog yog li pH ntawm kev daws teeb meem yog tswj hwm ntawm qib. Kev khaws cia ntawm cov tshuaj, nws cov dej num thiab kev ruaj khov ntawm cov tshuaj yog nyob ntawm theem ntawm acidity. Hauv kev tsim cov tshuaj txhaj tshuaj rau cov neeg mob ntshav qab zib, phosphates feem ntau yog siv rau lub hom phiaj no.

Rau cov tshuaj insulin nrog zinc, cov tshuaj tiv thaiv stabilizers tsis yog ib txwm xav tau, txij li cov hlau ions pab tswj qhov kev tshuav tsim nyog. Yog tias lawv tseem siv, tom qab ntawd lwm cov tshuaj sib txuas ntxiv yog siv tsis siv phosphates, vim tias kev sib txuam ntawm cov tshuaj no ua rau muaj dej nag lossis tsis haum ntawm cov tshuaj. Ib qho cuab yeej tseem ceeb qhia rau txhua tus neeg nyob twj ywm yog kev nyab xeeb thiab tsis muaj peev xwm nkag rau ib qho kev cuam tshuam nrog cov tshuaj insulin.

Tus kws tshaj lij endocrinologist yuav tsum nrog kev xaiv cov tshuaj txhaj rau ntshav qab zib rau txhua tus neeg mob. Kev ua haujlwm ntawm cov kua dej tsis yog tsuas yog tswj cov qib ntawm cov piam thaj hauv ntshav, tab sis kuj tsis ua rau lwm cov plab hnyuv siab raum thiab cov kab ke. Cov tshuaj yuav tsum yog cov tshuaj nruab nrab, tsis tshua muaj allergenic thiab pheej yig dua. Nws tseem yooj yim heev yog tias cov tshuaj insulin tuaj yeem sib xyaw nrog nws lwm cov ntawv ntxiv raws li kev ua haujlwm ntev.

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H ib txwm cwj mem (Berlinsulin H ib txwm cwj mem), Berlsulin H ib txwm U-40 (Berlinsulin H ib txwm U-40), Insuman sai (Insuman sai), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Pharmacological kev txiav txim

Nws yog cov tshuaj ua kom nruab nrab tsis haum rau tib neeg cov insulin. Hais txog cov insulins uas ua yeeb yam luv luv. Nws txo qis ntshav qabzib cov ntshav qabzib, txhim kho nws qhov kev nkag siab los ntawm cov ntaub so ntswg, lipogenesis, glycogenogenesis, synthesis protein, thiab txo qis ntshav qabzib ntau lawm los ntawm daim siab.

Qhov pib ntawm cov tshuaj yog 20-30 feeb tom qab kev tswj hwm. Qhov siab tshaj tawm tau tsim tawm ntawm 1 mus rau 3 teev Lub sijhawm ua haujlwm yog 6-8 teev.

Kev txiav txim ntawm tus kheej ntawm insulin nruab nrab soluble tib neeg insulin yog nyob ntawm qhov koob tshuaj thiab kev cuam tshuam tseem ceeb cuam tshuam- thiab intrapersonal deviations. Kev nqus tau los ntawm qhov chaw txhaj tshuaj yog sai dua li nqaij npuas nruab nrab soluble insulin.

,: theem ntawm kev tawm tsam rau qhov ncauj hypoglycemic, ib feem tawm tsam kev tiv thaiv kab mob hauv lub qhov ncauj (kev kho ua ke), cov kab mob sib kis, kev phais mob (mono- lossis kev sib txuas ua ke), cev xeeb tub (yog tias kev noj zaub mov noj tsis muaj txiaj ntsig).

Mob ntshav qab zib ketoacidosis, ketoacidotic thiab hyperosmolar coma, nrog kev phais tom ntej, kev ua xua rau insulin npaj ntawm tsiaj keeb kwm, insulin lipoatrophy, insulin tsis kam vim lub siab titer ntawm anti-insulin cov tshuaj tiv thaiv, thaum hloov ntawm islet hlwb ntawm lub txiav.

Sab sij huam

Kev mob ntshav qab zib tsawg (me ntsis ntau dua li thaum siv cov tshuaj insulin ntawm cov tsiaj keeb kwm), AR - tsawg dua. Kev hloov pauv tsis raug - feem ntau thaum pib cov tshuaj insulin.

Qib hormonal qib zoo tshaj yog lub hauv paus rau kev txhim kho tag nrho ntawm tib neeg lub cev. Ib qho ntawm cov tshuaj hormones tseem ceeb hauv tib neeg lub cev yog insulin. Nws qhov tsis muaj peev xwm lossis ntau dhau ua rau muaj kev coj tsis zoo. Ntshav qab zib mellitus thiab ntshav qab zib ntshav yog ob qhov kev phem tshaj plaws uas ua rau cov phooj ywg tsis zoo ntawm tib neeg lub cev, uas tsis quav ntsej cov ntaub ntawv hais txog dab tsi ntawm insulin thiab nws qib dab tsi yuav tsum yog.

Cov tshuaj insulin

Lub koob meej ntawm kev tsim thawj cov haujlwm uas tau tso rau txoj kev tshawb pom ntawm cov tshuaj hormones yog los ntawm Lavxias tus kws tshawb fawb Leonid Sobolev, uas nyob rau xyoo 1900 tau thov siv cov txiav ua ntej kom tau txais tshuaj tiv thaiv kab mob thiab tau muab lub tswvyim ntawm dab tsi yog cov tshuaj insulin. Ntau tshaj 20 xyoo tau siv rau kev tshawb nrhiav ntxiv, thiab tom qab xyoo 1923 kev tsim cov tshuaj insulin. Niaj hnub no, txoj kev loj hlob zoo tau kawm los ntawm kev tshawb fawb. Nws koom nrog kev rhuav tshem cov carbohydrates, lub luag hauj lwm rau metabolism thiab rog rog.

Lub cev twg tsim cov tshuaj insulin

Kev txiav ntshav, qhov chaw ua haujlwm ntawm B-cov hlwb muaj nyob, paub rau lub ntiaj teb science raws li Lawrence cov koog pov txwv lossis pancreatic islets, ua haujlwm ua cov insulin-uas ua khoom nruab nrog. Lub zog nqus tshwj xeeb ntawm cov hlwb muaj me me thiab ua rau tsuas yog 3% ntawm tag nrho qhov loj ntawm lub txiav ua ke. Kev tsim cov tshuaj insulin los ntawm beta hlwb tshwm sim, ib qho me me ntawm proinsulin yog zais cia los ntawm cov tshuaj hormones.

Dab tsi yog subtype ntawm cov kua dej tsis paub tag nrho. Qhov tshuaj hormones nws tus kheej, ua ntej noj daim ntawv ua tiav zaum kawg, nkag mus rau hauv lub chaw Golgi cell complex, qhov twg nws ua tiav rau lub xeev muaj cov tshuaj hormones tag nrho. Cov txheej txheem xaus thaum lub cev tso rau hauv cov granules tshwj xeeb ntawm cov txiav, qhov twg nws khaws cia kom txog thaum ib tus neeg noj zaub mov. Cov peev txheej ntawm B-cell raug txwv thiab txiav txim siab sai sai thaum ib tus neeg ua txhaum cai cov khoom noj khoom noj uas yooj yim carbohydrate, uas yog qhov ua rau muaj ntshav qab zib.

Dab tsi yog cov tshuaj insulin - qhov no yog qhov tseem ceeb tshaj plaws hauv cov kev zom zaub mov. Yog tias tsis muaj nws, cov piam thaj nkag mus rau hauv lub cev los ntawm cov zaub mov tsis tuaj yeem nkag mus rau hauv lub cev. Cov tshuaj hormones ua rau nce permeability ntawm cov qog ua cell, vim qhov ntawd tawm ntawm cov piam thaj hauv lub cev lub cev. Nyob rau tib lub sijhawm, cov tshuaj hormones txhawb qhov kev hloov pauv ntawm cov kua nplaum mus rau hauv glycogen, polysaccharide uas muaj cov khoom ntawm lub zog, uas yog siv los ntawm tib neeg lub cev raws li qhov tsim nyog.

Lub luag haujlwm ntawm cov kua dej yog qhov sib txawv. Nws muab cov leeg ua haujlwm ntawm tes, cuam tshuam rau cov txheej txheem ntawm cov protein thiab rog metabolism. Cov tshuaj hormone ua lub luag haujlwm ntawm cov ntaub ntawv xov xwm ntawm lub hlwb, uas raws li cov neeg txais kev txiav txim siab xav tau cov kev ua kom yuag sai: yog tias muaj ntau ntawm nws, lub hlwb txiav txim siab tias cov qog tshaib plab thiab nws tsim nyog los tsim cov peev nyiaj. Cov nyhuv ntawm insulin rau ntawm lub cev:

1. Nws tiv thaiv cov amino acids tseem ceeb los ntawm kev tawg rau hauv cov suab thaj yooj yim.
2. Txhim kho cov protein synthesis - lub hauv paus ntawm lub neej.
3. Tsis pub muaj protein nyob rau hauv cov leeg kom tsis zoo, tiv thaiv cov leeg mob atrophy - cov nyhuv anabolic.
4. Nws txwv nws tsub zuj zuj ntawm ketone lub cev, ntau dhau ntawm qhov uas ua rau tib neeg tuag taus.
5. Txhawb nqa qhov thauj ntawm poov tshuaj thiab magnesium ions.

Lub luag haujlwm ntawm insulin hauv tib neeg lub cev

Qhov kev tsis txaus cov tshuaj hormones yog txuam nrog ib tus kabmob hu ua ntshav qab zib. Cov uas raug tus mob no tau raug yuam muab cov tshuaj insulin ntxiv mus. Lwm qhov huab yog qhov dhau ntawm cov tshuaj hormones, hypoglycemia. Tus kab mob no ua rau nce ntxiv ntawm cov ntshav siab thiab txo qis ntawm vascular elasticity.Tsub kom qhov nce hauv insulin ntau ntxiv los ntawm cov tshuaj hormone glucagon uas ua los ntawm alpha hlwb ntawm pancreatic islets ntawm Langerhans.

Insulin cov ntaub so ntswg

Cov tshuaj insulin ua rau lub zog tsim cov protein ntau hauv cov leeg nqaij, yam tsis muaj qhov ua kom cov leeg mob tsis muaj peev xwm txhim kho. Qhov tsim los ntawm cov nqaij mos adipose, uas ib txwm ua cov haujlwm tseem ceeb, tsis yooj yim sua yam tsis muaj lub cev. Cov neeg mob uas pib mob ntshav qab zib ntsib ketoacidosis, uas yog ib hom kev mob tshwm sim hauv lub cev uas ua rau lub hnub poob siab tshaib plab.

Kev phiv los ntawm tib neeg cov insulin

Kev mob ntshav qab zib (pallor ntawm daim tawv nqaij, nce tawm hws, tsaus muag, tshee tshee, tshee tshee, tawm hws, xeev siab, ntuav, tachycardia, palpitations, tshaib plab, ntxhov siab, ntxhov siab, mob plab hauv lub qhov ncauj, mob taub hau, tsaug zog, pw tsaug zog, ntshai, chim siab , tus cwj pwm txawv, tsis meej ntawm kev txav, tsis meej pem, hais lus thiab tsis pom kev, tsis nco qab, hnov ​​qab, tuag), posthypoglycemic hyperglycemia (Somogy phenomenon), insulin tsis kam (txhua hnub qhov xav tau tshaj 20 0 ntu), edema, pom kev tsis zoo, ua xua (ua pob khaus, ua pob khaus, ua pob khaus khaus, ua pa luv, ua pa luv, ua pa tawm hws, tawm hws ntau heev, muaj lub plawv dhia, hypotension, anaphylactic ceeb), cov tshuaj hauv zos (o, khaus, mob, liab, tom qab txhaj tshuaj lipodystrophy, uas yog nrog los ntawm kev nqus tsis txaus ntawm cov tshuaj insulin, kev txhim kho ntawm kev hnov ​​mob thaum atmospheric siab hloov).

Ntshav cov ntshav

Kev ua haujlwm ntawm cov kua dej muaj xws li txhawb nqa cov ntshav qabzib hauv cov ntshav, tswj cov metabolism hauv cov rog thiab cov protein, hloov khoom noj khoom haus rau cov leeg nqaij. Ntawm theem ib txwm muaj teeb meem, cov hauv qab no tshwm sim:

• protein synthesis rau cov leeg leeg,
• qhov sib npaug ntawm cov metabolism thiab catabolism yog tswj tseg,
• stimulates lub synthesis ntawm glycogen, uas ua rau muaj kev tiv thaiv ntev thiab tsim dua tshiab ntawm cov leeg hlwb,
• amino acids, piam thaj, poov tshuaj nkag mus rau hauv lub hlwb.

Cov tshuaj insulin yog ntsuas hauv µU / ml (0.04082 mg ntawm crystalline yam khoom yog coj ua ib ntu). Cov neeg muaj kev noj qab haus huv muaj qhov taw qhia sib npaug nrog 3-25 rau cov koog. Rau cov menyuam yaus, qhov txo qis dua 3-20 μU / ml yog tso cai. Hauv cov poj niam cev xeeb tub, tus cai sib txawv - 6-27 mkU / ml, hauv cov neeg laus dua 60 xyoo qhov ntsuas no yog 6-35. Ib qho kev hloov pauv ntawm qhov tshwj xeeb qhia tau tias nws muaj cov kabmob hnyav.

Txhawb siab

Ntev li ntawm cov insulin muaj ntau heev ncua ntev txog qhov kev hloov pauv tsis tseeb ntawm lub cev. Tus mob no tshwm sim vim yog cov ntshav qab zib tsawg dua. Koj tuaj yeem nkag siab qhov dhau ntawm cov tshuaj insulin los ntawm cov cim: tshee, tawm hws, palpitations, sai nres ntawm kev tshaib plab, xeev siab, tsaus muag, tsis nco qab. Cov ntsuas no hauv qab no cuam tshuam qhov nce ntawm qib theem hauv keeb:

• lub cev ua si nyhav,
• kev nyuaj siab mob ntsws
• kab mob ntawm daim siab thiab tus po,
• rog dhau
• ua txhaum ntawm tsis kam ntawm lub hlwb rau carbohydrates,
• polycystic lub zes qe menyuam,
• tsis ua hauj lwm ntawm lub caj pas pituitary,
• mob qog thiab mob qog ua qog cov qog adrenal.

Tsawg qis dua

Kev poob qis hauv cov tshuaj insulin tshwm sim vim kev ntxhov siab, ua kom lub cev ua kom lub zog tsis txaus, ua rau lub cev tsis muaj zog, noj txhua hnub ntawm kev noj zaub mov ntau. Cov tshuaj insulin thaiv kev ntws ntawm cov piam thaj, nce nws cov peev xwm. Raws li qhov tshwm sim, muaj kev nqhis dej heev, ntxhov siab, tiv thaiv sai sai ntawm kev tshaib plab, txob taus, tso zis tsis tu ncua. Vim yog cov tsos mob zoo sib xws ntawm qis thiab siab insulin, kev kuaj mob yog nqa los ntawm kev kawm tshwj xeeb.

Cov tshuaj insulin twg ua rau cov neeg mob ntshav qab zib

Qhov teeb meem ntawm cov ntaub ntawv nyoos rau kev tsim cov tshuaj hormone yog kev txhawj xeeb rau ntau tus neeg mob. Cov tshuaj insulin hauv tib neeg lub cev yog tsim tawm los ntawm tus txiav, thiab cov yam hauv qab no tau txais artificially:

1. Nqaij npuas los yog bovine - ntawm tsiaj keeb kwm. Rau kev tsim khoom siv rau kev siv tshuaj tua tsiaj los ua tsiaj.Kev npaj ntawm nqaij npuas ua raw cov ntawv muaj proinsulin, uas tsis tuaj yeem sib cais, nws yuav dhau los ua qhov ua xua.
2. Kev hloov kho biosynthetic lossis nqaij npuas yug - npaj ua hluavtaws ib nrab yog tau los ntawm kev hloov cov amino acids. Ntawm cov txiaj ntsig yog kev sib raug zoo nrog tib neeg lub cev thiab qhov tsis muaj kev ua xua. Qhov tsis zoo - tsis txaus ntawm cov ntaub ntawv nyoos, kev nyuaj ntawm kev ua haujlwm, tus nqi siab.
3. Kev tsim kho caj ces hauv tshuab hluav taws xob - nws hu ua "tib neeg insulin" rau lwm txoj kev, vim tias nws zoo ib yam li lub cev ntuj. Cov tshuaj yog tsim tawm los ntawm cov enzymes ntawm cov poov xab mob plab thiab hloov pauv txhob kaw E. coli.

Cov lus qhia rau kev siv tshuaj insulin

Cov haujlwm ntawm cov kua dej yog qhov tseem ceeb heev rau tib neeg lub cev. Yog tias koj yog tus mob ntshav qab zib, tom qab ntawv koj tau txais kev xa mus los ntawm tus kws kho mob thiab cov ntawv sau tshuaj raws li cov tshuaj tau muab pub dawb hauv cov khw muag tshuaj lossis tsev kho mob. Yog tias muaj mob hnyav nws tuaj yeem yuav tsis tau daim ntawv yuav tshuaj, tab sis kev noj tshuaj yuav tsum tau ua neeg pom. Txhawm rau kom tsis txhob noj tshuaj ntau dhau, nyeem cov lus qhia rau kev siv tshuaj insulin.

Kev ntsuas rau siv

Raws li cov lus qhia uas teev rau hauv txhua pob ntawm insulin npaj, qhov ntsuas rau nws siv yog hom 1 mob ntshav qab zib mellitus (tseem hu ua insulin-tiv thaiv tsis tau) thiab, qee zaum, hom 2 mob ntshav qab zib mellitus (non-insulin-dependant). Yam tseem ceeb suav nrog kev tsis nkag siab rau qhov ncauj hypoglycemic tus neeg sawv cev, kev txhim kho ntawm ketosis.

Kev tswj hwm insulin

Tus kws kho mob sau cov tshuaj tom qab kuaj mob thiab kuaj ntshav. Txog rau kev kho mob ntshav qab zib siv tshuaj ntawm ntau lub zog ntawm kev ua: luv thiab ntev. Qhov kev xaiv yog nyob ntawm qhov mob hnyav ntawm cov chav kawm ntawm tus kab mob, tus mob ntawm tus neeg mob, qhov ceev ntawm qhov pib ntawm kev ua ntawm cov tshuaj:

1. Qhov npaj-luv ua yeeb yam yog npaj rau subcutaneous, leeg pob leeg lossis intramuscular thawj coj. Nws muaj qhov sai sai, luv luv, qab zib-txo cov nyhuv, nws siv sijhawm 15-20 feeb ua ntej noj mov ntau zaus / hnub. Cov nyhuv tshwm sim hauv ib nrab ib teev, qhov siab tshaj plaws - hauv ob teev, tsuas yog rau teev.
2. Ntev lossis ua ntev ntev - muaj cov txiaj ntsig ua haujlwm ntev 10-36 teev, tuaj yeem txo cov hnub txhaj tshuaj txhua hnub. Kev raug txwv tsis pub siv yog ua intramuscularly lossis subcutaneously, tab sis tsis yog ncau nrog.

Cov koob txhaj tshuaj siv rau kev ua kom nkag siab thiab muab cov tshuaj ua kom ntau dua. Ib qho kev sib faib ua rau qhov muaj pes tsawg qhov ntawm qhov ntsuas. Cov cai rau kev kho insulin:

• khaws cov kev npaj hauv tub yees, thiab cov pib nyob rau hauv chav tsev sov, sov cov khoom ua ntej nkag mus rau nws, vim tias qhov txias txias tsis muaj zog,
• nws zoo dua rau kev txhaj tshuaj lub cev luv-luv nyob hauv qab ntawm daim tawv nqaij ntawm lub plab - txhaj rau hauv tus ncej lossis sab saum toj lub pob tw ua ntau dua maj mam, txawm tias phem dua - hauv lub xub pwg,
• cov tshuaj ntev ntev tau txhaj rau hauv tus ncej puab sab laug lossis sab xis,
• ua ib qho kev txhaj tshuaj hauv thaj chaw sib txawv,
• nrog cov tshuaj insulin, ntes tag nrho thaj tsam ntawm lub cev - yog li koj tuaj yeem zam qhov mob thiab ntsaws ruaj ruaj,
• rov qab los ntawm kev txhaj tshuaj kawg tsawg kawg 2 cm,
• tsis txhob kho cov tawv nqaij nrog cawv, nws rhuav tshem cov tshuaj insulin,
• yog tias cov kua ntws tawm, cov koob tau ntxig tsis raug - koj yuav tsum tuav nws ntawm kaum ntawm 45-60 degrees.

Tus nqi tshuaj insulin

Tus nqi ntawm cov tshuaj insulin nyob ntawm hom ntawm cov chaw tsim khoom, hom tshuaj (luv luv / sijhawm ntev ntawm kev txiav txim, pub mov) thiab qhov ntim ntawm ntim. Tus nqi ntawm 50 ml ntawm cov tshuaj Insulinum yog kwv yees li 150 rubles hauv Moscow thiab St. Petersburg. Insuman nrog koob txhaj tshuaj - 1200, ncua kev kawm Protafan muaj tus nqi kwv yees li 930 rubles. Qib ntawm lub tsev muag tshuaj kuj tseem cuam tshuam ntau npaum li cas cov tshuaj insulin.

Tib neeg cov kua dej yog cov cuab yeej siv tau tsim los kho cov neeg mob uas muaj ob hom ntshav qab zib thawj thiab thib ob. Nws yog cov khoom lag luam uas muaj cov roj ntsha uas muaj soluble hauv dej. Pom zoo rau kev siv txawm tias thaum cev xeeb tub.

Actrapid, Humulin, Insuran.

INN: Semi-hluavtaws tib neeg insulin soluble.

Cov Tshuaj Pharmacokinetics

Tus nqi ntawm cov tshuaj insulin feem ntau nyob ntawm seb cov tshuaj ua kom muaj zog npaum li cas. Ntau yog vim lub koob tshuaj kawg, tag nrho cov tshuaj insulin hauv cov tshuaj txhaj thiab qhov chaw txhaj tshuaj sai. Cov ntaub so ntswg tau faib tsis zoo. Cov tshuaj insulin tsis tuaj yeem nkag mus rau hauv lub hnab tiv thaiv ntawm tus poj niam.

Nws tuaj yeem faib qee qhov los ntawm cov insulinase ncaj qha hauv lub siab. Nws yog tawm feem ntau los ntawm lub raum lim. Kev tshem tawm ib nrab-lub neej tsis pub dhau 10 feeb. Qhov siab kawg ntawm cov ntshav ntshiab nyob rau hauv cov ntshav raug pom hauv ib teev tom qab nws tswj hwm ncaj qha. Cov nyhuv tuaj yeem ntev txog 5 teev.

Yuav ua li cas noj tib neeg cov tshuaj insulin

Qhov ntau npaum li cas thiab cov kev coj noj coj ua ntawm kev txiav txim siab ncaj qha tau txiav txim siab tsuas yog ua tiav ntawm cov ntshav nruab nrab ntawm cov ntshav qab zib, thiab tom qab ntawd 2 teev tom qab noj mov. Ntxiv rau, qhov kev txais tos nyob ntawm qhov mob hnyav ntawm kev txhim kho glucosuria.

Feem ntau cov feem ntau, subcutaneous tswj hwm. Ua nws 15 feeb ua ntej noj mov loj. Yog hais tias muaj ntshav qab zib mob ketoacidosis lossis rov qab zoo li qub, txhaj tshuaj insulin yog txhaj rau cov dav hlau, ib txwm tso leeg lossis mus rau hauv cov nqaij gluteus, ua ntej kev phais mob.

Nws raug nquahu kom siv tshuaj tsawg kawg 3 zaug hauv ib hnub. Txhawm rau kom tsis txhob muaj cov pleev lipodystrophy, koj tsis tuaj yeem quav yeeb tshuaj rau ntawm qhov qub chaw. Tom qab ntawd tsis pom dab tsi ntawm cov rog subcutaneous rog.

Qhov nruab nrab ntawm cov neeg laus ib hnub tau txhaj yog 40 units, thiab rau cov menyuam yaus nws yog 8 units. Cov cai ntawm cov thawj coj yog 3 zaug hauv ib hnub. Yog tias muaj qhov xav tau ntawd, koj tuaj yeem tso cov tshuaj insulin txog 5 zaug.

Cov lus qhia tshwj xeeb

Ua ntej koj sau cov tshuaj los ntawm lub raj mis, koj yuav tsum twv xyuas nws kom pom tseeb. Yog tias muaj qhov pom sai sai, cov tshuaj no yuav tsum tsis txhob noj.

Cov koob tshuaj cov kua dej yuav hloov kho rau cov kev pathologies:

• kis kab mob
• malfunctioning ntawm lub qog gland,
• Addison's disease
• Kev Ua Siab Ncaj
• mob ntshav qab zib rau cov neeg laus.

Feem ntau, kev tshwm sim ntawm kev mob ntshav qab zib tsawg. Txhua tus tuaj yeem ua rau los ntawm kev noj ntau dhau, hloov pauv qhov tseeb ntawm cov kua dej los ntawm tib yam keeb kwm nrog tib neeg, kev tshaib plab, nrog rau mob raws plab, ntuav thiab lwm cov tsos mob ntawm intoxication. Kev mob ntshav qab zib me me tuaj yeem nres los ntawm kev noj suab thaj.

Yog tias cov phiaj xwm me ntsis uas qhia hauv lub qog ntshav qab zib tsawg dua, koj yuav tsum hu rau tus kws kho mob tshwj xeeb. Muaj qee qhov mob me, kev hloov kho ntau dua tuaj yeem pab tau. Hauv cov xwm txheej hnyav dua, kev siv tshuaj tua kab mob ua kom tshem tawm. Tau zuaj ib zaug, yuav tsum ua tag nrho kev noj tshuaj lossis tshuaj kho mob hloov.

Nws yuav tsum nco ntsoov tias nyob rau thaj tsam ntawm kev tswj hwm ncaj qha, kev ua haujlwm ntawm subcutaneous rog tuaj yeem tshwm sim. Tab sis qhov no tuaj yeem zam kom dhau los hloov chaw rau kev txhaj tshuaj.

Siv thaum cev xeeb tub thiab lactation

Kev tswj cov qib qab zib hauv lub cev ntawm tus poj niam cev xeeb tub yog qhov tseem ceeb. Hauv thawj peb lub hlis, xav tau cov ntshiab insulin tsawg dua, thiab thaum kawg ntawm lub sijhawm nws nce.

Thaum lub sijhawm pub mis niam, tus pojniam yuav xav tau qee yam kev kho ntawm cov tshuaj insulin thiab kev noj zaub mov tshwj xeeb.

MP tsis muaj kev hloov pauv ntawm cov tshuaj cev cev thiab cov tshuaj lom tsis haum rau lub cev.

Kev cuam tshuam nrog lwm yam tshuaj

Ib qho kev daws teeb meem ntawm cov kua tshuaj insulin yog nruj me ntsis txwv tsis pub coj los ua ke nrog lwm cov kev txhaj tshuaj. Lub ntsiab hypoglycemic tsuas yog txhim kho thaum siv ua ke nrog qee yam sulfonamides, MAO inhibitors, anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine thiab qee qhov beta-blockers kuj txhim kho cov nyhuv ntawm cov tshuaj.

Cov nyhuv hauv lub ntsej muag tsis muaj zog thaum noj nrog cov tshuaj loj ntawm cov thyroid, txwv tsis pub muaj, glucagon, estrogens, heparin, ntau yam sympathomimetics, qee cov tshuaj tiv thaiv kab mob, antagonists ntawm calcium, morphine thiab nicotine.

Ambiguously cuam tshuam cov tshuaj insulin rau ntawm qhov nqus ntawm glucose beta-blocker, reserpine thiab pentamidine.

Hom mob insulin

Cov tshuaj insulin yog thawj zaug tsim los ntawm kev txiav tawv nqaij dev. Ib xyoo tom qab, cov tshuaj hormones twb tau muab tso rau hauv kev siv. Lwm 40 xyoo dhau, thiab nws tau los ua hluav taws xob insulin sib xyaw.

Tom qab qee lub sijhawm, cov khoom lag luam purification siab tau ua. Tom qab ob peb xyoos ntxiv, cov kws tshwj xeeb tau pib txhim kho kev sib txuas ntawm tib neeg cov tshuaj insulin. Txij li xyoo 1983, cov tshuaj insulin tau pib tsim tawm ntawm qhov ntsuas ntawm kev lag luam.

15 xyoo dhau los, ntshav qab zib tau kho nrog cov khoom tsim los ntawm cov tsiaj. Tam sim no, nws yog txwv. Hauv cov khw muag tshuaj, koj tsuas yog nrhiav kev npaj ntawm kev tsim kho caj ces, kev tsim khoom ntawm cov nyiaj no yog ua raws cov kev hloov pauv ntawm cov khoom lag luam xa mus rau lub cell ntawm microorganism.

Rau lub hom phiaj no, cov poov xab lossis hom tsis-pathogenic ntawm cov kab mob ntawm Escherichia coli tau siv. Vim li ntawd, cov kab mob me me yuav pib tsim cov tshuaj insulin rau tib neeg.

Qhov sib txawv ntawm tag nrho cov cuab yeej siv tshuaj muaj nyob niaj hnub no yog:

• nyob rau hauv lub sijhawm ntawm kev sib kis, ua yeeb yam ntev ntev, ua yeeb yam luv luv insulin thiab luv luv ua yeeb yam insulin.
• hauv cov amino acid kab sab.

Kuj tseem muaj cov tshuaj sib ntxiv hu ua "sib tov", lawv muaj ob qho kev ua yeeb yam ntev thiab luv luv insulin. Txhua hom 5 tshuaj insulin yog siv rau lawv qhov laj thawj.

Luv luv ua yeeb yam insulin

Cov tshuaj insulins luv luv, qee zaum ultrashort, yog kev daws teeb meem ntawm crystalline zinc-insulin nyob rau hauv cov nyom nrog qhov nruab nrab pH yam. Cov peev nyiaj no muaj cov nyhuv sai, txawm li cas los xij, cov nyhuv ntawm cov tshuaj muaj sia nyob tsis ntev.

Raws li txoj cai, cov tshuaj no yog muab tshuaj subcutaneously 30-45 feeb ua ntej noj mov. Cov tshuaj zoo sib xws tuaj yeem muab rau ob qho tib si ua intramuscularly thiab intravenously, zoo li cov tshuaj insulin ntev ntev.

Thaum cov neeg sawv cev ultrashort nkag mus rau hauv cov hlab ntshav, ntshav plasma qab zib theem poob qis, cov nyhuv tuaj yeem pom tom qab 20-30 feeb.

Tsis ntev cov ntshav yuav tshem tawm cov tshuaj, thiab cov tshuaj hormones xws li catecholamines, glucagon thiab STH yuav nce cov piam thaj hauv qib thawj.

Nrog kev ua txhaum ntawm kev tsim cov tshuaj tiv thaiv kev tiv thaiv kab mob hauv lub cev, cov ntshav qab zib hauv lub cev tsis nce ntxiv rau ob peb teev tom qab kev txhaj tshuaj ntawm cov tshuaj, vim tias nws muaj feem cuam tshuam rau lub cev thiab tom qab tshem tawm los ntawm cov ntshav.

Kev ua yeeb yam luv-luv yuav tsum tau txhaj rau txoj hlab ntshav:

1. lub sij hawm kho mob hnyav thiab mob hnyav,
2. cov neeg mob uas mob ketoacidosis,
3. yog tias lub cev hloov pauv nws qhov xav tau ntawm cov tshuaj insulin.

Hauv cov neeg mob uas muaj lub hom phiaj ruaj khov ntawm ntshav qab zib mellitus, xws li cov tshuaj no feem ntau coj los ua ke nrog cov teebmeem ntev thiab nruab nrab ntawm kev ua.

Ultrashort insulin yog tshuaj tshwj xeeb uas tus neeg mob tuaj yeem nrog nws nyob hauv cov khoom siv tshwj xeeb metering.

Txhawm rau them tus nqi xa tawm khoom, cov khoom lag luam muag tau siv. Qhov no tsis pub muaj cov insulin rau cov kab mob hauv qab cov tawv nqaij hauv lub raj yas thaum lub sijhawm tswj hwm qeeb.

Niaj hnub no, qhov hormone ntawm luv luv cawv tau nthuav tawm nyob rau hauv daim ntawv ntawm hexamers. Cov lwg me ntawm cov tshuaj no yog cov polymers. Hexamers maj mam nqus, uas tsis pub kom mus txog theem ntawm cov tshuaj insulin hauv cov ntshav ntawm tus neeg noj qab haus huv tom qab noj mov.

Qhov xwm txheej no yog pib ntawm kev tsim khoom ntawm cov khoom hluav taws xob npaj uas sawv cev:

Ntau qhov chaw sim kuaj mob tau ua, vim li no, cov cuab yeej ua haujlwm zoo tshaj plaws, cov npe nrov tshaj plaws

Cov hom insulin no nqus los ntawm daim tawv nqaij 3 zaug sai dua piv rau tib neeg cov insulin. Qhov no ua rau muaj qhov tseeb tias qib siab ntawm cov insulin hauv ntshav nce mus txog sai, thiab cov tshuaj rau txo qis qis hauv qabzib sai dua.

Nrog cov kev qhia ntawm kev npaj semisynthetic 15 feeb ua ntej noj mov, cov nyhuv yuav zoo tib yam li txhaj tshuaj insulin rau ib tug neeg 30 feeb ua ntej noj mov.

Cov tshuaj hormones no dhau ntawm cov cawv sai dhau los muaj xws li lyspro-insulin. Nws yog ib qho muab tso ntawm tib neeg cov tshuaj insulin tau los ntawm kev sib pauv hloov proline thiab lysine hauv 28 thiab 29 B chains.

Raws li nyob rau hauv tib neeg insulin, hauv kev npaj cov khoom tsim, lyspro-insulin muaj nyob rau hauv daim ntawv ntawm hexamers, txawm li cas los xij, tom qab tus neeg sawv cev nkag mus rau tib neeg lub cev, nws hloov mus rau hauv monomers.

Vim li no, lipro-insulin muaj cov nyhuv sai, tab sis cov nyhuv kav tau ib lub sijhawm luv. Lipro-insulin yeej hauv kev sib piv nrog lwm cov tshuaj ntawm hom no rau cov yam hauv qab no:

• ua rau nws tuaj yeem txo qhov kev hem thawj ntawm kev mob ntshav qab zib los ntawm 20-30%,
• tuaj yeem txo cov tshuaj A1c glycosylated hemoglobin, uas qhia tau hais tias muaj kev kho mob ntshav qab zib kom tau txais txiaj ntsig.

Kev tsim cov tshuaj tiv thaiv aspart, ib qho tseem ceeb tau muab rau hloov pauv thaum aspartic acid hloov los ntawm Pro28 hauv txoj saw B. Raws li nyob rau hauv lyspro-insulin, cov tshuaj no, nkag mus rau hauv tib neeg lub cev, tau tawg sai sai rau hauv monomers.

Pharmacokinetic cov yam ntxwv ntawm cov tshuaj insulin

Hauv cov ntshav qab zib mellitus, cov yam ntxwv ntawm pharmacokinetic ntawm cov tshuaj insulin tuaj yeem sib txawv. Lub sijhawm siab tshaj plaws ntawm ntshav ntshav insulin thiab cov txiaj ntsig zoo tshaj plaws ntawm kev txo qis qab zib tuaj yeem sib txawv 50%. Qee qhov ntau ntawm cov kev hloov pauv nyob ntawm qhov sib txawv ntawm kev sib txig ntawm cov tshuaj los ntawm cov nqaij mos. Tseem, lub sijhawm rau cov insulin ntev thiab luv yog txawv heev.

Qhov muaj zog tshaj plaws yog cov tshuaj hormones ntawm qhov nruab nrab thiab ua kom ntev ntev. Tab sis tsis ntev los no, cov kws txawj pom tau tias cov tshuaj yeeb-luv luv muaj cov khoom qub.

Ua raws li cov tshuaj insulin, nws yog ib qho tsim nyog yuav tsum tau txhaj tshuaj lub cev ntev mus rau hauv cov nqaij mos. Qhov no kuj tseem siv tau rau cov neeg mob uas tsis tuaj yeem txo cov ntshav qabzib hauv plasma vim tias kev noj zaub mov noj thiab tshuaj uas muaj suab thaj tsawg dua, nrog rau cov poj niam muaj ntshav qab zib thaum cev xeeb tub, cov neeg mob uas muaj qhov mob ua rau lub hauv paus pacreatectomy. Ntawm no peb tuaj yeem hais tias lawv tsis ib txwm muab cov txiaj ntsig kev cia siab.

Kev kho mob Insulin yog qhov tsim nyog rau cov kab mob xws li:

1. hyperosmolar coma,
2. mob ketoacidosis,
3. tom qab phais mob rau cov neeg mob ntshav qab zib,
4. thaum kho cov tshuaj insulin pab ua rau cov piam thaj hauv ntshav ntau dua li qub,
5. tshem tawm ntawm lwm cov teeb meem metabolic.

Qhov txiaj ntsig zoo tshaj plaws tuaj yeem ua tiav nrog cov txheej txheem kho mob nyuaj:

Txhua hnub xav tau cov tshuaj insulin

Tus neeg muaj kev noj qab haus huv thiab lub cev zoo ua tau 18-40 units nyob rau ib hnub, lossis 0.2-0.5 units / kg ntawm insulin ntev. Txog ib nrab ntawm cov ntim no yog lub plab zom mov, qhov seem yog dhau los tom qab noj mov.

Qhov tshuaj lom neeg tsim tawm 0.5-1 units nyob rau ib teev. Tom qab cov piam thaj nkag mus rau hauv cov ntshav, qhov qog hormone tso tawm nce mus txog 6 units nyob rau ib teev.

Cov neeg uas rog dhau thiab muaj kev tiv thaiv insulin uas tsis raug kev mob ntshav qab zib muaj 4 zaug sai dua cov insulin ntau lawm tom qab noj mov. Muaj kev sib txuas ntawm cov tshuaj tsim los ntawm lub pob qhov rooj ntawm lub siab, qhov chaw ib qho raug rhuav tshem thiab tsis ncav cuag cov hlab ntshav.

Hauv cov neeg mob ntawm hom 1 mob ntshav qab zib mellitus, kev xav tau txhua hnub rau qhov tshuaj insulin yog txawv:

1. Feem ntau, qhov ntsuas no txawv ntawm 0.6 txog 0.7 units / kg.
2. Nrog rau qhov hnyav dhau, qhov xav tau ntawm cov tshuaj insulin nce.
3. Thaum ib tus neeg xav tau tsuas yog 0.5 units / kg hauv ib hnub, nws muaj cov tshuaj hormones txaus los yog lub cev zoo.

Qhov xav tau rau cov tshuaj insulin yog ntawm 2 hom:

Ib nrab ntawm cov kev xav tau niaj hnub nyob ntawm daim foos. Qhov no cov kab ke no koom tes hauv kev tiv thaiv kev rhuav tshem cov piam thaj hauv lub siab.

Hauv tsab ntawv tom qab kev pom zoo, qhov xav tau txhua hnub yog muab los ntawm kev hno ua ntej noj mov.Qhov tshuaj hormones no txuam nrog kev nqus ntawm cov as-ham.

Ib hnub ib zaug, tus neeg mob tau txhaj koob tshuaj insulin nrog lub sijhawm ua haujlwm nruab nrab, lossis tus neeg sawv cev sib xyaw ua ke yog muab cov tshuaj insulin nrog lub sij hawm luv luv ntawm cawv thiab ib nrab-ntev li cov tshuaj hormones. Txhawm rau tswj cov glycemia hauv ib qib, qhov no yuav tsis txaus.

Tom qab ntawd cov txheej txheem kev kho mob yog siv ntau qhov nyuaj, qhov twg ib nrab-lub sij hawm ntev insulin nrog luv luv insulin lossis luv luv ua yeeb yam nrog luv luv ua yeeb yam yog siv ua ke.

Feem ntau tus neeg mob tau kho raws li txoj kev kho kom sib xyaw, thaum nws noj ib koob thaum noj tshais, thiab ib qho noj thaum noj hmo. Cov tshuaj hormones hauv qhov no muaj cov tshuaj insulin ntawm lub sijhawm luv luv thiab nruab nrab ntev.

Thaum tau txais koob tshuaj thaum yav tsaus ntuj ntawm cov tshuaj HHH lossis tshuaj insulin, daim kab xev tsis muab qib uas yuav tsum tau ntawm glycemia thaum hmo ntuj, tom qab ntawd cov tshuaj txhaj tau muab faib ua 2 ntu: ua ntej noj hmo, tus neeg mob tau txhaj tshuaj insulin luv luv, thiab ua ntej yuav mus pw, lawv tau muab NPH insulin lossis insulin daim kab xev.

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H ib txwm cwj mem (Berlinsulin H ib txwm cwj mem), Berlsulin H ib txwm U-40 (Berlinsulin H ib txwm U-40), Insuman sai (Insuman sai), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Kev cuam tshuam ntawm tib neeg cov insulin nrog lwm yam tshuaj yeeb dej caw

Cov nyhuv hauv hypoglycemic ntawm tib neeg insulin raug txo los ntawm glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisone thiab lwm tus), amphetamines, adrenocorticotropic hormone, flucrocortisone, calcium channel blockers, estrogens, baclofen, heparin, levothyroxine sodium, gine diuretics (hydrochlorothiazide, indapamide thiab lwm tus), amprenavir, danazol, isoniazid, diazoxide, lithium carbonate, chlorprotixen, sympathomimetics, nicotinic acid, beta-adrenergic agonists (piv txwv li, ritodrin, salbutamol, terbutaline thiab lwm tus), tricyclic antidepressants, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, phenothiazine derivatives. Nws yuav tsim nyog nce qhov koob tshuaj biphasic tib neeg cov tshuaj tua kab mob thaum siv nrog cov tshuaj no.
Lub hypoglycemic nyhuv ntawm tib neeg insulin ua kom nrov loj Metformin, sulfonamides, repaglinide, androgens, qhov ncauj hypoglycemic agents, testosterone, anabolic steroids, bromocriptine, disopyramide, guanethidine, monoamine oxidase inhibitors, angiotensin II receptor antagonists, carbonic anhydrase inhibitors, fluoxetine, carvedilol, fenfluramine, angiotensin converting enzyme inhibitors (captopril , enalapril thiab lwm tus), tetracyclines, octreotide, mebendazole, ketoconazole, clofibrate, theophylline, quinidine, chloroquine, non-steroid cov tshuaj tiv thaiv, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol thiab lwm tus) (npog cov tsos mob ntawm hypoglycemia, suav nrog tachycardia, ntshav siab), ethanol thiab ethanol. Tej zaum nws yuav tsim nyog los txo cov koob tshuaj ntawm ob-theem tib neeg kev tshawb fawb engineering kev tsim tawm thaum siv nrog cov tshuaj no.
Beta-blockers, clonidine, reserpine tuaj yeem ua rau pom kev tsis muaj tsos mob ntawm qog ntshav qab zib.
Tawm tsam keeb kwm ntawm atenolol (tsis zoo li tsis xaiv cov beta-blockers), cov nyhuv tsis nce siab, nws yog qhov yuav tsum ceeb toom rau tus neeg mob tias nrog kev txhim kho hypoglycemia, tachycardia thiab tshee kuj yuav tsis tuaj, tab sis txob taus, tshaib plab, xeev siab yuav tsum ua siab ntev, thiab tawm hws txawm nce ntxiv.
Qhov kev nkag siab ntawm tib neeg cov insulin hauv cov ntshav tau nce (vim tias kev nrawm nrawm ntawm nqus) cov tshuaj muaj nicotine thiab haus luam yeeb.
Tawm tsam cov keeb kwm yav dhau los ntawm octreotide, reserpine, qhov hloov pauv ntawm cov nyhuv hypoglycemic yog muaj peev xwm ua tau (ob qho tib si nthuav dav thiab ua kom tsis muaj zog), xav tau ib qho kev kho kom haum ntawm cov tshuaj insulin.
Tawm tsam keeb kwm ntawm clarithromycin, tus nqi ntawm kev rhuav tshem qeeb thiab nyob rau qee kis, qhov ua haujlwm ntawm insulin yuav nce ntxiv.
Tawm tsam keeb kwm ntawm diclofenac, cov nyhuv ntawm cov tshuaj hloov pauv, thaum siv ua ke, nws yog qhov tsim nyog los tswj qib ntawm cov piam thaj hauv cov ntshav.
Tawm tsam cov keeb kwm yav dhau los ntawm metoclopramide, uas ua kom nrawm ntawm lub plab tsis zoo, kev hloov pauv ntawm koob tshuaj lossis kev tswj hwm tshuaj insulin tej zaum yuav tsum tau ua.
Tib neeg cov tshuaj insulin yog tshuaj tsis sib haum nrog kev daws teeb meem ntawm lwm yam tshuaj.
Yog tias nws yuav tsum siv lwm yam tshuaj, ntxiv rau tib neeg cov tshuaj insulin, nws yuav tsum tau sab laj nrog kws kho mob.

Cawv tau zoo

Kev noj tshuaj insulin tsis sib haum nrog haus cawv. Cov cim ntawm kev qaug cawv yog nce ntxiv, thiab cov nyhuv ntawm cov tshuaj tau txo ntau.

Muaj ob peb ua piv txwv:

• Berlinsulin N Li qub,
• Diarapid CR,
• Insulidd
• Insulin Actrapid,
• Insuman Sai Sai,

Cia rau cov mob rau cov tshuaj

Nws muab cia rau qhov kub tsis tshaj + 25 ° C hauv qhov chaw tiv thaiv tshaj plaws los ntawm menyuam yaus. Nws raug nquahu kom tsis txhob mus ncaj qha hnub ci.

Nws yog ib qho tsim nyog kom ntseeg tau tias txoj kev daws teeb meem tsis poob nws cov kev pom tseeb, thiab tsis muaj cov ntaub ntawv pov thawj nyob hauv qab. Yog tias qhov no tshwm sim, tom qab ntawd cov tshuaj tsis tuaj yeem siv.

Chaw tsim tshuaj paus

Muaj ntau ntau lub koomhaum uas tsim cov tshuaj insulin:

• Sanofi (Fabkis),
• NovoNordisk (Denmark),
• EliLilly (USA),
• Kws muag tshuaj OJSC (Russia),
• Lub teb chaws Biotechnology OJSC (Russia).

Lub luag haujlwm ntawm insulin hauv lub cev tsis tsim nyog rau kev ua haujlwm ntau dhau. Ib qib twg ntawm cov tshuaj insulin yog fraught nrog ib qho kab mob endocrine loj - ntshav qab zib. 40 xyoo dhau los, cov neeg mob ntshav qab zib nyob tsis tau ntau dua 10-15 xyoos.

Cov tshuaj niaj hnub siv cov feem ntau haum soluble tib neeg cov kev sib xyaw ua ntej tsim cov tshuaj insulin los ua kom cov ntshav ntshav qabzib hauv lub cev ntau dua. Ua tsaug rau cov tshuaj no, ntshav qab zib tau tas ib kab lus, muab txoj kev mob rau cov neeg mob kom tau ib lub neej thiab muaj sia ntev ntev.

Cov Yuav Tsum Muaj

• ntshav qab zib,
• tus kheej tsis kam lees lossis tso tshuaj lom rau qhov sib xyaw ntawm cov tshuaj.

Cov contraindications no yuav tsum raug xam tias ua ntej pib kev kho mob.

Yuav ua li cas noj tib neeg cov tshuaj insulin

Qhov ntau npaum li cas thiab cov kev coj noj coj ua ntawm kev txiav txim siab ncaj qha tau txiav txim siab tsuas yog ua tiav ntawm cov ntshav nruab nrab ntawm cov ntshav qab zib, thiab tom qab ntawd 2 teev tom qab noj mov. Ntxiv rau, qhov kev txais tos nyob ntawm qhov mob hnyav ntawm kev txhim kho glucosuria.

Feem ntau cov feem ntau, subcutaneous tswj hwm. Ua nws 15 feeb ua ntej noj mov loj. Yog hais tias muaj ntshav qab zib mob ketoacidosis lossis rov qab zoo li qub, txhaj tshuaj insulin yog txhaj rau cov dav hlau, ib txwm tso leeg lossis mus rau hauv cov nqaij gluteus, ua ntej kev phais mob.

Nws raug nquahu kom siv tshuaj tsawg kawg 3 zaug hauv ib hnub. Txhawm rau kom tsis txhob muaj cov pleev lipodystrophy, koj tsis tuaj yeem quav yeeb tshuaj rau ntawm qhov qub chaw. Tom qab ntawd tsis pom dab tsi ntawm cov rog subcutaneous rog.

Qhov nruab nrab ntawm cov neeg laus ib hnub tau txhaj yog 40 units, thiab rau cov menyuam yaus nws yog 8 units. Cov cai ntawm cov thawj coj yog 3 zaug hauv ib hnub. Yog tias muaj qhov xav tau ntawd, koj tuaj yeem tso cov tshuaj insulin txog 5 zaug.

Kev phiv los ntawm tib neeg cov insulin

Thaum siv, cov kev mob tshwm sim hauv qab no feem ntau txhim kho:

• kev tsis haum tshuaj: urticaria, Quincke's edema,
• txog siav siav ceev ceev, cia li poob siab hauv lub siab,
• Kev mob ntshav qab zib: nce tawm hws, pallor ntawm daim tawv nqaij, tshee tshee thiab kev siv lub zog ntau dhau, kev tshaib kev nqhis, nce siab ntawm lub cev, pw tsis tsaug zog, mob taub hau, ntau lub siab thiab nkees, tsis pom kev thiab hais lus, mob pob txha ntsej muag,
• hypoglycemic coma,
• hyperglycemia thiab acidosis: lub qhov ncauj qhuav tas li, qhov ploj ploj tsis qab los, ua pob liab ntawm daim tawv nqaij ntawm lub ntsej muag,
• tsis nco qab zoo
• tsis pom kev
• khaus thiab o nyob rau hauv qhov chaw uas muab tshuaj rau,
• cov tsos ntawm o ntawm lub ntsej muag thiab nqua, qhov kev ua txhaum ntawm qhov tsis kam.

Cov kev xav zoo li no tsuas yog ib ntus xwb thiab tsis tas yuav siv ib qho tshuaj dab tsi hlo li. Lawv dhau mus qeeb tom qab tshem tawm cov nyiaj.

Cuam tshuam rau lub peev xwm los tswj cov tshuab

Nrog txoj kev kho insulin, ib qho kev ua txhaum qee yam ntawm qee qhov kev xav thiab cov kev xav tsis meej yuav ua tau. Yog li ntawd, nws zoo dua kom tsis txhob tsav nws tus kheej tsav tsheb thiab cov tshuab hnyav.

Cov lus qhia tshwj xeeb

Ua ntej koj sau cov tshuaj los ntawm lub raj mis, koj yuav tsum twv xyuas nws kom pom tseeb. Yog tias muaj qhov pom sai sai, cov tshuaj no yuav tsum tsis txhob noj.

Cov koob tshuaj cov kua dej yuav hloov kho rau cov kev pathologies:

• kis kab mob
• malfunctioning ntawm lub qog gland,
• Addison's disease
• Kev Ua Siab Ncaj
• mob ntshav qab zib rau cov neeg laus.

Feem ntau, kev tshwm sim ntawm kev mob ntshav qab zib tsawg. Txhua tus tuaj yeem ua rau los ntawm kev noj ntau dhau, hloov pauv qhov tseeb ntawm cov kua dej los ntawm tib yam keeb kwm nrog tib neeg, kev tshaib plab, nrog rau mob raws plab, ntuav thiab lwm cov tsos mob ntawm intoxication. Kev mob ntshav qab zib me me tuaj yeem nres los ntawm kev noj suab thaj.

Yog tias cov phiaj xwm me ntsis uas qhia hauv lub qog ntshav qab zib tsawg dua, koj yuav tsum hu rau tus kws kho mob tshwj xeeb. Muaj qee qhov mob me, kev hloov kho ntau dua tuaj yeem pab tau. Hauv cov xwm txheej hnyav dua, kev siv tshuaj tua kab mob ua kom tshem tawm. Tau zuaj ib zaug, yuav tsum ua tag nrho kev noj tshuaj lossis tshuaj kho mob hloov.

Nws yuav tsum nco ntsoov tias nyob rau thaj tsam ntawm kev tswj hwm ncaj qha, kev ua haujlwm ntawm subcutaneous rog tuaj yeem tshwm sim. Tab sis qhov no tuaj yeem zam kom dhau los hloov chaw rau kev txhaj tshuaj.

Siv thaum cev xeeb tub thiab lactation

Kev tswj cov qib qab zib hauv lub cev ntawm tus poj niam cev xeeb tub yog qhov tseem ceeb. Hauv thawj peb lub hlis, xav tau cov ntshiab insulin tsawg dua, thiab thaum kawg ntawm lub sijhawm nws nce.

Thaum lub sijhawm pub mis niam, tus pojniam yuav xav tau qee yam kev kho ntawm cov tshuaj insulin thiab kev noj zaub mov tshwj xeeb.

MP tsis muaj kev hloov pauv ntawm cov tshuaj cev cev thiab cov tshuaj lom tsis haum rau lub cev.

Daim ntawv thov rau lub raum khiav tsis zoo

Yog tias tus neeg mob tau lub raum pathologies, nws yuav tsim nyog los kho lub khob ntawm cov tshuaj insulin.

Daim ntawv thov rau lub siab ua haujlwm tsis zoo

Nrog kev ceev faj, cov neeg muaj lub siab pathologies yuav tsum noj cov tshuaj. Ntawm qhov kev hloov me me hauv daim siab ua piv txwv, nws raug nquahu kom kho qhov tsuas tshuaj.

Noj ntau dhau

Overdose cov tsos mob yuav tshwm sim ntau:

• mob ntshav qab zib - tsis muaj zog, tawm hws ntau dhau, pallor ntawm daim tawv nqaij, tshee tshee ntawm qhov kawg, tshee tshee, tshaib plab,
• hypoglycemic coma nrog mob syndrome.

Cov kev kho mob yog feem ntau cov tsos mob. Cov ntshav qog ntshav qis yuav dhau mus tom qab siv cov zaub mov muaj piam thaj lossis carbohydrate.

Cov ntshiab glucagon tau txhaj tshuaj kom nres cov tsos mob ntawm kev haus luam yeeb heev. Thaum lub sijhawm tsis nco qab sai zuj zus, txog li 100 ml ntawm qhov kev daws teeb meem uas tau txhaj tshuaj txo qis kom txog thaum tus neeg mob hnyav tawm hauv lub cev tsis xeev.

Kev cuam tshuam nrog lwm yam tshuaj

Ib qho kev daws teeb meem ntawm cov kua tshuaj insulin yog nruj me ntsis txwv tsis pub coj los ua ke nrog lwm cov kev txhaj tshuaj. Lub ntsiab hypoglycemic tsuas yog txhim kho thaum siv ua ke nrog qee yam sulfonamides, MAO inhibitors, anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine thiab qee qhov beta-blockers kuj txhim kho cov nyhuv ntawm cov tshuaj.

Cov nyhuv hauv lub ntsej muag tsis muaj zog thaum noj nrog cov tshuaj loj ntawm cov thyroid, txwv tsis pub muaj, glucagon, estrogens, heparin, ntau yam sympathomimetics, qee cov tshuaj tiv thaiv kab mob, antagonists ntawm calcium, morphine thiab nicotine.

Ambiguously cuam tshuam cov tshuaj insulin rau ntawm qhov nqus ntawm glucose beta-blocker, reserpine thiab pentamidine.

Cawv tau zoo

Kev noj tshuaj insulin tsis sib haum nrog haus cawv. Cov cim ntawm kev qaug cawv yog nce ntxiv, thiab cov nyhuv ntawm cov tshuaj tau txo ntau.

Muaj ob peb ua piv txwv:

• Berlinsulin N Li qub,
• Diarapid CR,
• Insulidd
• Insulin Actrapid,
• Insuman Sai Sai,

Cov Cai Nyiaj So Tsev Khw

Tib neeg cov tshuaj insulin tuaj yeem tsuas yuav hauv cov chaw muag tshuaj tshwj xeeb.

Kuv tuaj yeem yuav yam tsis tas yuav tshuaj

Muag los ntawm daim ntawv qhia tshwj xeeb.

Tus nqi nyob ntawm lub tsev muag tshuaj npoo thiab tus naj npawb ntawm cov hwj nyob hauv pob. Tus nqi nruab nrab ntawm 500 txog 1700 rubles.

Cia rau cov mob rau cov tshuaj

Nws muab cia rau qhov kub tsis tshaj + 25 ° C hauv qhov chaw tiv thaiv tshaj plaws los ntawm menyuam yaus. Nws raug nquahu kom tsis txhob mus ncaj qha hnub ci.

Nws yog ib qho tsim nyog kom ntseeg tau tias txoj kev daws teeb meem tsis poob nws cov kev pom tseeb, thiab tsis muaj cov ntaub ntawv pov thawj nyob hauv qab. Yog tias qhov no tshwm sim, tom qab ntawd cov tshuaj tsis tuaj yeem siv.

Hnub tas sij hawm

Khaws qhib lub raj mis siv tau tsuas yog 30 hnub. Tom qab lub sijhawm no, cov tshuaj raug pov tseg.

Chaw tsim tshuaj paus

Muaj ntau ntau lub koomhaum uas tsim cov tshuaj insulin:

• Sanofi (Fabkis),
• NovoNordisk (Denmark),
• EliLilly (USA),
• Kws muag tshuaj OJSC (Russia),
• Lub teb chaws Biotechnology OJSC (Russia).

Lub luag haujlwm ntawm insulin hauv lub cev tsis tsim nyog rau kev ua haujlwm ntau dhau. Ib qib twg ntawm cov tshuaj insulin yog fraught nrog ib qho kab mob endocrine loj - ntshav qab zib. 40 xyoo dhau los, cov neeg mob ntshav qab zib nyob tsis tau ntau dua 10-15 xyoos.

Cov tshuaj niaj hnub siv cov feem ntau haum soluble tib neeg cov kev sib xyaw ua ntej tsim cov tshuaj insulin los ua kom cov ntshav ntshav qabzib hauv lub cev ntau dua. Ua tsaug rau cov tshuaj no, ntshav qab zib tau tas ib kab lus, muab txoj kev mob rau cov neeg mob kom tau ib lub neej thiab muaj sia ntev ntev.

Vim li cas cov tshuaj insulin hu ua "txhob kaw ntau ntxiv"

Qee cov neeg mob ntshai ntawm lub sijhawm "tsim kho txhob kaw," lawv hais txog "GMOs siab phem."

Qhov tseeb, nws yog qhov tsim muaj ntawm cov tshuaj no uas cawm ntau lab tus tib neeg ntawm cov neeg mob ntshav qab zib.

Thaum pib, cov kws kho mob siv cov tshuaj insulin cais tawm ntawm cov tsiaj (feem ntau yog npua thiab nyuj). Txawm li cas los xij, qhov kev loj hlob no tsis tsuas yog txawv teb chaws rau tib neeg, tab sis kuj tseem nkag rau hauv cov hlab ntshav, ua rau cov ntshav qabzib thiab ua ntau yam teeb meem.

Cov tshuaj insulin tau tsim kho rau hauv txhua qhov kev xav tau ntawm tus neeg mob ntshav qab zib, tshem tawm cov kev tsis haum tshuaj. Tom qab qhov kawg ntawm nws qhov kev txiav txim, nws tawg cia rau hauv cov amino acids zoo tib yam thiab nws tau tawm ntawm lub cev.

Cov khoom siv yooj yim

Solulin tib neeg cov kua dej yog hais txog luv luv ua yeeb yam insulin hloov yeeb tshuaj.

Ua ke nrog cov xovtooj ntawm phab ntsa receptor, cov tshuaj tsim cov tshuaj insulin receptor complex uas ua rau cov txheej txheem ua haujlwm:

1. Kev rho tawm ntawm cov enzymes rau kev ua tiav thiab nqus tau cov piam thaj los ntawm cov ntaub so ntswg,
2. Kev nce nyob rau hauv kev thauj thiab tso ntshav qab zib,
3. Tsawg tus nqi ntawm glycogen tsim nyob rau hauv daim siab,
4. Txhawb kev tsim cov protein thiab cov rog.

Nrog kev tswj hwm ntawm subcutaneous, cov tshuaj pib ua tom qab 20-30 feeb, mus txog nws qhov siab tshaj plaws hauv 1-3 teev, kav ntev txog 5-8 teev.

Cov tshuaj no tau muab faib rau qhov sib txawv ntawm cov ntaub so ntswg: piv txwv li, nws tsis nkag rau hauv qhov chaw tiv thaiv kab mob thiab tsis kis mus rau niam mis. Tom qab qhov kawg ntawm nws txoj kev txiav txim, tib neeg cov kua dej tawm sab nraud los ntawm lub raum (li 80%) tom qab nws rhuav tshem los ntawm insulinase.

Kev ntsuas rau siv

Feem ntau, cov kws kho mob tshaj tawm cov tshuaj insulin thaum muaj:

Cov Yuav Tsum Muaj

Cov tshuaj no feem ntau ua rau lub cev tiv thaiv zoo, vim tias nws tsis txawv ntawm lub ntuj pancreatic enzyme.

Contraindicated rau kev siv cov tshuaj insulin hauv:

• Txo cov ntshav qabzib (hypoglycemia),
• Ua kom lub cev nkag mus rau cov tshuaj insulin.

Kev xaiv thiab ntau npaum cov kev xaiv

Qhov koob tshuaj thiab cov txheej txheem ntawm kev tswj hwm tib neeg cov tshuaj insulin yog ib txwm txiav txim siab los ntawm tus neeg endocrinologist, coj mus rau hauv tus account tsim nyog ntsuas ntawm cov ntshav qabzib thiab zis ntawm tus neeg mob.

Cov tshuaj no muab rau hauv ntshav qab zib ua ntau txoj hauv kev: subcutaneously (s / c), intramuscularly (i / m) lossis tso ntshav (i / v). Ntau zaus, cov insulin raug tswj xyuas subcutaneously. Ua qhov no, siv thaj chaw:

Cov tshuaj no feem ntau tau txhaj tshuaj rau hauv kev mob hnyav los ntawm kev mob ntshav qab zib: ketoacidosis, mob ntshav qab zib coma.

Nws raug nquahu kom siv cov tshuaj insulin 15-30 feeb ua ntej noj mov, 3 zaug hauv ib hnub. Qee zaum 5-6 ib zaug kev tswj hwm ntawm cov tshuaj raug tso cai.

Cov tshuaj insulin feem ntau yog xam hauv ib qho kev faib tawm ntawm 0.5-1 units rau 1 kg ntawm qhov hnyav. Yog tias cov tshuaj insulin raug tshuaj ntau dua 0.6 mg rau ib kg ntawm lub cev qhov hnyav, ces cov tshuaj yuav tsum raug noj tsawg kawg 2 zaug hauv ib hnub. Qhov nruab nrab, cov tshuaj txhua hnub yog li 30-40 units (hauv cov menyuam yaus, 8 units).

Cov poj niam cev xeeb tub feem ntau yog tshuaj rau 0.6 PIECES ib kg ntawm qhov hnyav. Kev txhaj tshuaj feem ntau tsim 3-5 zaug hauv ib hnub, raws li tus naj npawb ntawm cov zaub mov.

Feem ntau, cov tshuaj insulin sai ua ke nrog cov insulin ntev dua.