Cov lus qhia rau kev siv tshuaj, tshuaj yeeb dawb, tshuaj xyuas

Glulin insulin yog qhov ua rau tib neeg siv tshuaj insulin. Cov tshuaj insulin glulisin yog sib npaug hauv lub zog rau tib neeg insulin. Nrog rau kev tswj hwm ntawm subulinaneous ntawm insulin, glulisin pib ua sai dua thiab muaj lub sijhawm luv luv ntawm kev txiav txim siab tshaj soluble tib neeg cov kua dej. Hauv cov tshuaj insulin glulisin, cov amino acid asparagine ntawm tib neeg insulin ntawm txoj haujlwm B3 yog hloov los ntawm lysine, thiab cov amino acid lysine ntawm txoj haujlwm B29 yog hloov los ntawm glutamic acid, uas ua rau kom sai dua ntawm cov tshuaj. Kev siv tshuaj insulin glulisin, zoo li insulin thiab lwm yam insulin analogues, tswj hwm kev ua haujlwm ntawm cov ntshav qabzib, uas yog qhov kev txiav txim siab tseem ceeb tshaj plaws. Cov tshuaj insulin glulisin txo cov ntshav qabzib hauv cov ntshav ntshav los ntawm kev ua kom nws nqus los ntawm cov ntaub so ntswg, tshwj xeeb tshaj yog cov leeg pob txha thiab cov nqaij adipose, nrog rau inhibiting nws tsim hauv daim siab. Cov tshuaj insulin glulisin tsub kom cov protein synthesis thiab inhibits adipocyte lipolysis, proteolysis. Hauv cov kev tshawb fawb uas tau ua rau cov neeg ua haujlwm noj qab haus huv thiab cov neeg mob ntshav qab zib mellitus, nws tau qhia tias insulin glulisin, thaum muab tshuaj subcutaneously, pib ua haujlwm sai dua thiab tseem muaj lub sijhawm luv luv ntawm kev nqis tes ua dua li kev tiv thaiv tib neeg cov kua dej. Nrog kev tswj hwm ntawm subcutaneous, cov nyhuv hypoglycemic ntawm insulin glulisin pib hauv 10 txog 20 feeb. Qhov teebmeem hypoglycemic ntawm insulin glulisin thiab solulin tib neeg cov kua dej thaum muab cov tshuaj ua kom sib luag yog qhov sib luag hauv lub zog. Ib qho glulisin insulin chav tsev muaj tib qhov kev ua haujlwm hauv hypoglycemic raws li ib qho soluble tib neeg insulin chav tsev.
Hauv kev tshawb fawb thawj-qib hauv cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus, hypoglycemic profiles ntawm insulin glulisin thiab soluble tib neeg insulin raug piv, uas tau muab tshuaj subcutaneously ntawm koob tshuaj ntawm 0.15 U / kg ntawm lub sijhawm sib txawv ntawm tus qauv noj zaub mov kaum tsib feeb. Nws tau qhia tias cov tshuaj insulin glulisin, uas tau siv ob feeb ua ntej noj mov, tau muab tib yam glycemic tswj tom qab noj mov ib yam li soluble tib neeg cov tshuaj insulin, uas tau siv ib nrab ib teev ua ntej noj mov. Glulisin insulin, uas tau siv ob feeb ua ntej noj mov, tau tswj cov glycemic zoo dua tom qab noj mov dua soluble tib neeg cov tshuaj insulin, kuj tau siv ob feeb ua ntej noj mov. Glulisin insulin, uas tau siv 15 feeb tom qab pib noj mov, tau muab tib yam glycemic tswj tom qab noj mov raws li cov tib neeg solulin, uas tau siv ob feeb ua ntej noj mov.
Hauv kev tshawb fawb ntawm thawj theem, uas tau ua nrog insulin glulisin, soluble tib neeg insulin, thiab lyspro insulin hauv ib pawg ntawm cov neeg mob rog, nws tau pom tias hauv cov neeg mob ntawm pab pawg no, insulin glulisin khaws nws cov yeeb yam ua haujlwm sai.
Hauv qhov kev tshawb fawb no, lub sijhawm mus txog 20% ntawm tag nrho thaj tsam hauv qab qhov chaw muag tshuaj pharmacokinetic nkhaus-sijhawm nkhaus yog 114 feeb rau insulin glulisin, 150 feeb rau soluble tib neeg insulin, 121 feeb rau lispro insulin, thiab thaj chaw hauv qab pharmacokinetic concentration-nkhaus yog lub sijhawm (hauv thawj ob teev ), uas hais txog thaum ntxov hypoglycemic kev ua si, yog 427 mg / kg rau insulin glulisin, 197 mg / kg rau solulin tib neeg cov tshuaj insulin, 354 mg / kg rau insulin lispro.
Hauv theem-3 cov chaw sim mus ntev ntev li 26 lub lis piam uas piv rau insulin glulisin thiab insulin lispro muab tshuaj subcutaneously 0 txog 15 feeb ua ntej noj mov, cov neeg mob ntshav qab zib hom 1 uas siv tshuaj insulin glargine, insulin glulisin thiab insulin lispro li basal insulin. tau sib piv nyob rau hauv cov nqe lus ntawm kev tswj glycemic, txiav txim siab los ntawm kev hloov pauv hauv theem ntawm glycosylated hemoglobin thaum lub sijhawm kawg ntawm qhov kawg ntawm kev kawm thaum piv nrog cov txiaj ntsig. Muaj cov nqi sib piv ntawm cov ntshav dej muaj qabzib, uas tau txiav txim los ntawm kev ntsuas tus kheej. Thaum siv cov tshuaj insulin glulisin, tsis zoo li kev siv tshuaj insulin nrog lyspro, kev nce ntxiv ntawm cov koob tshuaj insal basal tsis tas yuav ua.
Kev soj ntsuam kab mob thib peb, uas tau ncua 12 lub lis piam rau cov neeg mob ntshav qab zib hom 1 uas tau txais insulin glargine ua kev kho mob, qhia tawm tias cov tshuaj insulin glulisin tam sim ntawd tom qab noj mov tau muab piv rau qhov ntawd nrog insulin glulisin rau 0-15 feeb ua ntej noj mov los yog thaum siv cov tshuaj lom neeg insulin 30 rau 45 feeb ua ntej noj mov.
Hauv cov pejxeem ntawm cov neeg mob uas ua txoj kev tshawb no, nyob rau hauv pab pawg ntawm cov neeg mob uas tau txais insulin glulisin ua ntej noj mov, qhov kev poob qis ntau dua glycosylated hemoglobin tau pom thaum piv nrog pab pawg ntawm cov neeg mob uas tau txais insulin tib neeg.
Ib theem III kev soj ntsuam mus ntev ntev 26 lub lis piam, tom qab kev tshawb fawb txog kev nyab xeeb tau ntev txog 26 lub lis piam, tau siv los sib piv insulin glulisin (thaum siv sijhawm 0-15 feeb ua ntej noj mov) thiab tib neeg cov tshuaj insulin. (thaum muab 30 rau 45 feeb ua ntej noj mov), uas tau ua haujlwm subcutaneously rau cov neeg mob uas muaj ntshav qab zib hom 2 thiab qhov nruab nrab ntawm lub cev nruab nrab ntawm 34.55 kg / m2, ntxiv rau kev siv tshuaj insulin-isophan raws li kev kho mob hauv paus. Glulisin insulin tau piv rau soluble tib neeg insulin nrog kev hloov pauv hauv glycosylated hemoglobin ntau tom qab 6 lub hlis ntawm kev kho mob piv nrog tus nqi pib (0.46% rau glulisin insulin thiab 0.30% rau soluble tib neeg insulin) thiab tom qab 1 xyoo ntawm kev kho mob thaum piv nrog tus nqi pib (0.23% rau insulin glulisin thiab 0.13% rau soluble tib neeg insulin). Hauv txoj kev tshawb fawb no, ntau tus neeg mob (79%) tau sib xyaw lawv cov tshuaj insulin luv luv nrog isulin insulin tam sim ua ntej tswjhwm. 58 cov neeg mob thaum lub sijhawm xaiv rau txoj kev tshawb no siv cov tshuaj hypoglycemic qhov ncauj thiab tau txais cov lus qhia los txuas ntxiv lawv cov kev tswj hwm hauv ib qho tshuaj tsis hloov.
Thaum lub sijhawm ua haujlwm tsis tu ncua ntawm cov tshuaj insulin siv cov twj tso kua mis hauv 59 cov neeg mob ntshav qab zib hom 1 uas tau txais insulin glulisin lossis insulin aspart, qhov tsis tshua muaj catheter occlusion tau pom nyob hauv ob pawg kho mob (0.08 occlusions ib hlis thaum siv insulin glulisin thiab 0, 15 occlusions rau ib hlis thaum siv insulin aspart), thiab muaj kev tawm tsam tsawg ntawm qhov chaw txhaj tshuaj (10.3% thaum siv insulin glulisin thiab 13.3% thaum siv insulin aspart).
Hauv cov menyuam yaus thiab cov hluas muaj mob ntshav qab zib hom 1 mellitus, leej twg tau txais kev kho mob ob zaug ib hnub ib zaug thaum sawv ntxov thiab yav tsaus ntuj insulin isofan lossis ib hnub ib zaug nyob rau yav tsaus ntuj insulin glargine, thaum piv kev nyab xeeb thiab muaj txiaj ntsig ntawm insulin glulisin thiab insulin lispro nrog subcutaneous 15 feeb ua ntej noj mov, nws tau pom tias kev tswj glycemic, qhov tshwm sim ntawm kev mob ntshav qab zib, uas yuav tsum muaj kev cuam tshuam ntawm cov neeg thib peb, qhov xwm txheej ntawm cov ntshav qog ntshav hnyav tau sib piv hauv ob pawg kev kho. Nyob rau tib lub sijhawm, tom qab 26 lub lis piam ntawm kev kho, cov neeg mob uas siv insulin glulisin kom ua tiav glycemic tswj kev sib piv nrog glycemic tswj ntawm insulin lispro xav tau ib qho kev nce qis hauv kev noj tshuaj insulin txhua hnub rau kev kho mob basal, kev siv tshuaj insulin sai thiab tag nrho cov koob tshuaj insulin.
Hauv kev tswj xyuas cov chaw kho mob hauv cov neeg laus cov neeg mob, qhov sib txawv ntawm kev ua tau zoo thiab kev nyab xeeb ntawm insulin glulisin tsis tau pom nyob rau hauv kev tshawb xyuas ntawm pawg neeg tsawg uas tau paub meej los ntawm poj niam txiv neej thiab haiv neeg.
Thaj chaw ntawm pharmacokinetic concentration-lub sijhawm nkhaus ntawm insulin glulisin hauv cov neeg ua haujlwm pab dawb thiab cov neeg mob ntshav qab zib hom 1 thiab 2 ntshav qab zib mellitus qhia tias kev nqus ntawm insulin glulisin thaum piv nrog tib neeg cov tshuaj insulin yog li ob zaug sai dua, thiab qhov siab tshaj plaws ntshav plasma qhov ua tiav tau txog ob lub sijhawm siab dua. Hauv txoj kev tshawb nrhiav rau cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus, tom qab kev txhaj tshuaj subulinaneous ntawm insulin glulisin ntawm ib koob ntawm 0.15 U / kg, qhov siab tshaj plaws ntshav ntawm cov tshuaj tau mus txog tom qab 55 feeb thiab ncua txij li 70.7 txog 93, mcED / ml piv rau qhov siab tshaj plaws plasma concentration ntawm soluble tib neeg cov kua dej, mus txog tom qab 82 feeb thiab muaj li ntawm 44.7 txog 47.3 mkU / ml. Qhov chaw nyob nruab nrab lub sijhawm ntawm insulin glulisin nyob rau hauv cov kev ncig ua ke yog 98 feeb, uas yog luv dua thaum piv nrog tib lub ntsuas ntawm soluble tib neeg insulin ntawm 161 feeb. Hauv kev tshawb nrhiav hauv cov neeg mob uas muaj ntshav qab zib hom 2 mellitus nrog kev tswj hwm ntawm cov tshuaj insulin glulisin ntawm koob tshuaj 0.2 U / kg, qhov siab tshaj plaws nyob ntawm 78 txog 104 mcU / ml. Nrog kev tswj hwm ntawm subulinaneous ntawm insulin glulisin nyob rau thaj tsam ntawm thaj tsam ntawm lub plab phab ntsa sab xub pwg, xub pwg (hauv thaj tsam ntawm deltoid cov leeg), thiab ncej puab, qhov kev nqus ntawm cov tshuaj tau sai dua thaum qhia rau thaj av ntawm thaj tsam plab phab ntsa thaum piv nrog kev tswj hwm ntawm cov tshuaj hauv tus ncej puab. Tus nqi ntawm kev nqus ntawm lub xub pwg (thaj tsam ntawm deltoid leeg) yog nyob nruab nrab. Qhov tshwj xeeb bioavailability ntawm insulin glulisin thaum muab subcutaneously muaj qhov txawv txav ntawm cov neeg mob sib txawv thiab ntau npaum li cas kwv yees li 70% (68% los ntawm tus ncej puab, 71% los ntawm deltoid cov leeg, 73% los ntawm anterior plab phab ntsa). Kev nthuav tawm thiab kev faib tawm ntawm cov tshuaj insulin glulisin thiab soluble tib neeg cov insulin thaum lub sijhawm tswj hwm yog zoo ib yam, nrog ib nrab ntawm lub neej uas yog 13 thiab 17 feeb, feem, thiab nrog cov faib tawm uas yog 13 thiab 21 litres, feem. Nrog kev tswj hwm subcutaneous ntawm insulin, glulisin yog tawm sai dua soluble tib neeg cov kua dej. Pom meej ib nrab-lub neej ntawm insulin glulisin nrog kev tswj hwm subcutaneous yog 42 feeb, qhov pom meej ib nrab ntawm lub neej ntawm tib neeg lub cev insulin nrog subcutaneous tswj hwm yog 86 feeb. Qhov pom meej ib nrab-lub neej nyob ntawm 37 txog 75 feeb hauv kev soj ntsuam ib ntu ntawm kev tshawb fawb ntawm insulin glulisin hauv cov neeg muaj kev noj qab haus huv thiab cov neeg mob uas muaj hom 1 thiab hom 2 mob ntshav qab zib mellitus.
Hauv qhov kev tshawb fawb soj ntsuam ua rau cov tib neeg tsis muaj ntshav qab zib nrog ntau lub raum kev ua haujlwm (kev tsim lub peev xwm tshem tau ntau dua 80 ml / min, 30 txog 50 ml / min, tsawg dua 30 ml / min), qhov pib ntawm cov nyhuv ntawm insulin glulisin feem ntau tau khaws cia. Tab sis nrog kev ua txhaum ntawm kev ua haujlwm ntawm lub raum, xav tau cov tshuaj insulin tuaj yeem txo. Hauv cov neeg mob uas lub siab tsis zoo ua tsis tau zoo, pharmacokinetic tsis muaj peev xwm ntawm insulin glulisin tsis tau kawm. Tsuas muaj cov ntaub ntawv muaj tsawg tsawg ntawm cov pharmacokinetic tsis muaj tshuaj ntawm insulin glulisin hauv cov neeg laus uas muaj ntshav qab zib mellitus. Cov chaw muag tshuaj thiab cov tshuaj pharmacokinetic ntawm insulin glulisin tau kawm hauv cov menyuam yaus (7 txog 11 xyoos) thiab cov neeg hluas (12 txog 16 xyoo) uas muaj ntshav qab zib hom 1 mellitus. Hauv ob pawg hnub nyoog, insulin glulisin nrawm nrawm nrog lub sijhawm kom mus txog qhov siab tshaj plaws thiab nws cov nqi zoo ib yam li cov muaj hnub nyoog (cov neeg mob ntshav qab zib hom 1 thiab cov neeg ua haujlwm pab dawb noj qab haus huv). Raws li hauv cov neeg mob cov neeg laus, thaum cov tshuaj tau muab rau noj ua ntej ua ntej kev sim nrog zaub mov, insulin glulisin muab kev tswj ntshav qabzib zoo dua tom qab noj mov ntau dua li tib neeg cov tshuaj insulin. Qhov kev nce ntxiv ntawm cov ntshav qabzib tom qab noj mov (thaj chaw hauv qab qhov nkhaus pharmacokinetic yog qhov kev txiav txim siab ntawm cov piam thaj hauv cov ntshav rau thawj 6 teev) yog 641 mg / (h • dl) rau insulin glulisin thiab 801 mg / (h • dl) rau solulin tib neeg cov kua dej.

Mob ntshav qab zib mellitus, uas yuav tsum muaj kev siv tshuaj insulin, rau cov laus thiab cov menyuam yaus hnub nyoog tshaj li 6 xyoo.

Kev noj tshuaj thiab kev tswj hwm ntawm insulin glulisin thiab koob tshuaj

Insulin glulisin yog muab tshuaj subcutaneously. Kev noj tshuaj ntau dua ntawm insulin glulisin yog teeb tsa ib leeg zuj zus. Glulisin insulin yuav tsum tau siv sijhawm 0-15 feeb ua ntej noj mov lossis sai tom qab noj mov. Kev siv tshuaj insulin glulisin yuav tsum raug siv rau hauv kev kho mob uas suav nrog nruab nrab insulin nruab nrab, lossis insulin ntev ntev, lossis ntev ntev rau cov tshuaj insulin. Insulin glulisin kuj tseem siv tau nrog cov tshuaj hypoglycemic hauv qhov ncauj.
Kev siv tshuaj insulin glulisin yog muab tshuaj subcutaneous txhaj tshuaj lossis ua ib qho tshuaj txuas mus ntev los ntawm insulin siv cov twj tso kua mis uas tsim nyog rau tswj cov tshuaj insulin. Kev txhaj tshuaj subulinaneous ntawm insulin glulisin yuav tsum tau ua nyob rau thaj tsam ntawm sab xub ntiag phab ntsa, ncej puab, thiab xub pwg, thiab insulin glulisin yuav tsum tau tswj hwm los ntawm kev tsis txuas ntxiv subcutaneous infusion mus rau thaj tsam ntawm sab xub ntiag phab ntsa. Qhov chaw txhaj tshuaj thiab cov chaw txuas mus txuas ntxiv nqus dej yuav tsum tau hloov chaw nyob rau thaj chaw saum toj no nrog txhua qhov kev tswj hwm tshiab ntawm insulin glulisin. Qhov chaw tswj hwm, kev siv dag zog, thiab lwm yam mob tuaj yeem cuam tshuam tus nqi ntawm kev nqus thiab qhov pib thiab lub sijhawm ntawm insulin glulisin. Kev tswj hwm subcutaneous ntawm insulin glulisin nyob rau thaj tsam ntawm thaj tsam ntawm sab xub ntiag ntawm phab ntsa, piv nrog cov thawj coj ntawm cov tshuaj mus rau lwm qhov ntawm lub cev (ncej puab, xub pwg), muab me ntsis sai dua nqus cov tshuaj. Qhov kev ceeb toom yuav tsum tau ua kom ntseeg tau tias insulin glulisin tsis nkag ncaj qha rau cov hlab ntshav. Tom qab muab cov tshuaj insulin, glulisin, nws tsis muaj peev xwm zaws thaj tsam ntawm kev tswj hwm ntawm cov tshuaj. Cov neeg mob yuav tsum tau qhia cov txheej txheem tseeb rau kev txhaj tshuaj insulin glulisin.
Insulin glulisin tuaj yeem sib xyaw nrog tib neeg cov kua dej isulinne, nyob rau hauv rooj plaub no cov tshuaj insulin glulisin yuav tsum tau kos rau hauv cov koob txhaj tshuaj ua ntej. Kev tswj hwm tus neeg yuav tsum tau ua tam sim ntawd tom qab sib tov cov tshuaj. Siv cov tshuaj insulins (insulin glulisin thiab insulin-isophan) tsis tuaj yeem siv tshuaj pleev ib ce.
Kev siv tshuaj insulin glulisin tuaj yeem siv tau los ntawm kev siv lub tshuab nqus dej kom tau txais kev tswjhwm ntawm cov tshuaj insulin txuas ntxiv. Hauv qhov no, txoj kev lis ntshav thiab cov chaw tso dej siv nrog insulin glulisin yuav tsum tau hloov tsawg kawg txhua ob hnub nyob rau hauv raws li cov cai ntawm asepsis thiab antiseptics. Thaum siv cov tshuaj insulin glulisin nrog lub twj tso kua dej rau kev tswj hwm tsis tu ncua ntawm insulin, insulin glulisin tsis tuaj yeem sib xyaw nrog lwm cov insulins lossis cov kuab tshuaj. Cov neeg mob uas tau txais insulin glulisin los ntawm kev tswj hwm tsis tu ncua yuav tsum muaj lwm txoj hauv kev los tswj cov tshuaj insulin thiab yuav tsum tau kawm los tswj cov tshuaj insulin los ntawm kev txhaj tshuaj subcutaneous yog tias tawg ntawm lub twj tso kua mis siv.Thaum siv cov tshuaj insulin glulisin nrog cov twj tso kua mis ua rau kev tswj hwm tsis tu ncua ntawm insulin, ua haujlwm tsis zoo ntawm txoj kev lis ntshav, qhov ua haujlwm tsis zoo ntawm lub twj tso kua mis, thiab qhov yuam kev hauv kev tuav lawv tuaj yeem ua sai sai rau kev txhim kho hyperglycemia, ketosis thiab ketoacidosis mob ntshav qab zib. Nrog rau kev loj hlob ntawm hyperglycemia, ketosis lossis ntshav qab zib ketoacidosis, kev txheeb xyuas sai thiab tshem tawm cov laj thawj ntawm lawv txoj kev txhim kho yog tsim nyog.
Ua ntej muab cov glulisin tso rau hauv cov tshuaj insulin, nws yog qhov yuav tsum tau kuaj xyuas qhov pom, xim, muaj cov khoom txawv teb chaws, thiab xwm yeem. Glulisin insulin kua yuav tsum tsis muaj kob, pob tshab, pub dawb los ntawm pom cov teeb meem thiab muaj qhov sib xws li dej. Koj tuaj yeem siv tsis tau cov tshuaj yog tias cov tshuaj insulin ntawm glulisin muaj huab, muaj xim lossis txawv teb chaws.
Vim tias lub sijhawm luv luv ntawm kev ua haujlwm ntawm insulin glulisin, cov neeg mob ntshav qab zib mellitus ntxiv qhov xav tau ntawm kev hais tawm ntawm nruab nrab-ua yeeb yam insulins lossis kev lis ntshav ntawm insulin siv insulin twj tso kua mis kom tswj tau glycemic txaus.
Txhua qhov kev hloov pauv ntawm kev kho mob insulin yuav tsum ua nrog ceev faj thiab tsuas yog nyob ntawm kev saib xyuas ntawm kws kho mob. Hloov hauv insulin concentration, hom tshuaj insulin (insulin-isofan, insulin tib neeg, insulin analogues), cov tshuaj insulin, hom insulin, hom tshuaj insulin (tib neeg insulin, tsiaj insulin), hom kev tsim tawm ntawm cov tshuaj insulin (tsiaj insulin, insulin tau los ntawm recombinant deoxyribonucleic acid ) tej zaum yuav xav tau hloov pauv ntawm cov tshuaj insulin. Nws kuj tseem yuav tsum tau hloov pauv cov koob tshuaj ntawm cov tshuaj sib tiv thaiv qhov ncauj hypoglycemic.
Thaum cov kab mob sib kis, los ntawm kev ntxhov siab dhau los lossis ntxhov siab, qhov xav tau ntawm insulin tuaj yeem hloov.
Kev siv cov tshuaj tsis txaus ntawm cov tshuaj insulin lossis tsis ua haujlwm ntawm kev kho, tshwj xeeb tshaj yog nyob rau cov neeg mob uas muaj hom 1 mob ntshav qab zib mellitus, tuaj yeem ua rau kev loj hlob ntawm hyperglycemia thiab ntshav qab zib ketoacidosis, uas muaj kev pheej hmoo tuag taus.
Kev mob ntshav qab zib yog qhov ntau tshaj tsis xav tau ntawm kev siv tshuaj insulin. Lub sijhawm dhau los uas kev kho ntshav qab zib nce zuj zus nyob ntawm qhov txiaj ntsig ntawm qhov pib ntawm qhov cuam tshuam ntawm kev siv cov tshuaj insulin thiab yog li hloov pauv thaum hloov kho kev hloov pauv. Kev mob ntshav qab zib tsawg tuaj yeem tsim muaj nrog cov tshuaj insulin ntau dhau uas dhau qhov xav tau. Cov tsos mob ntawm tus mob hypoglycemia feem ntau tshwm sim sai. Tab sis feem ntau yog mob neuropsychiatric mob vim neuroglycopenia (kev qaug zog txawv txawv, mloog zoo li nkees, qaug zog txawv, nkees nkees, tsis muaj peev xwm tswj tau, pom kev tsis meej pem, mob taub hau, tsis meej pem, tsis nco qab, ua kom mob plab, tsis nco qab, xeev siab) yog ua ntej los ntawm cov tsos mob ntawm kev ua haujlwm ntawm lub sympathoadrenal system hauv teb rau hypoglycemia (adrenergic counter-regulation): kev voos, kev tshaib kev nqhis, zoo siab ntxhov siab, ntxhov siab, tshee, tawm hws txias, pallor ntawm daim tawv nqaij, ahikardiya qhia lub plawv dhia. Thiab sai dua hypoglycemia kev loj hlob, thiab qhov hnyav nws hnyav dua, qhov tseeb tshaj yog cov tsos mob ntawm kev ua kom muaj zog ntawm lub cev sympathoadrenal hauv kev teb rau hypoglycemia. Kev mob ntshav nce siab ntau, tshwj xeeb tshaj yog rov muaj dua, tuaj yeem ua kev puas tsuaj rau cov hlab ntshav ntawm lub hlwb. Mob ntshav qab zib tsawg thiab ntev heev tuaj yeem tsim kev puas tsuaj rau cov neeg mob lub neej, vim tias nrog txoj kev loj hlob ntawm hypoglycemia, muaj txiaj ntsig tuag tau yog qhov tshwm sim. Cov xwm txheej uas yuav ua rau lub sijhawm ua ntej ntawm hypoglycemia tsawg tshaj tawm lossis hloov pauv muaj xws li kev txhim kho tseem ceeb hauv kev tswj glycemic, kev sib zog ntau ntawm kev kho tshuaj insulin, kev txhim kho maj mam ntawm hypoglycemia, muaj cov neuropathy ntawm autonomic lub paj hlwb, cov neeg laus laus, txuas ntxiv muaj ntshav qab zib mellitus, thiab siv qee yam tshuaj. Cov xwm txheej zoo li no tuaj yeem ua rau muaj ntshav qab zib tsawg (ua rau tsis nco qab zoo) ua ntej tus neeg mob paub tseeb tias nws muaj kev mob ntshav qab zib tsawg.
Yuav tau kho cov tshuaj insulin yog tias cov neeg mob hloov lawv lub caij nyoog noj mov lossis nce kev ua si. Kev tawm dag zog uas tau ua tam sim ntawd tom qab noj mov tuaj yeem ua rau muaj kev txo ntshav qab zib hauv lub cev.
Thaum piv rau soluble tib neeg cov tshuaj insulin tom qab kev coj ua sai sai ntawm insulin analogues (suav nrog insulin glulisin), hypoglycemia yuav tshwm sim thaum ntxov.
Kev tsis pom txog hyperglycemic lossis hypoglycemic tshua tuaj yeem ua rau tsis nco qab, tsis nco qab, lossis tuag.
Cov tshuaj tiv thaiv kab mob ua kom lub cev tsis haum rau insulin glulisin tuaj yeem ua pob, khaus, nruj hauv siab, txhawm chim, txo ntshav siab, ntshav nce siab, thiab tawm hws. Cov mob uas muaj feem yuav ua xua, nrog rau cov tshuaj tiv thaiv anaphylactic tuaj yeem hem tus neeg mob lub neej.
Thaum siv cov tshuaj insulin glulisin, cov tshuaj tiv thaiv tsis haum ntshav hauv zos tuaj yeem tsim (nrog rau hyperemia ntawm qhov chaw txhaj tshuaj, o ntawm thaj chaw txhaj tshuaj, nws khaus ntawm qhov chaw txhaj tshuaj). Feem ntau, cov kev tawm tsam no ploj tom qab ob peb hnub lossis lub lim tiam ntawm kev siv insulin glulisin. Qee qhov xwm txheej, cov tshuaj tiv thaiv no tsis cuam tshuam nrog kev siv cov tshuaj insulin glulisin, tab sis tuaj yeem los ntawm daim tawv nqaij mob, uas yuav yog los ntawm kev kho mob antiseptic ua ntej kev txhaj tshuaj lossis kev tswj hwm tsis tseem ceeb ntawm insulin glulisin (hauv kev ua txhaum ntawm cov txheej txheem tsim nyog rau kev txhaj tshuaj subcutaneous).
Ib yam li lwm yam insulin, thaum siv cov tshuaj insulin glulisin, lipodystrophy yuav tshwm sim ntawm qhov chaw txhaj tshuaj, uas tuaj yeem ua rau qeeb ntawm kev nqus ntawm insulin glulisin. Kev qhia ntawm cov tshuaj ntawm tib qhov chaw tuaj yeem pab txhawb kev txhim kho lipodystrophy, yog li ntawd, kev ua txhaum ntawm kev hloov chaw ntawm chaw tswj hwm ntawm insulin glulisin tuaj yeem pab txhawb kev txhim kho lipodystrophy. Kev sib pauv tas li ntawm qhov chaw txhaj tshuaj ntawm insulin glulisin nyob rau hauv ib qho chaw txhaj tshuaj (lub xub pwg, ncej puab, sab hauv ntawm lub plab phab ntsa) tuaj yeem pab txo qis thiab tiv thaiv kev txhim kho ntawm lipodystrophy.
Kev tswj hwm kev saib xyuas los ntawm lwm cov insulins los ntawm kev ua yuam kev tau tshaj tawm, tshwj xeeb tshaj yog cov insulins ntev ntev, tsis txhob siv cov insulin glulisin.
Qhov xav tau rau insulin glulisine, ib yam li lwm yam insulins, tuaj yeem txo qis vim qhov ua tsis taus ntawm lub raum hloov zuj zus. Hauv cov neeg mob uas muaj lub siab ua haujlwm tsis txaus siab, qhov xav tau rau insulin glulisin tsawg dua vim tias qeeb ntawm cov metabolism hauv insulin glulisin thiab txo qis kev muaj peev xwm gluconeogenesis hauv lub siab. Lub raum khiav tsis zoo hauv cov neeg laus cov laus tuaj yeem ua rau txo qis qhov xav tau ntawm insulin glulisin. Cov neeg laus yuav muaj teeb meem kom paub txog cov tsos mob thiab tus mob hypoglycemia. Cov tshuaj insulin glulisin tuaj yeem siv rau hauv cov menyuam yaus hnub nyoog dhau 6 xyoo. Cov ntaub ntawv kho mob txog kev siv insulin glulisin rau cov menyuam yaus hnub nyoog qis dua 6 xyoo yog txwv. Cov chaw muag tshuaj thiab cov tshuaj pharmacokinetic ntawm insulin glulisin tau kawm txog cov menyuam yaus hnub nyoog 6 xyoo nrog hom 1 mob ntshav qab zib mellitus. Hauv cov menyuam yaus hnub nyoog dhau 6 xyoo, insulin glulisin tau nqus sai, thiab nws qhov nqus dej tsis txawv ntawm cov neeg laus (cov neeg tuaj noj qab haus huv thiab cov neeg mob uas muaj ntshav qab zib hom 1). Raws li cov neeg laus, hauv cov menyuam yaus hnub nyoog tshaj 6 xyoo nrog kev qhia ntawm insulin glulisin tam sim ntawd ua ntej kev kuaj mob nrog rau kev noj mov, cov tshuaj muab cov tswj cov ntshav qabzib zoo dua tom qab noj mov ntau dua li cov tshuaj tiv thaiv tib neeg.
Lub peev xwm xav tau thiab qhov ceev ntawm psychomotor cov kev cuam tshuam hauv cov neeg mob ntshav qab zib mellitus tuaj yeem ua rau tsis muaj dab tsi vim muaj ntshav qab zib tsawg, hyperglycemia, pom kev tsis sib haum xeeb, uas tuaj yeem ua rau muaj kev pheej hmoo nyob rau hauv qhov xwm txheej uas cov peev xwm no tseem ceeb (piv txwv li, thaum ua cov haujlwm phom sij, tsav tsheb cov tshuab). Thaum lub sijhawm siv cov tshuaj insulin glulisin, cov neeg mob yuav tsum qhia kev tawm dag zog thiab zam kev txhim kho hypoglycemia thaum ua cov haujlwm uas muaj kev phom sij uas xav tau kev nce siab ntawm kev saib xyuas thiab ceev ntawm lub hlwb psychomotor (nrog rau kev tsav tsheb, kev siv tshuab). Qhov no yog qhov tshwj xeeb tshaj yog nyob rau hauv cov neeg mob uas tsis tuaj kawm ntawv lossis txo lub peev xwm los paub txog cov tsos mob uas qhia tias kev txhim kho hypoglycemia, lossis nrog rau kev pheej muaj ntshav tsis tu ncua. Hauv cov neeg mob zoo li no, nws yog ib qho tsim nyog los ntawm kev txiav txim siab ib leeg ntawm kev muaj peev xwm ua tau cov haujlwm uas muaj peev xwm txaus ntshai uas yuav tsum muaj kev xav ntau ntxiv thiab ceev ntawm cov kev xav psychomotor (suav nrog kev tsav tsheb, cov tshuab).

Cev xeeb tub thiab lactation

Tsis muaj kev tswj xyuas tau zoo hauv kev siv tshuaj tua kab mob glulisin rau cov poj niam thaum cev xeeb tub. Cov ntaub ntawv muaj tsawg tsawg uas tau txais ntawm kev siv tshuaj insulin glulisin rau cov poj niam thaum cev xeeb tub (tsawg tshaj li 300 tawm cov txiaj ntsig ntawm cev xeeb tub) tsis qhia txog qhov tshwm sim tsis zoo ntawm cov tshuaj ntawm kev txhim kho intrauterine ntawm tus me nyuam hauv plab, cev xeeb tub, menyuam mos. Cov kev tshawb fawb tsiaj yug me nyuam tsis tau qhia txog qhov sib txawv ntawm insulin glulisin thiab tib neeg insulin nrog rau kev txhim kho embryonic, kev loj hlob ntawm tus me nyuam, kev xeeb tub, kev yug menyuam thiab kev loj hlob tom qab. Kev siv cov tshuaj insulin glulisin rau cov poj niam thaum cev xeeb tub yuav tsum tau ua nrog ceev faj. Ua tib zoo saib xyuas cov ntshav qabzib ntau ntxiv thiab tswj cov glycemic tswj kev ua haujlwm. Cov poj niam uas muaj ntshav qab zib ua ntej cev xeeb tub los yog muaj tus mob ntshav qab zib hauv lub poj niam yuav tsum tswj tau glycemic thoob plaws hauv lawv cev xeeb tub. Hauv thawj peb lub hlis thaum cev xeeb tub, xav tau cov tshuaj insulin tuaj yeem txo qis, nyob rau lub hlis thib ob thiab thib peb, kev xav tau cov tshuaj insulin feem ntau yuav nce ntxiv. Qhov xav tau rau insulin tam sim ntawd tom qab yug me nyuam feem ntau poob sai. Nws tseem tsis tau paub meej tias insulin glulisin raug cais tawm hauv niam cov kua mis. Hauv cov poj niam, thaum pub niam mis, nws yuav tsim nyog kho qhov tshuaj ntau npaum li cas ntawm cov tshuaj insulin thiab / lossis noj zaub mov.

Cov kev mob tshwm sim ntawm insulin glulisin

Tej leeg hauv nruab nrog cev, mob hlwb thiab hnov lub cev: chim siab, ntxhov siab ntxhov siab, ntxhov siab, tshee tshee, txawv txawv, nkees nkees, qaug zog txawv, nkees nkees, tsis muaj peev xwm tswj tau, mob taub hau, tsis meej pem, tsis nco qab, ua rau lub hlwb puas, ua kom mob hlwb, cuam tshuam rau qhov muag.
Lub plawv mob: tachycardia, mob caj dab, lub hauv siab nruj, txo ntshav siab, ntshav nce siab.
Digestive system: xeev siab
Kab mob ua pa: zawm caj pas.
Kev lom zem hauv lub cev: kev mob ntshav qab zib (npau taws, tshaib plab, ntxhov siab, ntxhov siab, tshee, tawm hws txias, pallor ntawm daim tawv nqaij, tachycardia, palpitations, nkees nkees, txawv txawv, nkees, txawv txawv, qaug zog, tsis muaj peev xwm mloog, pom kev tsis sib haum, mob taub hau, tsis meej pem) kev nco qab, poob ntawm kev nco qab, kev mob taub hau, xeev siab, kev puas tsuaj rau cov hlab ntsha puas tsuaj, tsis nco qab, tuag yog ua tau).
Lub cev tsis muaj zog: cov tshuaj tiv thaiv kab mob hauv ib puag ncig (nrog rau hyperemia ntawm qhov chaw txhaj tshuaj, o ntawm qhov chaw txhaj tshuaj, khaus ntawm qhov chaw txhaj tshuaj), cov tshuaj tiv thaiv kab mob siab (nrog rau pob, khaus, nruj hauv siab, txhawm chim, txo ntshav siab, ntshav nce siab, nce hws, ua xua, kev siv tshuaj anaphylactic).
Daim tawv nqaij thiab cov nqaij mos nqaij subcutaneous: lipodystrophy, tawm hws txias, pallor ntawm daim tawv nqaij, tawm pob, khaus, hyperemia, o ntawm thaj chaw txhaj tshuaj.
Lwm yam: kev tshaib kev nqhis, kev yuam kev tswj ntawm lwm cov tshuaj insulin.

Kev cuam tshuam ntawm insulin glulisin nrog lwm yam tshuaj

Cov kev tshawb fawb txog kev sib cuam tshuam pharmacokinetic ntawm insulin glulisin nrog lwm cov tshuaj tsis tau ua. Raws li muaj qhov kev paub tseeb txog lwm yam tshuaj zoo sib xws, kev txhim kho kev sib raug zoo ntawm cov chaw muag tshuaj muaj nqis ntawm insulin glulisin nrog lwm cov tshuaj tsis zoo li.
Qee cov tshuaj yuav cuam tshuam rau cov metabolism hauv qabzib, uas yuav tsum tau tsim kho kom haum rau cov tshuaj insulin glulisin thiab tshwj xeeb yog saib xyuas kev kho mob. Cov tshuaj uas tuaj yeem ua rau cov hypoglycemic ua haujlwm ntawm insulin glulisin thiab nce qhov kev xav ua rau hypoglycemia suav nrog angiotensin-hloov enzyme inhibitors, tshuaj tiv thaiv kab mob hypoglycemic, fibrates, disopyramide, fluoxetine, pentoxifylline, monoamine oxidase inhibitors, sulphonamidobenamycin tshuaj tshuaj insulin glulisin. Cov tshuaj noj uas tuaj yeem txo qhov hypoglycemic nyhuv ntawm insulin glulisin suav nrog danazol, diazoxide, diuretics, glucocorticosteroids, glucagon, phenothiazine derivatives, isoniazid, somatropin, sympathomimetics (e.g., epinephrine (adrenaline), terbutaline, salbutamole, e.g. kev tiv thaiv qog,) cov thyroid hormones, protease inhibitors, atypical antipsychotics (e.g., clozapine, olanzapine), nws yuav tsim nyog hloov pauv ntawm cov tshuaj insulin glulisin. Beta-blockers, lithium ntsev, clonidine, ethanol tuaj yeem txhim kho lossis ua kom cov nyhuv tsis muaj zog hypoglycemic ntawm insulin glulisin, nws yuav tsim nyog hloov lub koob tshuaj insulin glulisin. Pentamidine thaum siv ua ke nrog insulin glulisin yuav ua rau hypoglycemia nrog hyperglycemia txuas ntxiv, nws yuav tsim nyog hloov pauv ntawm insulin glulisin. Hauv qab ntawm cov tshuaj uas muaj kev cuam tshuam sympatholytic, xws li clonidine, beta-blockers, reserpine, guanethidine, cov tsos mob ntawm reflex adrenergic kev ua haujlwm nyob rau hauv teb rau hypoglycemia tej zaum yuav tsis tuaj, nrog rau cov lus tsawg.
Vim tias tsis muaj kev kawm tshawb tau zoo, insulin glulisin yuav tsum tsis txhob xyaw nrog lwm cov tshuaj dua li tib neeg insulin-isophan. Thaum cov tshuaj insulin raug muab nrog glulisin siv cov twj tso kua mis infusion, cov tshuaj yuav tsum tsis txhob tov nrog cov kuab tshuaj lossis lwm yam tshuaj (suav nrog kev npaj tshuaj insulin).

Noj ntau dhau

Tsis muaj cov ntaub ntawv tshwj xeeb muaj hais txog insulin noj ntau dhau los ntawm glulisin.Nrog rau qhov dhau ntawm cov koob tshuaj insulin glulisin hauv kev sib piv rau qhov xav tau nws, uas yog txiav txim siab los ntawm lub zog nqi ntawm lub cev thiab kev noj zaub mov, hypoglycemia tuaj yeem txhim kho (uas tau tshwm sim los ntawm cov tsos mob hauv qab no: txob taus, tshaib plab, poob siab, ntxhov siab, tshee, txias hws, tawv daj, tachycardia lub plawv dhia ceev, nkees nkees, nkees nkees, ua haujlwm tsis muaj zog, qaug zog, tsis muaj peev xwm tswj hwm, ua kom pom kev txawv txav, mob taub hau, s utan, hnovqab, convulsions, xeev siab, kev puas tsuaj rau lub paj hlwb, coma, kev tuag) yog ua tau.
Kev mob ntshav qab zib me me tuaj yeem nres los ntawm kev noj ntshav qab zib lossis cov zaub mov uas muaj suab thaj. Yog li, nws tau pom zoo tias cov neeg mob ntshav qab zib ib txwm nqa khoom qab zib, ncuav qab zib, khob qab zib lossis kua txiv qab zib. Kev mob ntshav qab zib nrog mob tsis nco qab, ua kom mob hlwb thiab mob hlwb tuaj yeem nres los ntawm qhov kev tswj hwm ntshav khov ntawm cov tshuaj muaj zog (20%) cov kua nplaum (dextrose) lossis los ntawm kev tswj hwm ntawm 0.5-1 mg ntawm glucagon los ntawm tus kws kho mob. Tom qab nws rov qab nco qab, tus neeg mob tau pom zoo kom muab cov carbohydrates hauv tsev kom tiv thaiv qhov kev rov txhim kho ntawm hypoglycemia, uas yog ua tau tom qab pom meej kho qhov chaw kho mob. Txhawm rau tsim qhov ua rau muaj ntshav nce siab ntau thiab tiv thaiv kev txhim kho ntawm lwm qhov kev mob sib xws, tus neeg mob yuav tsum pom nyob hauv tsev kho mob.

Kho nyhuv

Glulin insulin yog ib qho tshuaj (ua ke rov los) ntawm tib neeg cov tshuaj insulin. Lub zog ntawm nws kev ua yog sib npaug ntawm cov neeg insulin zoo tib yam. Glulisin pib sai dua, tab sis muaj lub sijhawm luv dua li soluble tib neeg cov kua dej.

Cov tshuaj insulin glulisin txhaj rau hauv qab daim tawv nqaij ua tom qab 10-20 feeb.

Cov txheej txheem ntawm kev tswj hwm ntawm insulin glulisin yog kev txhaj tshuaj subcutaneous los yog kev txuas ntxiv mus rau hauv lub cev subcutaneous rog ntawm lub plab los ntawm lub twj tso kua mis. Tshuaj Insulin yog muab sijhawm luv (0-15 feeb.) Ua ntej lossis sai sai tom qab noj mov.

Mob ntshav qab zib mellitus xav tau kev kho mob insulin.

Txoj kev ntawm daim ntawv thov

Glulisin insulin yuav tsum tau tswj hwm lub sijhawm luv (0-15min.) Ua ntej lossis tam sim ntawd tom qab noj mov.

Qhov insulin no yog siv rau hauv kev kho mob uas suav nrog qhov tshuaj insulin nruab nrab lossis ntev ntev, suav nrog ib qho tshuaj ntawm cov kab mob basal insulin. Insulin glulisin kuj tseem siv ua ke nrog hypoglycemic tus neeg sawv cev hauv daim ntawv ntawm cov ntsiav tshuaj.

Cov tshuaj yog tswj los ntawm kev txhaj tshuaj subcutaneous lossis kev nqus ua haujlwm mus rau hauv plab (mus rau hauv cov rog subcutaneous) uas siv lub tshuab nqus dej.

Kev txhaj tshuaj subcutaneous tau nqa tawm hauv plab, ncej puab lossis xub pwg, txoj kev lis ntshav tas mus li tuaj yeem nqa tawm hauv plab.

Sab sij huam

Cov tshuaj tiv thaiv kab mob hauv ib puag ncig hauv zos (liab, o lossis khaus ntawm qhov chaw txhaj tshuaj). Cov kev ua zoo li no feem ntau yog ua dhau los, ploj mus nrog kev kho mob txuas ntxiv. Qee lub sij hawm muaj qhov tshwm sim ntawm lipodystrophy (nyob rau hauv kev ua txhaum ntawm kev hloov chaw ntawm kev txhaj tshuaj nyob hauv tib thaj chaw).

Kev ua xua rau kev ua xua (urticaria, ua tsis taus pa ua pa, bronchospasm, khaus, ua xua tuaj yeem ua xua), suav nrog cov mob hnyav ntawm kev tsis haum tshuaj (suav nrog anaphylactic), uas tuaj yeem tsim kev phom sij rau lub neej.

Cov lus qhia tshwj xeeb

Thaum ua ke nrog cov tshuaj tiv thaiv kab mob hauv lub qhov ncauj, ACE inhibitors, disopyramide, fluoxetine, fibrates, MAO inhibitors, pentoxifylline, salicylates, propoxyphene thiab sulfanilamide antimicrobials, insulin glulisin yuav nce hypoglycemic effect thiab ua rau muaj kev pheej hmoo.

Thaum muab sib xyaw nrog GCS, diazoxide, danazole, diuretics, somatropin, isoniazids, phenothiazine derivatives, sympathomimetics (e.g., epinephrine, terbutaline, salbutamol), cov thyroid hormones, estrogens thiab progestins (e.g., tshuaj tiv thaiv qhov ncauj, thiab tshuaj tiv thaiv), tshuaj (piv txwv li, olanzapine thiab clozapine) insulin glulisin yuav txo qhov cuam tshuam hypoglycemic.

Beta-blockers, clonidine, nrog rau cov roj ntsha lithium thiab ethanol tuaj yeem ua rau muaj zog lossis ua kom tsis muaj zog ntawm cov tshuaj insulin. Pentamidine provokes hypoglycemia thiab hyperglycemia txuas ntxiv.

Kev siv cov tshuaj sympatholytic (beta-blockers, clonidine thiab guanethidine, zoo li reserpine) npog cov tsos mob ntawm adrenergic reflex activation.

Thaum hloov mus rau tus neeg mob mus rau lwm hom tshuaj insulin lossis insulin ntawm tus tsim tshiab, nws yog qhov yuav tsum tau ua raws li kev saib xyuas kev kho mob nruj, vim kev kho ntawm kev kho yuav tsum tau ua. Kev noj tshuaj insulin tsis txaus lossis tsis ua haujlwm rau kev kho mob ua rau kev loj hlob ntawm hyperglycemia, nrog rau cov kab mob ntshav qab zib ketoacidosis, cov mob uas tuaj yeem ua rau muaj kev phom sij rau lub neej.

Lub sijhawm ntawm lub peev xwm ntawm kev txhim kho hypoglycemia yuav yog nyob ntawm tus nqi ntawm qhov pib ntawm kev ua ntawm kev siv tshuaj insulin thiab tuaj yeem hloov pauv, nrog rau kev hloov pauv ntawm kev kho mob. Cov xwm txheej uas hloov lossis tsis tshua pom zoo ua ntej ntawm kev txo lub qog ntshav qab zib muaj xws li: lub sijhawm mob ntshav qab zib mellitus, kev siv tshuaj tua kab mob ntau dhau, kev mob ntshav qab zib neuropathy, kev siv qee yam tshuaj (piv txwv, beta-blockers), lossis hloov tus neeg mob los ntawm tsiaj insulin rau tib neeg.

Kev kho cov tshuaj insulin yog qhov yuav tsum tau hloov thaum hloov kev noj mov lossis hloov qoj ib ce. Kev tawm dag zog tam sim ntawd tom qab noj mov tag yuav yog qhov muaj kev pheej hmoo qog ntshav qab zib. Nrog kev qhia txog kev ua yeeb yam sai ntawm tib neeg cov tshuaj insulin, Kev mob ntshav qab zib tuaj yeem txhim kho sai dua li siv cov soluble neeg siv cov tshuaj insulin.

Qhov tsis nco qab txog lub cev hypoglycemic lossis hyperglycemic tshua tuaj yeem ua rau tsis nco qab, tsis nco qab, thiab txawm tuag.

Kev siv cov tshuaj insulin glulisin hauv cov poj niam cev xeeb tub yuav tsum tshwm sim los ntawm kev saib xyuas cov ntshav qab zib hauv lub siab.

Insulin glulisin tsis nkag mus rau hauv niam mis, yog li nws tuaj yeem siv rau lactation.

Thaum lub sij hawm pub mis niam, tus poj niam yuav xav tau kho qhov tshuaj ntawm cov tshuaj insulin.
Qhov koob tshuaj yuav hloov kho cov tshuaj insulin kuj tseem xav tau cov kab mob sib kis, nrog rau kev ntxhov siab ntau dhau.

Khaws cov tshuaj insulin glulisin hauv qhov chaw tsaus thaum kub txog 8 ° C yam tsis muaj qhov khov. Txee lub neej mus txog 2 xyoos.

SAWV DAWS SAWV DAWS

«Cib Toom"- ib qho kev ua tau lub zog antioxidant hnyav uas muab lub neej tshiab zoo rau ob qho tib si metabolic syndrome thiab ntshav qab zib. Qhov ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj yog qhov tseeb tau hais tawm. Cov tshuaj yog pom zoo rau kev siv los ntawm Lavxias Kev Ntshav Qab Zib Association. Tshawb nrhiav ntxiv >>>

Qhia txog ntawm cov tshuaj

Cov tshuaj "Insulin glulisin" yog cov tshuaj uas muaj cov xim dawb. Cov tshuaj yog txhaj rau hauv qab daim tawv nqaij ntawm lub plab, ncej puab lossis xub pwg. Nws raug nquahu kom hloov mus rau lwm qhov chaw txhaj tshuaj. Yog tias tsim nyog, nws muaj peev xwm nqa tawm cov tshuaj txuas ntxiv hauv thaj tsam ntawm lub plab rog lub plab yog siv lub twj tso kua mis. Kev qhia ntawm cov tshuaj "Insulin glulisin" yuav tsum tau ua tom qab noj mov, nyob rau hauv cov xwm txheej huab, tsis ntev ua ntej noj mov.

Yuav ua li cas coj INSULIN GLULISINE

Tus kws kho mob sau ntawv muab cov tshuaj insulin glulisin ntau npaum li cas rau txhua tus neeg mob. Thaum cev xeeb tub lossis pub mis, qhov ntim ntawm cov tshuaj yuav tsum tau kho tas li nyob ntawm qhov xwm txheej ntawm tus pojniam. Kev siv ua ke ntawm cov tshuaj nrog lwm cov tshuaj nquag tuaj yeem txo lossis nce nws cov txiaj ntsig.

Hloov cov koob tshuaj ntawm cov tshuaj "Insulin glulisin" rau tus neeg mob yog qhov tsim nyog thaum:

kev ua neej pauv
hloov pauv kev noj haus
kev hloov pauv ntawm theem kev ntxhov siab ntawm lub cev,
kis thiab lwm yam kab mob
kev nyuaj siab ntxhov plawv thiab dhau haujlwm

Sab sij huam

Cov tshuaj "Insulin glulisin" muaj qee qhov kev mob tshwm sim uas koj yuav tsum tau npaj rau lub sijhawm nws siv: liab, txog siav, ua pa thiab lwm yam, muaj ntau qhov tshwm sim hnyav. Kev siv tshuaj ntau dhau ntawm cov tshuaj tsuas yog tuaj yeem ua rau cov ntshav qab zib kom tsawg thiab tsis muaj qabzib ntxiv uas tsis ua rau muaj lwm yam kev cuam tshuam loj hauv lub cev. Koj tuaj yeem rov qab ua kom cov piam thaj nyob hauv kev noj cov zaub mov uas muaj suab thaj.

Yog tias tus neeg mob hloov mus los ntawm Insulin Glulisin mus rau lwm cov tshuaj, kev saib xyuas kev kho mob ntawm tus neeg mob yog tsim nyog rau qee lub sijhawm tsim nyog rau kev hloov kho ntawm lub cev. Cov txheej txheem thim rov qab tsis tas yuav tsum muaj kev pom tshwj xeeb los ntawm tus kws kho mob.

Cov yam ntxwv ntawm Pharmacological

Cov Tshuaj Hauv Tshuaj Kev ua tseem ceeb ntawm cov tshuaj insulin thiab tag nrho nws cov tshuaj noj (insulin-glulisin tsis muaj kev zam) yog qhov ib txwm ua ntawm cov ntshav qab zib.

Ua tsaug rau cov tshuaj insulin, gluzulin, cov concentration ntawm cov piam thaj hauv cov hlab ntshav poob qis thiab nws txoj kev nqus tau yog txhawb los ntawm cov ntaub so ntswg, tshwj xeeb tshaj yog cov rog, pob txha thiab nqaij. Ib qho ntxiv, insulin:

inhibits zus tau tej cov piam thaj hauv lub siab,
nce protein synthesis,
inhibits proteolysis,
inhibits lipolysis hauv adipocytes.

Cov kev tshawb fawb ua rau cov neeg ua haujlwm noj qab haus huv thiab cov neeg mob ntshav qab zib mellitus tau qhia meej meej tias kev tswj hwm subcutaneous ntawm insulin-glulisin tsis yog tsuas yog txo lub sijhawm tos kom raug, tabsis tseem txo lub sijhawm siv tshuaj. Qhov no txawv nws los ntawm tib neeg cov kua dej.

Nrog kev tswj hwm subcutaneous, cov piam thaj txo qis ntawm cov tshuaj insulin-glulisin hauv cov ntshav pib tom qab 15-20 feeb. Nrog kev txhaj tshuaj tiv thaiv kab mob, cov nyhuv ntawm tib neeg cov tshuaj insulin thiab cov cuam tshuam ntawm insulin-glulisin ntawm cov ntshav qab zib yog kwv yees li qub.

Chav tsev ntawm Kev Npaj Apidra muaj tib qhov kev ua haujlwm hauv hypoglycemic uas yog chav tsev ntawm tib neeg cov kua dej. Hauv kev tshawb fawb soj ntsuam hauv cov neeg mob uas muaj ntshav qab zib hom 1, qhov cuam tshuam ntawm tib neeg lub cev insulin thiab Apidra tau raug soj ntsuam.

Ob qho ntawm lawv tau raug tswj ntawm ib koob tshuaj ntawm 0.15 U / kg subcutaneously ntawm cov sij hawm sib txawv hauv kev sib piv nrog 15 feeb ntawm pluas noj, uas tau txiav txim siab tus qauv.

Cov txiaj ntsig ntawm kev tshawb fawb pom tias insulin-glulisin, siv 2 feeb ua ntej noj mov, tau muab tib txoj kev kuaj glycemic tom qab noj mov raws li tib neeg cov tshuaj insulin, uas tau txhaj 30 feeb ua ntej noj mov.

Yog tias cov tshuaj insulin-glulisin noj 2 feeb ua ntej noj mov, cov tshuaj muab glycemic zoo soj ntsuam tom qab ib pluas noj. Zoo tshaj qhov kev tswj hwm tib neeg cov kua dej ua si 2 feeb ua ntej noj mov.

Cov tshuaj insulin-glulisin, uas tau siv 15 feeb tom qab pib noj mov, tau muab tshuaj glycemic saib xyuas tom qab noj mov zoo ib yam li tau muab los ntawm tib neeg cov tshuaj insulin, kev qhia ntawm uas tshwm sim 2 feeb ua ntej pib noj mov.

Kev tshawb xyuas ntawm thawj theem, ua nrog Apidra, tib neeg soluble insulin thiab insulin-lyspro hauv ib pawg ntawm cov neeg mob rog thiab mob ntshav qab zib mellitus, qhia tau tias hauv cov neeg mob no insulin-glulisin tsis plam nws qhov ua tau zoo sai.

Hauv qhov kev tshawb fawb no, tus nqi nce mus txog 20% ntawm tag nrho thaj tsam hauv qib theem-nkhaus nkhaus (AUC) rau insulin-glulisin yog 114 feeb, rau insulin-lispro -121 feeb thiab rau tib neeg cov tshuaj insulin - 150 feeb.

Thiab AUC (0-2 teev), kuj tseem cuam tshuam txog thaum ntxov hypoglycemic kev ua si, tau ntsig txog 427 mg / kg rau insulin-glulisin, 354 mg / kg rau insulin-lispro thiab 197 mg / kg rau tib neeg cov kua dej.

Yam 1 ntshav qab zib

Cov chaw tshawb fawb. Ntawm hom 1 mob ntshav qab zib mellitus, insulin-lyspro tau muab piv nrog insulin-glulisin.

Hauv qhov kev tshawb nrhiav thib peb uas tau kav ntev li 26 lub lis piam, cov neeg mob ntshav qab zib hom 1 tau muab insulin glulisin ua ntej noj mov (nrog insulin glargine ua yeeb yam xws li insulin basal insulin hauv cov neeg mob no).

Hauv cov neeg no, insulin-glulisin hauv kev sib piv nrog kev tswj glycemic tau muab piv nrog insulin-lyspro thiab raug soj ntsuam los ntawm kev hloov pauv ntawm glycosylated hemoglobin (L1L1c) thaum kawg ntawm kev tshawb fawb nrog pib pib.

Cov neeg mob tau pom tias sib piv, tswj tau tus kheej, kom muaj txiaj ntsig ntawm ntshav qab zib hauv cov hlab ntshav. Qhov sib txawv ntawm insulin-glulisin thiab kev npaj tshuaj insulin-lyspro yog tias thaum lub sijhawm qub tau tswj hwm, nws tsis tas yuav tsum tau nce qhov koob tshuaj ntawm cov tshuaj insulin.

Cov kev soj ntsuam ntawm cov theem peb kav ntev li 12 lub lis piam (cov neeg mob ntshav qab zib hom 1 siv cov tshuaj insulin-glargine ua cov kev kho mob tseem ceeb tau raug caw tuaj pab ua haujlwm pab dawb) pom tias kev cuam tshuam ntawm kev txhaj tshuaj insulin-glulisin tam sim ntawd tom qab noj mov tau muab piv rau qhov ntawm kev txhaj tshuaj insulin-glisin. sai li sai tau ua ntej noj mov (0-15 feeb). Los yog 30-45 feeb ua ntej noj insulin tib neeg cov kua dej.

Cov neeg mob uas dhau qhov kev ntsuam xyuas tau muab faib ua ob pawg:

Thawj pab pawg tau siv cov tshuaj insulin apidra ua ntej noj mov.
Qhov thib ob pab pawg tau muab kev tswj hwm tib neeg cov kua dej.

Qhov kev kawm ntawm thawj pab pawg pom tau txo qis dua HL1C ntau dua li cov neeg pab dawb ntawm pab pawg thib ob.

Mob ntshav qab zib Hom 2

Ua ntej, kev sim kho mob ntawm qib peb tau ua dhau los 26 lub lis piam. Lawv tom qab 26-lub lim tiam kev tshawb fawb txog kev nyab xeeb, uas yog qhov tsim nyog los sib piv cov txiaj ntsig ntawm Apidra (0-15 feeb ua ntej noj mov) nrog soluble tib neeg cov insulin (30-45 feeb ua ntej noj mov).

Ob qho tshuaj no tau muab rau cov neeg mob ntshav qab zib hom 2 subcutaneously (cov neeg no tau siv insulin-isofan ua cov tshuaj insulin tseem ceeb). Qhov ntsuas nruab nrab ntawm lub cev qhov hnyav ntawm cov ncauj lus yog 34.55 kg / m².

Nrog rau kev hloov pauv hauv HL1C cov ntsiab lus, tom qab rau lub hlis ntawm kev kho mob, insulin-glulisin qhia tias nws qhov kev sib piv nrog tib neeg cov tshuaj insulin piv nrog tus nqi pib ntawm txoj kev no:

rau tib neeg cov kua dej-insulin-0.30%,
rau cov tshuaj insulin-glulisin-0.46%.

Thiab tom qab 1 xyoos ntawm kev kho mob, daim duab hloov zoo li no:

rau tib neeg cov kua dej hauv tshuaj lom neeg - 0.13%,
rau cov tshuaj insulin-glulisin - 0.23%.

Feem ntau ntawm cov neeg mob koom nrog txoj kev tshawb fawb no sib xyaw cov tshuaj insulin-isophan nrog cov yeeb yam luv luv tam sim ntawd ua ntej txhaj tshuaj. Thaum lub sijhawm ntawm randomization, 58% ntawm cov neeg mob siv cov tshuaj hypoglycemic thiab enlisted cov lus qhia los txuas ntxiv noj lawv ntawm kev noj tshuaj tib.

Hauv kev tswj xyuas cov kab mob hauv cov neeg laus, tsis muaj qhov sib txawv ntawm kev ua tau zoo thiab kev nyab xeeb ntawm insulin-glulisin hauv kev tshuaj ntsuam ntawm pawg neeg txheeb tau txheeb xyuas los ntawm poj niam txiv neej thiab haiv neeg.

Hauv Apidra hloov chaw ntawm cov amino acid asparagine ntawm txoj hauj lwm B3 ntawm tib neeg insulin nrog lysine, thiab ntxiv rau, lysine ntawm txoj haujlwm B29 nrog glutamic acid, txhawb kev nqus sai.

Pab Pawg Neeg Tshwj Xeeb

Cov neeg mob lub raum. Hauv qhov kev tshawb fawb soj ntsuam ua rau cov tib neeg muaj kev noj qab haus huv nrog rau ntau yam kev ua haujlwm lub raum (kev tsim kho lub peev xwm tshem tau (CC)> 80 ml / min, 30 ml50 ml / min, Kev Qhia Tawm thiab muab tshuaj

Yam 1 ntshav qab zib mellitus hauv cov menyuam yaus tom qab muaj 6 xyoo, cov hluas thiab cov laus.

Insulin-glulisin yuav tsum ua kom sai sai lossis noj mov nrog noj mov.Apidra yuav tsum tau siv nyob rau hauv kev kho mob, uas suav nrog ntev, nruab nrab, ntev ua yeeb yam insulins lossis lawv analogues.

Tsis tas li ntawd, Apidra tuaj yeem siv ua ke nrog hypoglycemic qhov ncauj tshuaj. Cov tshuaj ntawm cov tshuaj yog ib txwm xaiv ib tus zuj zus.

Cov hau kev tswj hwm

Cov tshuaj yog muab los ntawm kev txhaj tshuaj subcutaneous los yog los ntawm kev ua kom tas mus li rau hauv cov rog subcutaneous siv lub twj tso kua mis. Kev txhaj tshuaj subcutaneous ntawm cov tshuaj yog tsim hauv plab, ncej puab lossis xub pwg. Kev hno tawm kuj yog ua rau hauv plab.

Cov chaw ntawm Txoj kev lis ntshav thiab txhaj tshuaj nrog txhua cov tshuaj insulin tshiab yuav tsum ua lwm txoj haujlwm. Thaum pib ntawm kev nqis tes ua, nws lub sijhawm thiab tus nqi ntawm adsorption, kev siv dag zog thiab thaj chaw ntawm cov thawj coj tuaj yeem cuam tshuam. Kev tswj hwm tus neeg mob rau lub plab ua rau muaj kev tshaj tawm sai dua li kev txhaj tshuaj rau lwm qhov ntawm lub cev.

Txhawm rau tshem tawm cov tshuaj los ntawm kev nkag mus ncaj qha rau hauv cov hlab ntshav, qhov yuav tsum tau ceev faj tshwj xeeb. Sai li sai tau tom qab ua haujlwm ntawm cov tshuaj, lub vev xaib yuav tsum tsis txhob zaws.

Nws raug tso cai kom sib xyaw Apidra tsuas yog siv nrog tib neeg insulin-isophan.

Insulin twj tso kua mis rau kev nruam subcutaneous Txoj kev lis ntshav

Yog hais tias Apidra tau siv los ntawm lub twj tso kua mis lub zog rau kev txuas ntxiv infusion ntawm insulin, nws yog txwv tsis pub nws xyaw nrog lwm cov tshuaj.

Txhawm rau tau txais cov ntaub ntawv ntxiv rau kev ua haujlwm ntawm cov tshuaj, nws yog ib qho tsim nyog yuav tsum kawm cov lus qhia nrog rau nws. Nrog rau qhov no, tag nrho cov lus pom zoo hais txog kev siv cov kua dej puv lub taub hau yuav tsum tau ua raws.

Cov pab pawg tshwj xeeb ntawm cov neeg mob suav nrog cov neeg mob uas muaj:

Lub raum khiav tsis zoo (nrog rau cov kab mob zoo li no, xav tau cov tshuaj insulin tuaj yeem txo qis),
kev ua haujlwm tsis haum rau hepatic (zoo li yav dhau los, qhov kev xav tau los ntawm insulin yuav tuaj yeem txo vim muaj peev xwm txo qis gluconeogenesis thiab txo qis hauv insulin metabolism).

Cov ntaub ntawv ntawm pharmacokinetic kev tshawb fawb ntawm cov tshuaj hauv cov neeg laus yog tseem tsis txaus. Txoj kev xav tau cov tshuaj insulin hauv cov neeg laus cov neeg laus tuaj yeem txo vim yog lub raum tsis ua haujlwm.

Cov tshuaj tuaj yeem muab rau cov menyuam yaus tom qab 6 xyoo thiab cov hluas. Cov ntaub ntawv qhia txog cov tshuaj ntawm cov menyuam yaus hnub nyoog qis dua 6 xyoo tsis muaj.

Kev phiv tshuaj

Feem ntau cov kev xav tsis zoo uas tshwm sim thaum kho cov tshuaj insulin thaum kev noj tshuaj ntau dua yog qhov ua kom tsis txhob mob ntshav qab zib.

Muaj lwm qhov kev phiv tshuaj uas cuam tshuam nrog kev siv tshuaj yeeb thiab tau pom hauv kev sim tshuaj, lawv cov ntau zaus muaj tshwm sim hauv lub rooj.

Nquag muaj tshwm sim	Ntau tshaj	Tsawg dua
Tsis tshua muaj neeg pom	—	1/10000
Tsawg	1/10000	1/1000
Tau sib deev	1/1000	1/100
Nquag	1/100	1/10
Tsis tshua muaj neeg nquag	1/10	—

Kev cuam tshuam los ntawm cov metabolism thiab daim tawv nqaij

Heev feem ntau hypoglycemia tsim. Cov tsos mob ntawm tus mob no feem ntau tshwm sim sai. Cov qauv hauv qab no yog rau cov tsos mob neuropsychiatric:

Qaug qaug zog, mloog zoo li qaug zog, qaug zog.
Tsis tshua muaj peev xwm ua kom pom tseeb.
Pom kev tsis sib haum xeeb.
Kev nkees nkees.
Mob taub hau, xeev siab.
Tsis meej pem ntawm kev nco qab lossis nws qhov ua tiav tsis tiav.
Xaus cov leeg mob.

Tab sis feem ntau, cov cim neuropsychiatric yog ua ntej los ntawm cov cim ntawm adrenergic counter-regulation (teb rau hypoglycemia ntawm lub cev sympathoadrenal):

Tsaus arousal, chim siab.
Tsov siab, ntxhov siab.
Tsaus muag pom tsis zoo.
Pallor ntawm daim tawv nqaij.
Tachycardia.
Ua fws hws.

Tseem Ceeb! Rov ua dua ntawm cov ntshav qog ua kom ntshav qab zib tuaj yeem ua kev puas tsuaj rau cov hlab ntshav ntawm lub paj hlwb. Kev mob tshwm sim ntawm qhov mob ntshav qab zib thiab lub sijhawm ntev ntev ua rau muaj kev hem thawj rau lub neej ntawm tus neeg mob, vim tias txawm tias txoj kev tuag yuav tshwm sim nrog lub xeev nce ntxiv.

Ntawm qhov chaw txhaj tshuaj ntawm cov tshuaj, hauv zos qhov pom ntawm hypersensitivity feem ntau pom:

Yeej, cov kev cuam tshuam no yog hloov thiab feem ntau feem ntau ploj nrog kev kho ntxiv.

Xws li cov tshuaj tiv thaiv los ntawm cov nqaij mos subcutaneous, xws li lipodystrophy, yog qhov tsawg heev, tab sis nws tuaj yeem tshwm sim vim qhov kev ua txhaum ntawm qhov hloov ntawm qhov chaw txhaj tshuaj (koj tsis tuaj yeem nkag rau hauv insulin hauv tib thaj chaw).

Kev ntsawv siab dav

Cov kab ke ua rau lub cev tsis tshua nco qab muaj tsawg, tab sis yog tias lawv tshwm sim, tom qab ntawv cov tsos mob li no:

urticaria
zawm caj pas
hauv siab nruj
khaus
ua xua dermatitis.

Cov teeb meem tshwj xeeb ntawm kev tsis haum tshuaj (qhov no suav nrog kev nthuav qhia) ua rau muaj kev hem thawj rau tus neeg mob lub neej.

Cev xeeb tub

Cov ntaub ntawv hais txog kev siv insulin-glulisin los ntawm cov poj niam cev xeeb tub tsis muaj. Cov kev sim me nyuam hauv tsiaj tsis tau qhia txog qhov sib txawv ntawm tib neeg cov tshuaj lom neeg insulin thiab insulin-glulisin cuam tshuam nrog kev xeeb tub, kev loj hlob ntawm tus menyuam hauv plab, yug menyuam thiab tom qab yug menyuam.

Txawm li cas los xij, cov poj niam cev xeeb tub yuav tsum sau cov tshuaj kom zoo zoo. Thaum lub sijhawm kho mob, kev saib xyuas cov ntshav qab zib yuav tsum tau saib xyuas tsis tu ncua.

Cov neeg mob uas muaj ntshav qab zib ua ntej cev xeeb tub lossis tus neeg uas muaj tus mob ntshav qab zib hauv kev xeeb tub hauv cov poj niam cev xeeb tub yuav tsum tswj kev tiv thaiv glycemic thoob plaws lub sijhawm.

Hauv thawj peb lub hlis thaum cev xeeb tub, tus neeg mob xav tau cov tshuaj insulin yuav poob qis. Tab sis, raws li txoj cai, hauv kev txiav txim siab tom qab, nws nce.

Tom qab yug menyuam tas, xav tau cov tshuaj insulin tsawg dua. Cov poj niam npaj ua cev xeeb tub yuav tsum qhia lawv tus kws kho mob txog qhov no.

Tseem tsis tau paub meej tias insulin-glulisin tuaj yeem nkag mus rau hauv niam mis tau li cas. Cov poj niam thaum lub sij hawm pub mis niam yuav xav tau los kho qhov ntau npaum ntawm cov tshuaj thiab kev noj haus.