Soluble ea tlhaho e entsoe ka insulin le tsohle ka eona

Lihormone le bahanyetsi ba tsona ba nakoana ba etsang lintho tse ling.

100ME / ml-5ml D.t.d.№5 ho Flac.

S: ka mokhoa o ikhethileng metsotso e 30 pele o ja makhetlo a 4 ka letsatsi

Rp. Insulini 40 ME (5 ml)

Koahela ka mokhoa o ikhethileng ka li-0.5 ml makhetlo a 3 ka letsatsi metsotso e 30 pele ho lijo.

Ho sebelisana le li-receptor tse ikhethang ho membrane e ka ntle ea lisele, ho etsa motsoako oa "insulin" receptor

Mofuta oa 1, lefu la tsoekere la 2 lefu la tsoekere, lefu la tsoekere, ketoacidotic le hyperosmolar coma, lefu la tsoekere la basali baimana pele a fetohela kalafo ka litokisetso tsa nako e telele tsa insulin.

Litla-morao, hypoglycemia, hypoglycemic coma, ho senyeha ha nakoana hoa pono (hangata qalong ea kalafo), hyperemia, pruritus, le lipodystrophy (sebakeng sa ente).

50 Insulin-Isophan (Boenjiniere ba Liphatsa tsa Motho)

Insulin ea Nako e Bohareng

S: entša ho emisoa ka makhetlo a mabeli ka letsatsi

Rp. Insulini-isophani 40 ME (5 ml)

Koahela ka mokhoa o ikhethileng ka li-0.5 ml makhetlo a 2 ka letsatsi metsotso e 30 pele ho lijo.

E sebetsana le li-receptor tse ikhethang tsa lera le ka ntle la cytoplasmic ea sele le ho theha motsoako oa "insulin-receptor" o tsosetsang ts'ebetso ea methapo ea kutlo

Mofuta oa lefu la tsoekere la 1.2, mellitus ea mofuta oa 2 ho basali baimana.

maemo a hypoglycemic hypoglycemic coma. ho ruruha, liphoso tsa nakoana tse hlahang

51 ipratropium bromide

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

S.: 0.5 mg (marotholi a 40) makhetlo a 3-4 ka letsatsi ka nebulizer, eo pele e neng e hlapolotsoe ka 4 ml ea saline.

Rp: Sol. Ipratropiibromidi 0,25% - 20ml

D.S .: 2 ml (marotholi a 40) e qhibilihile ka 2 ml ea tharollo ea sodium chloride ea 0,9, e tšollele ka nebulizer. 1 inhalation makhetlo a 3 ka letsatsi.

Boloetse bo sa foleng ba 'mele oa pulmonary (bronchitis e sa feleng), pulmonary emphysema), asthma ea bronchial (e leka-lekaneng le e bonolo).

Hypersensitivity ho atropine le lihlahisoa tsa eona, le likarolo tse ling tsa lithethefatsi, boimana (I trimester), bana ba ka tlase ho lilemo tse 6

ho opeloa ke hlooho, ho nyekeloa ke pelo, molomo o omileng, tachycardia, palpitations, likhathatso tsa sebaka sa bolulo, ho fokotseha ha lekunutu la mofufutso, ho senyeha ha matla a ka mpeng, ho lula ka mokokotlong, ho kulisa.

52 Itracanazole. Baemeli ba antifungal ba sehlopha sa tse tsoang ho triazole

Rp. Intraconazoli 0,1

S: kahare ho 1 capsule 1 nako ka letsatsi.

inhibits cytochrome-P450 e itšetlehileng ka mofuta oa ergosterol - karolo ea bohlokoa ea membrane ea sele ea fungal.

Mycoses ea letlalo, mucosa ea molomo le mahlo, onychomycosis e bakoang ke dermatophytes, tomoso le hlobo, candidiasis e nang le tšenyo letlalong le mucous membrane. vulvovaginal candidiasis, pityriasis versicolor, systemic mycoses

dyspepsia, bohloko ba ka mpeng, ho eketsa ts'ebetso ea "transaminase" ea sebete, hlooho, ho tsekela, ho ruruha ha maikutlo, mokhathala, ho otsela.

Phapang ke efe pakeng tsa litokisetso tsa "insulin" ho tloha ho e mong

1. Sekhahla sa tlhoekiso.
2. Mohloli oa risiti ke nama ea kolobe, bovine, insulin ea motho.
3. Likarolo tse ling tse kenyelletsoeng tharollong ea lithethefatsi ke litlhare, litlatsetso le tse ling.
4. Phokotso.
5. pH ea tharollo.
6. Bokhoni ba ho kopanya lithethefatsi tse khutšoane le tse telele.

Insulin ke hormone e hlahisoang ke lisele tse ikhethileng makhophong. Ke protheine e mekhahlelo e 'meli, e kenyeletsang li-amino acid tse 51.

Hoo e ka bang limillione tse 6 tsa insulin li nooa selemo le selemo lefatšeng ka bophara (unit e le 'ngoe e le li-microgram tse 42). Ho hlahisoa ha insulin ho na le theknoloji e phahameng haholo 'me ho etsoa feela ke mekhoa ea indasteri.

Mehloli ea insulin

Hajoale, ho latela mohloli oa tlhahiso, li-insulin tsa "pig" le litokisetso tsa insulin ea motho li ikhethile.

Hona joale insulin ea nama ea kolobe e na le tekanyo e phahameng haholo ea tlhoekiso, e na le phello e ntle ea hypoglycemic, 'me ho hang ha ho na lintho tse ka re sitisang.

Litokisetso tsa insulin ea motho li lumellana ka botlalo sebopeho sa lik'hemik'hale le hormone ea motho. Hangata li hlahisoa ke biosynthesis li sebelisa mahlale a boenjiniere ba liphatsa tsa lefutso.

Baetsi ba kholo ba sebelisa mekhoa e joalo ea tlhahiso e netefatsang hore lihlahisoa tsa bona li fihlella litekanyetso tsohle tsa boleng. Ha ho phapang e kholo ketsong ea "insulin" ea motho le ea porcine monocomponent (i .e., E hloekisitsoeng haholo) e fumanoeng; mabapi le sesole sa 'mele, ho latela lithuto tse ngata, phapang e nyane.

Lintho tse thusang tse sebelisoang ho hlahisa insulin

Ka botlolong e nang le moriana o na le tharollo e senang insulin feela, empa le lisebelisoa tse ling. E mong le e mong oa bona o bapala karolo ea hae:

• ho lelefatsa ketso ea moriana,
• tharollo disinversal
• boteng ba thepa ea "buffer" ea tharollo le ho boloka pH e sa nke lehlakore.

Katoloso ea insulin

Ho theha insulin e atisang ho sebetsa, e 'ngoe ea metsoako e' meli, zinki kapa protamine, e eketsoa ka tharollo ea "insulin" e tloaelehileng. Ho latela sena, insulin tsohle li ka aroloa ka lihlopha tse peli:

• protamine insulin - protafan, insuman basal, NPH, humulin N,
• zinc-insulin - insulin-zinc-suspensions ea mono-tard, theipi, humulin-zinc.

Protamine ke protheine, empa lintho tse feto-fetohang ka tsela e tšoanang le tsona ha li na seoelo.

Ho theha tikoloho ea tharollo ea tharollo, ho eketsoa phosphate buffer ho eona. Ho lokela ho hopoloa hore insulin e nang le phosphates e thibetsoe ka thata ho kopana le insulin-zinc emisation (ICS), kaha zinc phosphate e fana ka mokhoa ona, mme ketso ea zinc-insulin e khutsufalitsoe ka tsela e sa lebelloang.

Lisebelisoa tse bolaeang likokoana-hloko

Tse ling tsa likhokahanyo tseo, ho ea ka litekanyetso tsa meriana le theknoloji, li lokelang ho kenngoa tšebetsong, li na le litlamorao tse bolaeang likokoana-hloko. Tsena li kenyelletsa cresol le phenol (bobeli ba tsona li na le monko o itseng), hammoho le methyl parabenzoate (methyl paraben), e se nang monko.

Kenyelletso ea efe kapa efe ea li-preservices tsena mme e baka monko o itseng oa litokisetso tse ling tsa insulin. Lintho tsohle tse bolokiloeng ka nako eo li fumanoang ka litokisetso tsa insulin ha li na phello e mpe.

Protamine insulin hangata e kenyelletsa cresol kapa phenol. Phenol e ke ke ea eketsoa ho tharollo ea ICS hobane e fetola likarolo tsa mmele tsa lihormone. Lithethefatsi tsena li kenyelletsa methyl paraben. Hape, li-ion tsa zinki ka tharollo li na le phello ea antimicrobial.

Ka lebaka la ts'ireletso ea antibacterial ea mekhahlelo e mengata, lithibela-mafu li thibeloa ho theha mathata a ka bang teng ka lebaka la tšoaetso ea baktheria ha nale e kenngoa khafetsa tharollo ea vial.

Ka lebaka la ts'ebetso ea ts'ireletso e joalo, mokuli a ka sebelisa syringe e le ngoe bakeng sa ente ea subcutaneous ea moriana matsatsi a 5 ho isa ho a supileng (ha feela a sebelisa syringe). Ho feta moo, meriana e thibelang bokhachane e etsa hore ho se sebelisoe joala ho phekola letlalo pele ho ente, empa hape haeba feela mokuli a intša kotsi ka ente e nang le nale e tšesaane (insulin).

Insulin Syringe calibration

Litokelong tsa pele tsa insulin, ho ne ho e-na le karolo e le 'ngoe feela ea lihormone e neng e le ka ml e le ngoe ea tharollo. Hamorao, mahloriso a ile a eketseha. Boholo ba litokisetso tsa insulin ka libotlolong tse sebelisoang Russia li na le li-unit tse 40 ho 1 ml ea tharollo. Hangata, likhahla li tšoailoe li-unit tsa U-40 kapa 40 / ml.

E etselitsoe tšebeliso e pharalletseng, feela bakeng sa insulin e joalo le ho lekanya ha eona ho etsoa ho latela molaoana o latelang: ha syringe e tletse ka 0.5 ml ea tharollo, motho o fumana likarolo tse 20, 0,35 ml e tsamaellana le likarolo tse 10, joalo-joalo.

Letšoao le leng le le leng ka syringe le lekana le bophahamo bo itseng, 'me mokuli o se a tseba hore na li-unit tsena li kae. Ka hona, tekanyo ea liponts'oa ke likhakanyo ka bophahamo ba moriana, o balletsoeng ts'ebeliso ea insulin U-40.Likarolo tse 4 tsa insulin li teng ka li-0.1 ml, li-unit tse 6 - ho 0,15 ml ea moriana, joalo-joalo, ho fihla ho li-unit tse 40, tse lumellanang le 1 ml ea tharollo.

Meropa e meng e sebelisa insulin, 1 ml e na le li-unit tsa 100 (U-100). Bakeng sa lithethefatsi tse joalo, li-syringe tse khethehileng tsa insulin li hlahisoa, tse tšoanang le tseo ho neng ho buisanoe ka tsona ka holimo, empa li kentsoe mokhoa o fapaneng oa ho lekola.

E nka mohopolo ona (o phahame ka makhetlo a 2,5 ho feta tekanyetso). Maemong ana, tekanyetso ea insulin bakeng sa mokuli, ehlile e lula e le joalo, kaha e khotsofatsa tlhoko ea 'mele ea insulin e itseng.

Ka mantsoe a mang, haeba mokuli a kile a sebelisa lithethefatsi U-40 'me a kenya li-unit tsa 40 ka letsatsi, o lokela ho amohela likarolo tse 40 ha a kenya insulin U-100, empa a e ente ka makhetlo a 2,5. Ka mantsoe a mang, li-unit tse 40 li tla ba teng ka har'a 4,4 ml ea tharollo.

Ka bomalimabe, ha se lingaka tsohle mme haholo-holo tse nang le lefu la tsoekere tse tsebang sena. Mathata a pele a qalile ha bakuli ba bang ba fetohela ho sebelisa lipilisi tsa insulin (lipentšele tsa syringe), tse sebelisang lipallo (mabokose a khethehileng) a nang le insulin U-40.

Haeba u tlatsa syringe ka tharollo e ngotsoeng U-100, ka mohlala, ho fihla ho li-unit tsa 20 (i.etsi la 0.5 ml), moqolo ona o tla ba le likarolo tse ka bang 50 tsa moriana.

Nako le nako, ha a tlatsa lisirinji tsa U-100 ka lisirinji tse tloaelehileng ebe o sheba li-unit tse khaotsoeng, motho o tla fumana tekanyetso makhetlo a 2,5 ho feta e bonts'itsoeng boemong ba letšoao lena. Haeba ngaka kapa mokuli a sa bone phoso ena ka nako, menyetla ea ho ba le hypoglycemia e phahameng e phahame ka lebaka la lithethefatsi tse ngata tse sebelisoang nako le nako tseo hangata li etsahala.

Ka lehlakoreng le leng, ka linako tse ling ho na le li-insulin tsa insulin tse lekantsoeng ka ho khetheha bakeng sa lithethefatsi U-100. Haeba syringe e joalo e tlatsitsoe ka phoso ka tharollo e tloaelehileng ea U-40, tekanyetso ea insulin ho syringe e tla ba tlase ho makhetlo a 2,5 ho feta e ngotsoeng haufinyane le letšoao le lumellanang le seratsoana.

Ka lebaka la sena, keketseho e sa reroang ea tsoekere ea mali e ka etsahala qalong. Ebile, ehlile, ntho e ngoe le e ngoe e ea utloahala - bakeng sa motsoako o mong le o mong oa lithethefatsi ho hlokahala ho sebelisa syringe e loketseng.

Ka linaha tse ling, mohlala, Switzerland, ho ile ha nahanoa leano ka hloko, ho latela phetoho e nang le bokhoni ea ho hlophisa insulin ho reha U-100. Empa sena se hloka ho kopana haufi-ufi le bohle ba amehang: lingaka tsa maemo a mangata, bakuli, baoki ba tsoang mafapheng afe kapa afe, litsebi tsa meriana, bahlahisi, ba boholong.

Naheng ea rona, ho thata haholo ho fetisetsa bakuli bohle ts'ebeliso ea insulin U-100 feela, hobane, ho ka etsahala, sena se tla lebisa ho eketseha ha palo ea liphoso tsa ho fumana lethal dose.

Tšebeliso e kopaneng ea insulin e khutšoane le e telele

Ka bongaka ba sejoale-joale, kalafo ea lefu la tsoekere, haholo-holo mofuta oa pele, hangata e etsahala ka ho kopanya mefuta e 'meli ea insulin - ketso e khutšoane le e telele.

Ho ka ba bonolo haholoanyane ho bakuli haeba lithethefatsi tse nang le linako tse fapaneng tsa ts'ebetso li ka kopanngoa syringe e le ngoe mme li fanoe ka nako e le ngoe ho qoba ho otloa ka makhetlo a mabeli.

Lingaka tse ngata ha li tsebe hore na ke eng e lekang bokhoni ba ho kopanya li-insulin tse fapaneng. Motheo oa sena ke khokahano ea lik'hemik'hale le galenic (e khethiloeng ke sebopeho) ho lumellana ha li-insulin tse atolositsoeng le tse khutšoane.

Ho bohlokoa haholo hore ha o kopanya mefuta e 'meli ea lithethefatsi, ts'ebetso ea ts'ebetso ea insulin e khuts'oane ha e otlolle kapa ea nyamela.

Ho netefalitsoe hore setlhare se sebetsanang le nako e khuts'oane se ka kopanngoa ka ente e le 'ngoe le protulin-insulin, ha ho qalella ha insulin e nkang nako e khuts'oane ha e liehe, hobane insulin e sa sebetseng ha e tlamele protamine.

Tabeng ena, moetsi oa lithethefatsi ha a na taba.Mohlala, o ka kopantsoe le humulin H kapa protafan. Ho feta moo, metsoako ea litokisetso tsena e ka bolokoa.

Mabapi le litokisetso tsa zinc-insulin, e se e le khale e thehiloe hore insulin-zinc-suspension (kristalline) e ka se kopane le insulin, kaha e tlama li-ion tse feteletseng ebe e fetoha insulin ea nako e telele, ka linako tse ling e le karolo.

Bakuli ba bang ba qala ho fana ka moriana o nkang nakoana, ntle le ho tlosa nale ka tlasa letlalo, ba fetole tsela eo ba e tsamaisang ebe zinc-insulin e kenella ka har'a eona.

Ho ea ka mokhoa ona oa tsamaiso, ho entsoe lipatlisiso tse ngata tsa mahlale, ka hona ho ke ke ha ahloloa hore maemong a mang ka mokhoa ona oa ente motsoako oa zinc-insulin le sethethefatsi se sebetsanang le nako e khuts'oane se ka theha ka tlasa letlalo, se lebisang ho kenngoeng hampe hoa morao.

Ka hona, ho molemo ho tsamaisa insulin e khuts'oane ka botlalo le zinc-insulin, etsa liente tse peli tse arohaneng libakeng tsa letlalo tse bonyane 1 cm ka thoko ho e ngoe. Sena ha se bonolo, re sa bue ka tekanyetso e tloaelehileng.

Insulin e kopaneng

Hona joale indasteri ea litlama e hlahisa litokisetso tsa ho kopanya tse nang le insulin e nkang nakoana le protamine-insulin ka tekanyo e hlalositsoeng hantle ea liperesente. Lithethefatsi tsena li kenyelletsa:

Motsoako o sebetsang ka ho fetisisa ke oo ho oona karo-karolelano ea insulin e telele ho isa ho 30:70 kapa 25:75. Tekanyo ena e lula e bonts'oa litaelo tsa ts'ebeliso ea moriana o mong le o mong.

Lithethefatsi tse joalo li loketse batho ba latelang ho ja kamehla, ka ho ikoetlisa khafetsa. Mohlala, hangata li sebelisoa ke bakuli ba tsofetseng ba nang le lefu la tsoekere la mofuta oa 2.

Li-insulin tse kopaneng ha li tšoanelehe bakeng sa ts'ebetsong kalafo ea "insulin" eo ho thoeng e "feto-fetohang", ha ho hlokahala hore kamehla e fetole litekanyetso tsa insulin.

Mohlala, sena se lokela ho etsoa ha ho fetoloa palo ea lik'habohaedreite lijong, ho fokotsa kapa ho eketsa ts'ebetso ea 'mele, jj. Tabeng ena, tekanyetso ea basal insulin (ea nako e telele) ha e fetohe.

Foromo, lebitso la lik'hemik'hale: ha ho na data.
Sehlopha sa litloholo: lihormone le bahanyetsi ba tsona / insulin.
Ketso ea pharmacological: hypoglycemic.

Melemo ea pharmacological

Insulin ea motho ke tokisetso ea insulin e sebetsang ea mahareng e fumanoang ka mokhoa oa theknoloji ea DNA e kopanyang. Insulin ea motho e laola ho kenella ha glucose maling, ho hlaha le metabolism ea lik'habohaedreite, mafura, liprotheine tse ka har'a litho tsa sepheo (mesifa ea marapo, sebete, lithaelese tsa adipose). Insulin ea motho e na le thepa ea anabolic le anti-catabolic athari. Liseleng tsa mesifa, ho na le keketseho ea litaba tsa glycerol, glycogen, mafura acid, keketseho ea liprotheine e kopaneng le keketseho ea tšebeliso ea li-amino acid, empa ho na le ho fokotseha ha gluconeogeneis, lipolysis, glycogenolysis, ketogeneis, proteni catabolism le tokollo ea liamino acid. Insulin ea motho e tlama mokokotlo oa "membrane receptor" ("tetramer", e nang le li-subunits tse 4, tse 2 tsa tsona (beta) li kenelletse ka har'a litho tsa cytoplasmic mme li kenya ts'ebetso ea tyrosine kinase, mme tse ling tse peli (alpha) ke extramembrane mme li ikarabella bakeng sa ho kopanya ha hormone). e fetang tlasa Autophosphorylation. Ho rarahana hona ha lisele tse sa sebetseng hantle phosphorylates threonine le lipheletso tsa serine tsa liprotheine tsa protheine, tse lebisang ho thehoeng ha phosphatidylinositol glycan le ho tsosa phosphorylation, e hlahisang ts'ebetso ea enzymatic liseleng tse reriloeng. Ka mesifa le lisele tse ling (ntle le boko), e phahamisa phetisetso e kenelletseng ea tsoekere le amino acid, e fokotsa butle-butle protheine ea protheine, 'me e tsosa lits'ebetso tsa maiketsetso.Insulin ea motho e khothalletsa ho bokellana ha tsoekere maling ka mokhoa oa glycogen le inhibits glycogenolysis (gluconeogenesis). Phapang e ikhethang ea ts'ebetso ea insulin e itšetlehile ka tekanyetso, sebaka sa ente, ts'ebetso ea 'mele ea mokuli, lijo le lintlha tse ling.
Ho kenngoa ha insulin ea motho ho latela mokhoa le sebaka sa tsamaiso (serope, mpa, mpa), khatello ea insulin, bophahamo ba ente. Insulin ea motho e ajoa ka tsela e sa lekanang liseleng tsohle, ha e kenelle ka lebeseng la mpa le ka sehikeng sa placental. Ho hlepha ha lithethefatsi ho etsahala ka har'a sebete tlas'a ts'ebetso ea insulinase (glutathione-insulin transhydrogenase), e leng hydrolyzes discride bond pakeng tsa liketane A le B mme e li etsa hore li fumanehe ka li-enzyme tsa protein. Insulin ea motho e epolloa ke liphio (30 - 80%).

Mofuta oa 1 le mofuta oa 2 lefu la tsoekere le hlokang ho phekoloa ka insulin (ka ho hanyetsana le lithethefatsi tse tsoang ka molomo kapa ka kalafo e kopaneng), lefu la tsoekere nakong ea kemolo.

Tekanyetso le tsamaiso ea insulin ea motho

Mokhoa oa tsamaiso ea lithethefatsi o latela mofuta oa insulin. Ngaka e beha lethal dose ka bonngoe, ho latela boemo ba glycemia.
Ho kenngoa liente ka sekontiri leboteng la mpa ea mpa, thipa, lehetla, buttock. Litsi tsa ente li tlameha ho fetoloa e le hore sebaka se le seng se se ke sa hlola se sebelisoa hanngoe ka khoeli. Ka tsamaiso e tsamaisang insulin, tlhokomelo e lokela ho nkuoa hore e se ke ea kena ka sejelong sa mali nakong ea ente. Bakuli ba lokela ho koetlisetsoa tšebeliso e nepahetseng ea sesebelisoa sa ho tsamaisa insulin. Se ke oa silila sebaka sa ente ka mor'a ente. Mocheso oa lithethefatsi tse tsamaisitsoeng o lokela ho ba ka mocheso oa kamore.
Ho fokotsa palo ea liente tsa letsatsi le letsatsi ho fihlella ka ho kopanya insulin ea durations tse fapaneng tsa ketso.
Ka nts'etsopele ea maikutlo a ho kula, ho pepesetsoa mokuli sepetlele, ho khetholloa ha karolo ea motsoako eo e neng e le allergen, ho khethoa ha kalafo e lekaneng le ho khutlisetsa insulin hoa hlokahala.
Ho khaotsa ho phekoloa kapa tšebeliso ea litekanyetso tse sa lekaneng tsa insulin, haholo-holo ho bakuli ba nang le lefu la 1 lefu la tsoekere, ho ka lebisa ho hyperglycemia le lefu la tsoekere la lefu la tsoekere (maemo a ka behang bophelo ba mokuli kotsing).
Ntshetsopele ea hypoglycemia ka ts'ebeliso ea lithethefatsi e etsa hore ho be le ts'oaetso e feteletseng, ts'ebetso ea 'mele, tlolo ea lijo, ho senyeha ha liphio, sebete sa mafura.
Tekanyetso ea "insulin" e lokela ho fetoloa haeba maemo a sebetsang a tšoelesa ea pituitary, gland ea adrenal, tšoelesa ea qoqotho, liphio le / kapa sebete e senyehile, lefu la Addison, hypopituitarism le lefu la tsoekere ho bakuli ba lilemo tse fetang 65. Hape, phetoho ea tekanyetso ea insulin e ka hlokahala ka keketseho ea matla a ho ikoetlisa kapa phetoho ea lijo tse tloaelehileng. Ho ja ka mokhoa oa Ethanol (ho kenyeletsa le lino tse fokolang tsa joala) ho ka baka hypoglycemia. Se ke oa nka ethanol ka mpeng e se nang letho. Ka mafu a mang a kopaneng (haholo-holo a tšoaetsanoang), maemo a tsamaeang le feberu, khatello ea maikutlo, tlhoko ea insulin e ka eketseha.
Matšoao a li-insulin tsa hypoglycemia ha a sebelisa insulin ea motho ho bakuli ba bang a ka fokotsoa haholo kapa a fapana le a ileng a bonoa ka ts'ebeliso ea insulin ea tlhaho ea liphoofolo. Ka normalization ea tsoekere maling, ka mohlala, ka kalafo e matla e nang le insulin, matšoao kaofela kapa a mang a matšoao a hore pele ho hypoglycemia a ka nyamela, mabapi le hore na bakuli ba lokela ho tsebisoa eng. Matšoao a pele ho hypoglycemia a ka fokotsoa haholo kapa a fetoloa ka tsela e telele ea lefu la tsoekere, lefu la tsoekere le ts'ebeliso ea batho ba beta.
Bakeng sa bakuli ba bang, phetoho ea tekanyo e ka hlokahala ha ho tloha insulin e tsoang ho phoofolo ho ea ho insulin ea motho. Sena se ka etsahala nakong ea tsamaiso ea pele ea tokisetso ea insulin ea motho kapa butle-butle ka mor'a libeke kapa likhoeli tse seng kae ka mor'a phetiso.
Phetoho ea ho tsoa mofuteng o mong oa insulin e ea ho e ngoe e tlameha ho etsoa ka tlasa tlhokomelo e thata ea bongaka le taolo ea tsoekere ea mali. Liphetoho ts'ebetsong, brand (moetsi), mofuta, mefuta (motho, phoofolo, li-insulin analogs) le / kapa mokhoa oa tlhahiso (DNA recombinant insulin kapa insulin ea tlhaho ea liphoofolo) e kanna ea hloka tokiso ea tekanyetso.
Ha u sebelisa litokisetso tsa insulin ka nako e le ngoe le lithethefatsi tsa sehlopha sa thiazolidinedione, kotsi ea ho ba le edema le ho nyekeloa ke pelo ho sa feleng ea eketseha, haholo ho bakuli ba nang le methapo ea methapo ea methapo ea mali le ho ba teng hoa mabaka a ho se sebetse hantle ha pelo.
Ka hypoglycemia ho mokuli, lebelo la maikutlo le khatello ea maikutlo le ka fokotseha. Sena se ka ba kotsi ha bokhoni bona bo hlokahala haholo (mohlala, ho laola mechini, ho khanna makoloi le ba bang). Bakuli ba lokela ho eletsoa hore ba nke mehato ea ho thibela nts'etsopele ea hypoglycemia ha ba etsa lintho tse ka bang kotsi tse hlokang ho fetoha ha psychomotor kapele le tlhokomelo e eketsehileng (ho kenyelletsa le likoloi tsa ho khanna, ho sebetsa ka methapo). Sena se bohlokoa haholo ho bakuli ba nang le matšoao a ho ba sieo kapa a bobebe matšoao a hypoglycemia, hammoho le nts'etsopele ea hypoglycemia khafetsa. Maemong a joalo, ngaka e lokela ho lekola hore na menyetla ea mokuli e na le monyetla oa ho etsa ketso e joalo.

Bokhachane le pelehi

Nakong ea kemolo, ho bohlokoa haholo ho boloka taolo e ntle ea glycemic ho basali ba fumanang kalafo ea insulin. Nakong ea kemaro le ho lactation, ho hlokahala ho fetola tekanyetso ea insulin ho lefella lefu la tsoekere. Tlhokahalo ea insulin hangata e fokotseha ho trimester ea pele ea boimana mme e eketseha ka trimester ea bobeli le ea boraro ea kemaro. Tlhokahalo ea insulin e ka fokotseha haholo nakong ea tlhaho ea ngoana le hang ka mor'a eona. Basali ba nang le lefu la tsoekere ba hloka ho tsebisa ngaka ea bona ka ho ima kapa ho rera ka eona. Ho basali ba nang le lefu la tsoekere mellitus, ho ka hlokahala hore ho sebelisoe tokiso ea insulin le / kapa lijo nakong ea kanyeso. Insulin ea motho e ne e se mutagenic lethathamong la in vitro le la vivo lithutong tsa lefutso la liphatsa tsa lefutso.

Hobaneng insulin e bitsoa "genetically engineer"

Bakuli ba bang ba tšohile ha ba re "ba entsoe ka liphatsa tsa lefutso, 'ba ba hopotsa ka" li-GMO tse mpe. "

Ebile, e ne e le qibollo ea sethethefatsi sena se pholositseng bophelo ba batho ba limilione.

Qalong, lingaka li ne li sebelisa insulin e arohaneng le liphoofolo (boholo ba likolobe le likhomo). Leha ho le joalo, lihormone tsena e ne e se tsa batho ba tsoang linaheng tse ling, empa hape li ile tsa kena hang-hang maling, tsa baka tsitsipano ea tsoekere mme ea baka mathata a mangata.

Ho ile ha qaptjoa insulin ea insulin molemong oa ho nahanisisa ka litlhoko tsohle tsa mokuli ea nang le lefu la tsoekere, a etsa hore ho be le lintho tse ngata tse fapaneng tse fapaneng. Kamora ho qeta ts'ebetso ea eona, e ikhula ho li-amino acid tse tloaelehileng mme e tsoa 'meleng.

Melemo ea mantlha ea pharmacological

Soluble human insulin e bua ka lithethefatsi tse nkang nakoana insulin.

Hammoho le cell wall receptor, sethethefatsi se etsa mofuta oa "insulin" receptor o tsosetsang ts'ebetso ea methating:

1. Ho itšehla thajana ka botlalo bakeng sa ts'ebetso e felletseng le ho monya ha tsoekere ke lisele,
2. Keketseho ea lipalangoang tse makatsang le ho ts'oaroa ha glucose,
3. Tekanyetso e theohileng ea sebopeho sa glycogen sebeteng,
4. Ho susumetsa tlhahiso ea liprotheine le mafura.

Ka tsamaiso ea subcutaneous, moriana o qala ho sebetsa kamora metsotso e 20-30, o fihla o fihla ka nako ea lihora tse 1-3, o nka lihora tse ka bang 5-8.

Setlhare sena se ajoa ka tsela e fapaneng lithong: mohlala, ha se kenelle ka har'a sethopo sa placental ebile ha se fetele ka lebeseng la matsoele. Kamora ho qeta ts'ebetso ea eona, insulin ea motho e epuoa ho tsoa lipelong (hoo e ka bang 80%) kamora ho felisoa ha eona ke insulinase.

Matšoao a ho sebelisoa

Hangata, lingaka li fana ka insulin e qhibilihang maemong a:

• Boitlhapiso kapa kalafo e kopaneng ea mofuta oa tsoekere 1 le 2,
• Ho hanyetsa ka botlalo kapa ho se lekane (ho hanyetsa) ha mmele ho lithethefatsi tse tsoang ka molomo (tse nkiloeng ka molomo),
• Lefu la tsoekere ka nako ea boimana (haeba lijo li sa sebetse)
• Mathata a lefu la tsoekere mellitus (ketoacidosis, hypersmolar kapa ketoacidotic coma),
• Tsela ea kalafo ea lefu la tsoekere khahlanong le semelo sa ts'oaetso e fapaneng,
• Maemo a tšosang ho batho ba nang le lefu la tsoekere ba taolong ea molomo ea lithethefatsi tse fokotsang tsoekere (nako ea ts'ebetso, maloetse a tebileng, likotsi kapa serame pele a hlaha.,
• Lefu la tsoekere kapa ho fokola ha hepatic,
• Marapo a letlalo la letlalo la sefahleho (furunculosis, carbuncle, ulcers),
• Phetoho ea insulin ka ketso ea nako e telele (e telele).

Lintho tse fapaneng tse tla etsahala

Leha e na le mamello e ntle, insulin e ka ba le litlamorao ha e sebelisoa joalo ka:

1. Nts'etsopele ea hypoglycemia ka lebaka la ho lahloa ha sethethefatsi ke 'mele kapa karabelo ea immunological ka insulin ea eona.
2. Bohloko bo hlalosang (urticaria, ho hlohlona kapa ho tebileng ha Quincke edema ka ho ruruha ho tebileng ha sefahleho le membrane ea mucous, pallor le ho hema ka thata).
3. Hypoglycemic coma,
4. Ho ferekana kelellong (ka linako tse ling ho fihlela ho akheha),
5. Hyperglycemia kapa lefu la tsoekere (khahlanong le semelo sa feberu kapa tšoaetso, lijo tse se nang phepo e ntle, kamora ente e lahlehileng kapa tekanyo e fosahetseng),
6. Ho theoha ha bophelo bo botle ka sebopeho sa lenyora, ho otsela, takatso e fokotsehileng, bofubelu ba sefahleho,
7. Boitšoaro ba lehae selelekeleng hammoho (ho chesa, ho hlohlona, ​​bofubelu, ho tlokoma kapa atrophy ea adipose tiske).

Ho kopanya le lithethefatsi tse ling

Ha u sebelisa insulin ea motho ka lithethefatsi tse ling, phello ea eona ea hypoglycemic ea matlafala kapa ea fokola.

Phello ea ho fokotsa tsoekere e ka eketseha ha o nka insulin le:

1. Sulfonamides (sulfonamide kapa li-agents tsa hypoglycemic),
2. MAO inhibitors (furazolidone, jj),
3. Li-inhibitors tsa ACE (Captopril, enalapril, jj.),
4. Li-NSAIDs (aspirin, diclofenac, jj.),
5. Androgens le anabolic steroids (Anavar, Androxon, jj.),
6. Lithethefatsi tsa Antimalarial (quinoline, quinidine, jj),
7. Tetracyclines (tetracycline, doxycycline),
8. Lithethefatsi tse ling (theophylline, pyridoxine, morphine, jj)

Ho fokotsa phello ea hypoglycemic ea lithethefatsi, tšebelisano ea eona le:

• Glucocorticoids
• Amphetamines
• Estrogens (ho kenyelletsa le lithibela-pelehi tsa molomo),
• Diuretics
• Sympathomimetics
• Lihomone tsa qoqotho
• Lithethefatsi tse ikhethileng (triamterone, phenytoin, glucagon).

Hape, hammoho le insulin, lithethefatsi li ka fokotsa kapa tsa ntlafatsa sephetho sa hypoglycemic:

1. Beta blockers,
2. Reserpine
3. Morphine
4. Octreotide Ts'ebeliso le litlhare

Tekanyetso le mokhoa oa tsamaiso ea insulin ea motho o lula o khethoa ka mokhoa o fapaneng ke endocrinologist, ho nahanela matšoao a hlokahalang a tsoekere ea mali le moroto oa mokuli.

Setlhare sena se fanoa ka lefu la tsoekere ka mekhoa e mengata: subcutaneously (s / c), intramuscularly (i / m) kapa intravenously (i / v). Hangata, insulin e tsamaisoa ntle ho tšenyo ea nako. Ho etsa sena, sebelisa sebaka:

• Belly
• Mahetla
• Letlalo le phuthoa ka holim'a monyako.

Hangata lithethefatsi li fanoa ka methapo e matla maemong a hlobaetsang a bakoang ke lefu la tsoekere: ketoacidosis, lefu la tsoekere.

E eletsoa ho tsamaisa insulin metsotso e 15-30 pele ho lijo, makhetlo a 3 ka letsatsi. Ka linako tse ling ho laoloa lithethefatsi tse le 'ngoe tsa 5-6.

Tekanyetso ea insulin hangata e baloa ka tekanyo ea likarolo tsa 0.5-1 ka boima ba kilo e le ngoe. Haeba insulin e fanoa ka makhetlo a fetang 0,6 mg ka boima ba 'mele ka nako eo, moriana o lokela ho fuoa bonyane makhetlo a 2 ka letsatsi. Ka karolelano, litekanyetso tsa letsatsi le letsatsi li ka ba 30-40 unit (ho bana, likarolo tsa 8).

Bakhachane ba tloaetseng ho fuoa tekanyetso ea boima ba 'mele ea 0,6 PESCES. Lijana hangata li hlahisa makhetlo a 3-5 ka letsatsi, ho latela palo ea lijo.

Hangata, insulin e sebetsang ka potlako e kopantsoe le insulin e nkang nako e telele.

Melao ea tsamaiso ea insulin

Le bo-diabetes ba nang le boiphihlelo ba etsa liphoso ha ba tsamaisa insulin.

Melao ea bohlokoahali ea kalafo ea insulin ke:

1. Ho hlahloba bophelo ba sehatsetsing le maemo a polokelo ea lithethefatsi: ha ea lokela ho pepesetsoa ho chesa haholo kapa hypothermia.
2. Fokotsa likhahla tsa insulin tse tsoang ka sehatsetsing. Ho lekane ho boloka botlolo e qalileng sebakeng se lefifi ka mocheso oa kamore.
3. Pholoso ea litekanyetso tsa moriana ka litaelo le litlhahiso tsa ngaka.
4. Lokolla moea ho tsoa syringe pele ho ente. Ha ho hlokahale ho hlakola letlalo ka joala. Tšoaetso ka kalafo ea insulin ha e na seoelo, 'me joala bo fokotsa litlamorao tsa sethethefatsi.
5. Ho khetha sebaka se nepahetseng seo o ka se hlahisang. Bakeng sa insulin e nkang nakoana, ena ke mpa. Ha e kenngoa lehetleng kapa lemong la gluteal, moriana o sebetsa butle butle.
6. Thibelo ea mathata a setsing sa ente ea popelo ka mokhoa oa ho sebelisa sebaka sohle se kahare. Mpa eohle e sebelisetsoa ho tsamaisa insulin e haufinyane: ho tloha holimo mabarong a theko e boima ho isa molikong oa inguinal, ka bokaholimo ba teranka. Ho bohlokoa ho khutlisetsa lisenthimithara tse peli ho tloha litsing tsa khale tsa ente, ho hlahisa syringe ka li-degrees tsa 45-60, e le hore mori o se ke oa lutla.
7. Pele o fana ka moriana, ho molemo ho phutha letlalo ka thipa le phatla. Haeba e kena mesifa, moriana o tla fokotsa ts'ebetso ea ona. Kamora ho kenya nale, ts'oara syringe hoo e ka bang metsotso e 5-10.
8. Ka mpeng, insulin e nkang nakoana e tsamaisoa hofihlella metsotso e 20 pele ho lijo. Libakeng tse ling, moriana o fuoa halofo ea hora pele ho lijo.

Khoebo lebitso la lithethefatsi

Insulin e etsoa ka tsela ea tharollo ea ente 'me e rekisoa meriana.

Li-insulin tsa motho tse entsoeng ka liphatsa tsa lefutso li ka hlahisoa tlasa mabitso a mabitso:

Ka lebaka la mahlale a morao-rao a liphatsa tsa lefutso, ho ile ha etsoa insulin ea batho ea maiketsetso (recombinant). Ke eena mohloli oa tšebetso: Humodar, Humulin, Insuman, Gansulin, Humalog, Apidra SoloStar, Mikstard. Lithethefatsi tsena li fapana le tsa pele ka tatellano e fapaneng ea li-amino acid, e eketsang thepa e ncha ho tsona (mohlala, phello e telele ea mekha e 'meli), e bohlokoa haholo ho bakuli ba lefu la tsoekere.

Bongata

Hoa etsahala hore tsamaiso ea insulin maemong a mang e lebisa ho hyperglycemia.

Matšoao a mantlha a hyperglycemia ke lipontšo ka mokhoa oa:

• Bofokoli
• Pallor
• Mofufutso o batang
• Ho otla hoa pelo
• Ho opeloa ke hlooho
• Maikutlo a tlala
• Ho thothomela 'meleng
• Bofuma ba leleme, molomo, maoto le matsoho.

Ha matšoao a tšoanang a qala, mokuli o lokela ho nka lijo tsa lik'habohaedreite habonolo (hangata pompong, sengoathoana sa tsoekere kapa tee e tsoekere).

Mathata

Ho phekoloa ka nako e telele ka insulin ho ka lebisa mathateng a fapaneng. Tse ka sehloohong ke:

1. Ketsahalo ea hypoglycemia. Mathata a amanang le phepo ea lijo, ho ata ha lithethefatsi, ho ikoetlisa ka ho feteletseng, mafu a liphio le sebete a ka kenya letsoho ho sena.
2. Postinjection lipodystrophy. Thibelo ea ts'ebetso ea methapo ea mafu ke ho fetola sebaka sa ente, ho eketsa tharollo ea novocaine (0.5-1,5 ml) ho insulin, le ho kenya ente ka inject ea botenya ba lithane tsa adipose.
3. Khanyetso ea lithethefatsi. Lithethefatsi tse ling tse atisang ho theoleloa tsoekere lia khethoa.
4. Litla-morao.Re sebelisitse kalafo e rarahaneng (li-antihistamines, glucocorticoids) le phetisetso e nepahetseng ea lithethefatsi.

Insulin ea insulin ea motho ke eona e bolokang bakuli ba bangata ba nang le lefu la tsoekere. Leha ho le joalo, ho bohlokoa ho sebelisa lithethefatsi tsena ka bohlale, o ela hloko melao eohle bakeng sa tsamaiso ea eona. Hoa hlokahala hore ngaka e laele moriana ona, ho bala tekanyo ea eona le ho lekola boemo ba mokuli nakong eohle ea kalafo.

Model Clinical-Pharmacological Article 1

Ketso ea polasi. Ho itokisetsa insulin kapele. Ho sebelisana le li-receptor tse ikhethang ho membrane e ka ntle ea lisele, ho etsa motsoako oa "insulin" receptor. Ka ho eketsa motsoako oa cAMP (liseleng tsa mafura le lisele tsa sebete) kapa ho kenella ka ho toba ka seleng (mesifa), motsoako oa "insulin" o hlohlelletsa lits'ebetso tse kahare ho eona, ho kenyeletsa synthetise ea li-enzymes tse 'maloa tsa bohlokoa (hexokinase, pyruvate kinase, glycogen synthetase, jj.). Ho fokotseha ha tekanyo ea tsoekere maling ho bakoa ke keketseho ea lipalangoang tsa eona tse kenang kahare, ho eketsoa hoa manonyeletso le ho ts'oaroa ha li-tishu, ho hlohlelletsa polelo lipoisis, glycogenogeneis, synthetiti ea protheine, ho fokotseha ha sekhahla sa tlhahiso ea tsoekere ke sebete (ho fokotseha ha ho putlama ha glycogen) joalo-joalo ka mor'a ho kenngoa ka sefuba sa glycogen. Min, e fihla holimo ka mor'a lihora tse 1-3 mme e tšoarella, ho latela tekanyetso, lihora tse 5-8. Nako ea lithethefatsi e itšetlehile ka tekanyo, mokhoa, sebaka sa tsamaiso mme o na le litšobotsi tse ikhethang tsa motho ka mong.

Mofumahali Phello ea ho monya ho latela mokhoa oa tsamaiso (s / c, i / m), sebaka sa tsamaiso (mpa, thipa, buttocks), tekanyetso, insulin mahlahana a moriana, joalo-joalo e ajoa ka ho hloka toka lithong. Ha e tšele setsi sa placental mme e kene ka lebese la matsoele. E senngoa ke insulinase, haholo-holo ka har'a sebete le liphio. T_1/2 - ho tloha ho metsotso e fokolang ho isa ho e 10. E epolloa ke liphio (30-80%).

Matšoao. Mofuta oa 1 oa lefu la tsoekere, mofuta oa 2 lefu la tsoekere: sethala sa ho hanana le lithethefatsi tse tsoang molomong, lefu la tsoekere le ketoacidosis, ketoacidotic le hyperosmolar coma, lefu la tsoekere le ileng la etsahala nakong ea boimana. Tšebeliso e tloaelehileng ea bakuli ba nang le lefu la tsoekere khahlanong le tšoaetso e tsamaeang le feberu e matla, ka lits'ebetso tse tlang tsa ho buoa, likotsi, ho beleha bana, le litlolo tsa molao mabapi le ts'oaetso. Ho fapanyetsana lintho pele u fetohela kalafo ka litokisetso tsa insulin tsa nako e telele.

Contraindication Hypersensitivity, hypoglycemia.

Tekanyetso Tekanyetso le tsela ea tsamaiso ea moriana e khethoa ka bonngoe maemong ka seng ho latela taba ea tsoekere maling maling pele ho lijo le lihora tse 1 ka mor'a ho ja, hape ho latela tekanyo ea glucosuria le litšobotsi tsa nako ea lefu lena.

Moriana o fanoa ka / s, ka / m, ka / ka, metsotso e 15-30 pele ho lijo. Mokhoa o tloaelehileng oa tsamaiso ke sc. Ka lefu la tsoekere la ketoacidosis, lefu la tsoekere, nakong ea ts'ebetso ea ts'ebetso ea bongaka - in / in and / m.

Ka monotherapy, hangata khafetsa ea tsamaiso ka makhetlo a 3 ka letsatsi (haeba ho hlokahala, ho fihlela makhetlo a 5-6 ka letsatsi), sebaka sa ente se fetoloa nako le nako ho qoba nts'etsopele ea lipodystrophy (atrophy kapa hypertrophy ea mafura a subcutaneous).

Karolelano ea litekanyetso tsa letsatsi le letsatsi ke li-PIECES tse 30-40, ho bana - LI-PIERES tse 8, ebe ka nako eo u sebelisa tekanyetso ea letsatsi le letsatsi - 0.5-1 PIECES / kg kapa makhetlo a 3040 ka makhetlo a mararo ka letsatsi, haeba ho hlokahala - makhetlo a 5-6 ka letsatsi . Ka tekanyetso ea letsatsi le letsatsi e fetang 0,6 U / kg, insulin e lokela ho fanoa ka mokhoa oa liente tse 2 kapa ho feta libakeng tse fapaneng tsa 'mele. Hoa khoneha ho kopanngoa le li-insulin tse nkang nako e telele.

Tharollo ea "insulin" e bokelloa ka hara vial ka ho phunya ka nale ka sekontiri se nang le silika e kolobisang, e hlakotsoe kamora ho tlosa hlooho ea aluminium ka ethanol.

Litla-morao. Litla-morao tse o utloisang bohloko (urticaria, angioedema - feberu, ho hema ka thata, ho fokotseha ha khatello ea mali),

hypoglycemia (pallor ea letlalo, ho fufuleloa ho eketsehileng, ho fufuleloa, manonyeletso, ho thothomela, tlala, ho ferekana, ho tšoenyeha, ho sethepelo ka hanong, ho opeloa ke hlooho, ho otsela, ho hloka boroko, ho tšoha, ho sithabela maikutlo, ho hloka taolo, boits'oaro bo sa tloaelehang, ho hloka motsamao, mathata a puo le puo) pono), hypoglycemic coma,

hyperglycemia and diabetesic acidosis (ka tekanyetso e tlase, ho se tsitse lijoko, ho ja lijo tse fokolang, khahlanong le semelo sa feberu le tšoaetso): ho otsela, lenyora, takatso e fokotsehileng, ho fifala sefahlehong).

letsoalo le sa holofetseng (ho fihlela nts'etsopele ea precomatose le kome),

ho senyeha ha nakoana (hangata qalong ea phekolo),

tšusumetso ea matla a amanang le insulin le insulin ea motho, keketseho ea karolo ea lithibela-mafu tse khahlanong le insulin, tse lateloang ke keketseho ea glycemia,

hyperemia, ho hlohlona le lipodystrophy (atrophy kapa hypertrophy ea mafura a ikhethileng) sebakeng sa ente.

Qalong ea kalafo - ho ruruha le ho holofala 'metso (ke tsa nakoana ebile lia nyamela ka kalafo e tsoelang pele).

Bongata. Matšoao: hypoglycemia (bofokoli, mofufutso o batang, pallor ea letlalo, palpitations, ho thothomela, ho tšoha, tlala, paresthesia matsohong, maoto, melomo, leleme, hlooho), hypoglycemic coma, ho thothomela.

Phekolo: mokuli a ka tlosa hypoglycemia ka boeena ka ho inela tsoekere kapa lijo tse nang le lik'habohaedreite tse bonolo tse jang lijo.

Subcutaneous, i / m kapa iv ente glucagon kapa iv hypertonic dextrose tharollo. Ka nts'etsopele ea komello ea hypoglycemic, 2040 ml (ho fihlela ho 100 ml) ea tharollo ea dextrose 40% e kenngoa kahare ka nqeng ho mokuli ho fihlela mokuli a akheha.

Tšebelisano. Ka meriana ha a lumellane le tharollo ea lithethefatsi tse ling.

Phello ea hypoglycemic e ntlafatsoa ke li-sulfonamides (ho kenyeletsa le lithethefatsi tsa molomo tsa hypoglycemic, sulfonamides), li-inhibitors tsa MAO (ho kenyeletsoa furazolidone, procarbazine, selegiline), carbonic anhydrase inhibitors, li-inhibitors tsa ACE, li-NSAIDs (ho kenyeletsa le li-salicylates), anabolic (ho kenyelletsa stanozolol, oxandrolone, methandrostenolone), androgens, bromocriptine, tetracyclines, clofibrate, ketoconazole, mebendazole, theophylline, cyclophosphamide, phenfluramine, Li + litokisetso, pyridoxine, quinidine, quinine, chloroine, quinine, chloroine, quinine, etloro.

litla Hypoglycemic la litsebeng glucagon, khōlo hormone, corticosteroids, molomo lithibela-pelehi, estrogens, thiazide le sekgoqetsane diuretics, li-hormone BCCI, thyroid, heparin, sulfinpyrazone, sympathomimetics, danazol, tricyclics, clonidine, k'halsiamo ba khahlanong le lōna, diazoxide, morphine e, matekoane, bokoali, phenytoin, epinephrine blockers H₁li-histamine receptors.

Beta-blockers, reserpine, octreotide, pentamidine ka bobeli li ka ntlafatsa le ho fokolisa phello ea hypoglycemic ea insulin.

Litaelo tse khethehileng. Pele u nka insulin ho vial, ho hlokahala hore u hlahlobe ho bona tharollo. Ha litopo tse tsoang kantle ho naha li hlaha, ho koaheloa ke ntho kapa ho sesa hoa ntho ka khalase ea vial, sethethefatsi se ke ke sa sebelisoa.

Mocheso oa "insulin" o sebelisoang o lokela ho ba ka mocheso oa kamore. Tekanyetso ea "insulin" e lokela ho fetoloa maemong a tšoaetsanoang ke mafu a tšoaetsanoang, lefu la tšoelesa ea qoqotho, lefu la Addison, hypopituitarism, ho hloleha ha renal le lefu la tsoekere ho batho ba lilemo tse fetang 65.

Lisosa tsa hypoglycemia e ka ba: tšebeliso e ngata ea insulin, ho khutlisetsa lithethefatsi, ho tlōla lijo, ho hlatsa, lets'ollo, khatello ea mmele, mafu a fokotsang tlhoko ea insulin (mafu a tsoetseng pele a liphio le sebete, hammoho le hypofunction ea adrenal cortex, pituitary kapa gland ea tšoelesa). ente (mohlala, letlalo le ka mpeng, lehetleng, thipa), hammoho le ho sebelisana le lithethefatsi tse ling. Ho a khonahala ho fokotsa khatello ea "glucose" e ngata maling ha o fetisetsa mokuli ho tsoa ho insulin ea motho.

Phetisetso ea mokuli ho insulin ea batho e lokela ho lula e lokafatsoa ho tsa bongaka mme e etsoe feela ka taolo ea ngaka.Tšekamelo ea ho ba le hypoglycemia e ka fokolisa bokhoni ba bakuli ba ho nka karolo ka mafolofolo sephethephethe, le ho hlokomela mechini le metjeko.

Bakuli ba nang le lefu la tsoekere ba ka emisa hypoglycemia e nyane eo ba e utloang ka ho ja tsoekere kapa lijo tse nang le lik'habohaedreite (ho khothalletsoa hore o be le bonyane 20 g ea tsoekere le uena). Mabapi le hypoglycemia e fetiselitsoeng, ho bohlokoa ho tsebisa ngaka e eang ho etsa qeto ka tlhoko ea khalemelo ea kalafo.

Molemong oa kalafo ea "insulin" e sebelisang nako e khuts'oane maemong a arohaneng, ho ka khoneha ho fokotsa kapa ho eketsa molumo oa lisele tsa adipose (lipodystrophy) sebakeng sa ente. Lintho tsena li qojoa haholo ka ho fetolela sebaka sa ente kamehla. Nakong ea kemolo, ho hlokahala ho nahanela ho fokotseha (I trimester) kapa keketseho (II - III trimesters) ea litlhoko tsa insulin. Nakong ea ha lesea le hang kamora ho hlaha, litlhoko tsa insulin li ka theoha haholo. Nakong ea lactation, ho lekola letsatsi le letsatsi ho hlokahala likhoeli tse 'maloa (ho fihlela tlhoko ea insulin e tsitsitse).

Bakuli ba fumanang insulin e fetang 100 ea letsatsi ka letsatsi, ha ba fetola moriana o hloka ho kena sepetlele.

Ngoliso ea naha ea meriana. Phatlalatso ea semmuso: ho li-vols tse 2. M: Lekhotla la Bongaka, 2009. - Moq. 2, karolo ea 1 - 568 s. Karolo ea 2 - 560 s.

Litokisetso tse fumanoang lihlahisoa tse tala tsa tlhaho ea liphoofolo

Ho fumana lihormone ho tsoa makhophong a likolobe le likhomo ke theknoloji ea khale e seng e sa sebelisoe haholo kajeno. Sena se bakoa ke boleng bo tlase ba moriana o amohetseng, tšekamelo ea ona ea ho baka mafu le ho hlatsuoa ka mokhoa o sa lekanang. Taba ke hore kaha lihormone ke ntho ea protheine, e na le karolo e itseng ea li-amino acid.

Insulin e hlahisoang 'meleng oa kolobe e fapana ka sebopeho sa amino acid ho tsoa ho insulin ea motho ka 1 amino acid, le 3 ea insulin.

Qalong le bohareng ba lekholo la bo20 la lilemo, ha lithethefatsi tse tšoanang li ne li le sieo, esita le insulin e joalo e ne e le phetoho ea bongaka mme e lumelletse ho nka kalafo ea batho ba lefu la tsoekere ho ba isa maemong a macha. Lihormone tse fumanoeng ke mokhoa ona li fokotsa tsoekere ea mali, leha ho le joalo, hangata li ne li baka litla-morao. Liphapang mabapi le sebopeho sa li-amino acid le litšila tse ling tsa lithethefatsi li amme boemo ba bakuli, haholo-holo maemong a tlokotsing a bakuli (bana le maqheku). Lebaka le leng la ho se mamelle insulin e joalo ke ho ba teng ha eona e sa sebetseng kahare ho moriana (proinsulin), o neng o sa khone ho tlosa phapusing ena ea lithethefatsi.

Matsatsing ana, ho na le li-insulin tse tsoetseng pele tsa nama ea nama ea nama ea nama ea kolobe ntle le mefokolo ena. Li fumanoa ho tsoa matšoaong a kolobe, empa kamora moo li kenngoe ts'ebetsong le tlhoekiso e eketsehileng. Li na le lintho tse ngata tse fapaneng, 'me li na le likheo tsa tsona.

Insulin e fetotsoeng nama ea kolobe ha e tšoane le lihormone tsa motho, ka hona e ntse e sebelisoa le ho ikoetlisa

Lithethefatsi tse joalo li lumelloa ke bakuli hamolemo mme ha li bake litšitiso, ha li thibele sesole sa 'mele mme li fokotsa tsoekere ea mali ka katleho. Bovine insulin ha e sebelisoe ho tsa bongaka kajeno, hobane ka lebaka la sebopeho sa eona sa kantle ho naha e ama hampe tsamaiso ea 'mele ea ho itšireletsa mafung le' mele oa motho.

Insulin Boreli

Insulin ea motho, e sebelisetsoang batho ba nang le lefu la tsoekere, molemong oa indasteri e fumanoa ka litsela tse peli:

• U sebelisa kalafo ea enzymatic ea porcine insulin,
• sebelisa mefuta e fetotsoeng liphatsa tsa lefutso ea Escherichia coli kapa tomoso.

Ka phetoho ea lik'hemik'hale tsa physico, limolek'hule tsa porcine insulin tlasa ts'ebetso ea li-enzyme tse khethehileng li tšoana le insulin ea motho.Karolo ea amino acid e litokisetso tse etsahalang ha e tšoane le sebopeho sa lihimo tsa tlhaho tse hlahisoang 'meleng oa motho. Nakong ea ts'ebetso ea tlhahiso, moriana o itlhoekisa haholo, ka hona ha e bake lintho tse bohloko kapa lipontšo tse ling tse sa rateheng.

Empa khafetsa, insulin e fumanoa e sebelisoa ka li-microorganisms tse fetotsoeng (liphatsa tsa lefutso). U sebelisa mekhoa ea biotechnological, baktheria kapa tomoso e fetoloa ka tsela eo ka eona e ka hlahisang insulin.

Ntle le tlhahiso ea insulin ka boeona, tlhoekiso ea eona e bapala karolo ea bohlokoa. E le hore sethethefatsi se se ke sa baka karabelo leha e le efe ea ho kula le ho ruruha, sethaleng ka seng ho hlokahala hore ho be le ho hloeka ha litšila tsa likokoana-hloko le tharollo tsohle, hammoho le metsoako e sebelisitsoeng.

Ho na le mekhoa e 'meli bakeng sa tlhahiso ea insulin. Ya pele ho tsona e thehiloe ts'ebelisong ea mefuta e 'meli e fapaneng ea "mofuta" oa "microorganism" e le' ngoe. E 'ngoe le e' ngoe ea tsona e kopanya ketane e le 'ngoe ea molek'hule ea DNA ea li-hormone (ho na le tse peli feela tsa tsona,' me li hokahantsoe hammoho). Ebe liketane tsena li hokahane, 'me tharollong e hlahisitsoeng e se e khona ho arola mefuta e sebetsang ea insulin ho tse sa jereng bohlokoa ba tlhaho.

Mokhoa oa bobeli oa ho fumana moriana o sebelisa Escherichia coli kapa tomoso e thehiloe holima taba ea hore Microbe pele e hlahisa insulin e sa sebetseng (ka mantsoe a mang, proinsulin ea eona ke proinsulin). Ebe, ka ho sebelisa kalafo ea enzymatic, foromo ena e sebetsa 'me e sebelisoa ho tsa bongaka.

Basebetsi ba nang le phihlello ea lits'ebeletso tse ling tsa tlhahiso ba tlameha ho apesoa sutu e sa itšireletsang e felisang ho kopana ha sethethefatsi ka maro a tlhaho a motho.

Ts'ebetso tsena kaofela li etsoa ka boiketsetso, moea le libaka tsohle tse hokahaneng le li-ampoules le li-vials li hloekile, 'me mela e nang le lisebelisoa e tiisitsoe ka mokhoa o makatsang.

Mekhoa ea biotechnology e thusa bo-rasaense ho nahana ka tharollo e 'ngoe ea lefu la tsoekere. Mohlala, ho fihlela joale, lithuto tsa pele tsa ho etsoa ha lisele tsa maiketsetso tsa pancreatic beta li ntse li etsoa, ​​tse ka fumanoang ka mekhoa ea boenjiniere ba liphatsa tsa lefutso. Mohlomong nakong e tlang li tla sebelisoa ho ntlafatsa ts'ebetso ea setho sena ho motho ea kulang.

Ho hlahisa tsa sejoale-joale ke mokhoa o rarahaneng oa theknoloji, o kenyelletsang boits'oaro le ho kenella ha batho hanyane

Lintho tse ling

Ho hlahisoa ha insulin ntle le li-excipients lefats'eng la kajeno ho batla ho le thata ho nahana, hobane ba ka ntlafatsa thepa ea eona ea lik'hemik'hale, ba atolosa nako ea ts'ebetso le ho fihlela bohloeki bo phahameng.

Ka thepa ea bona, lisebelisoa tsohle tse ling li ka aroloa ka lihlopha tse latelang:

• li-prolongators (lintho tse sebelisetsoang ho fana ka tšebeliso e telele ea lithethefatsi),
• dikarolo tsa sebolaya-mafu
• ba tsitsitseng, ka lebaka leo acidity e nepahetseng e bolokiloeng tharollong ea lithethefatsi.

Ho eketsa nako

Ho na le li-insulin tse sebetsang nako e telele tseo mosebetsi oa tsona oa tlhaho o tsoalang lihora tse 8 ho isa ho tse 42 (ho latela sehlopha sa moriana). Phello ena e fihlella ka lebaka la kenyelletso ea lintho tse khethehileng - li-prolongator tharollo ea ente. Hangata, e 'ngoe ea likhomphutha tse latelang e sebelisetsoa morero ona:

Liprotheine tse eketsang ts'ebetso ea lithethefatsi li hloekisoa ka botlalo mme li na le allergenic e tlase (mohlala, protamine). Letsoai la Zinc le lona ha le ame mosebetsi o mongata oa insulin kapa ho phela hantle ha motho.

Libaka tsa tikoloho

Lithibela-mafu ka sebopeho sa insulin lia hlokahala e le hore limela tse sa bonahaleng li se ke tsa ngatafala nakong ea polokelo le tšebeliso ho eona. Lintho tsena ke lintho tse bolokang matla le ho netefatsa polokeho ea tšebetso ea tlhaho ea sethethefatsi.Ntle le moo, haeba mokuli a tsamaisa lihormone ho tloha ho vial e le 'ngoe feela ho eena, moriana o ka nka matsatsi a' maloa. Ka lebaka la likarolo tsa boleng bo phahameng ba antibacterial, a ke ke a ba le tlhoko ea ho lahla sethethefatsi se sa sebelisoeng ka lebaka la monyetla oa ho ikatisa ka tharollo ea likokoana-hloko.

Lintho tse latelang li ka sebelisoa e le lithibela-mafu tlhahisong ea insulin:

Haeba tharollo e na le li-ion tsa zinc, li sebetsa hape e le setlhare se bolokiloeng ka lebaka la thepa ea bona ea antimicrobial

Bakeng sa tlhahiso ea mofuta o mong le o mong oa insulin, likarolo tse ling tsa sesole li loketse. Tšebelisano ea bona le lihormone e tlameha ho hlahlojoa sethaleng sa liteko tsa tlhahlobo ea pele, hobane setlokotsebe ha sea lokela ho senya ts'ebetso ea biulin ea insulin kapa ka tsela e mpe e ama thepa ea eona.

Ts'ebeliso ea litlhare maemong a mangata e lumella lihormone ho tsamaisoa tlasa letlalo ntle le kalafo ea pele ka joala kapa li-antiseptics tse ling (hangata moetsi o bua ka sena ho latela litaelo). Sena se nolofalletsa tsamaiso ea lithethefatsi le ho fokotsa palo ea litokiso pele ho ente ka boeona. Empa tlhahiso ena e sebetsa feela haeba tharollo e fanoa ho sebelisoa sindano ea insulin e le ngoe ka nale e tšesaane.

Ba tsitsitseng

Li-stabilizer lia hlokahala e le hore pH ea tharollo e bolokoe boemong bo fanoeng. Ho bolokoa ha moriana, ts'ebetso ea ona le botsitso ba thepa ea lik'hemik'hale ho latela boemo ba acidity. Ha ho etsoa lihormone tsa ente ho bakuli ba nang le lefu la tsoekere, hangata phosphates e sebelisetsoa morero ona.

Bakeng sa insulin e nang le zinc, li-stabilizer tsa tharollo ha li hlokehe kamehla, kaha li-ion tsa tšepe li thusa ho boloka botsitso bo hlokahalang. Haeba li sebelisoa leha ho le joalo, metsoako e meng ea lik'hemik'hale e sebelisoa sebakeng sa phosphates, kaha motsoako oa lintho tsena o lebisa ho sethethefatsi le ho se sebetse hantle ha moriana. Thepa ea bohlokoa e bonts'itsoeng ho bohle ba tsitsitseng ke polokeho le ho se khone ho kena lipakeng ka insulin.

Ngaka e nang le bokhoni ea endocrinologist e lokela ho sebetsana le khetho ea lithethefatsi tse ka kenngoang tsoekere bakeng sa mokuli ka mong. Mosebetsi oa insulin ha se feela ho boloka tsoekere e tloaelehileng maling, empa hape ha se ho lematsa litho tse ling le litsamaiso tse ling. Setlhare se lokela ho se nke lehlakore ka mokhoa oa lik'hemik'hale, se tlase haholo 'me ka theko e tlase se khonehe. Ho boetse ho bonolo haholo haeba insulin e khethiloeng e ka tsoakoa le mefuta e meng ho latela hore na ketso e kae.

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H peni e tloaelehileng (Berlinsulin H tloaelehileng peni), Berlsulin H tloaelehileng U-40 (Berlinsulin H tloaelehileng U-40), Insuman ka potlako (Insuman kapele), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Ketso ea pharmacological

Ke tharollo ea insulin e sa jeleng paate e tšoanang le insulin ea motho. E bua ka li-insulin tse nkang nakoana. Mokokotlo oa mali o theola "glucose", e ntlafatsa ho monya ha eona ka linama, lipogenis, glycogenogeneis, semelo sa protheine, se fokotsa sekhahla sa tlhahiso ea tsoekere ke sebete.

Ho qala ha moriana ke metsotso e 20-30 ka mor'a ho tsamaisoa. Phello e phahameng e hlaha pakeng tsa lihora tse 1 le tse 3. Nako ea ts'ebetso ke lihora tse 6-8.

Boemo ba ts'ebetso ea "insulin" e sa sebetseng hantle ea insulin ea motho e itšetlehile ka tekanyetso mme e bonts'a ho kheloha ho hoholo pakeng le ka hare ho motho. Ho chesa ho tloha sebakeng sa ente ho potlakile ho feta "insulin" e kenang ka lero la insulin.

,: sethala sa ho hanyetsa li-agent tsa hypoglycemic tsa molomo, ho hanyetsa ka tsela e sa lekanyetsoang ho li-activator tsa hypoglycemic (phekolo ea motsoako), mafu a kahare, ho buoa (phekolo ea motsoako kapa motsoako), boimana (haeba kalafo ea phepo e sa sebetse).

"Diabetes" ketoacidosis, ketoacidotic le hyperosmolar coma, ka ts'ebetso e tlang, allergies ho etsa litokisetso tsa insulin tsa tlhaho ea liphoofolo, insulin lipoatrophy, ho hanyetsa insulin ka lebaka la karolo e phahameng ea li-anti-insulin antibodies, nakong ea phetisetso ea lisele tsa seketsoana tsa manyeme.

Litla-morao

Hypoglycemia (hangata haholo ho feta ha o sebelisa insulin litokisetso tsa tlhaho ea liphoofolo), AR - hangata haholo. Liphoso tse khutsitseng tsa nakoana - hangata qalong ea kalafo ea insulin.

Boemo bo loketseng ba lihormone ke motheo oa kholo e phethahetseng ea 'mele oa motho. E 'ngoe ea lihormone tsa bohlokoa' meleng oa motho ke insulin. Ho haella ha eona kapa ho fetella ho lebisa liphellong tse mpe. Lefu la tsoekere le hypoglycemia ke maemo a feteletseng a feto-fetohang a ba metsoalle e sa khahliseng ea 'mele oa motho, e hlokomolohang tlhahisoleseling mabapi le hore na insulin ke eng le hore na boemo ba eona bo lokela ho ba bofe.

Hormone insulin

Tlotla ea ho theha mesebetsi ea pele e ileng ea betla tsela ea ho sibolloa ha hormone ke ea rasaense oa Russia Leonid Sobolev, eo ka 1900 a ileng a etsa tlhahiso ea ho sebelisa manyeme ho fumana setlhare sa antidiabetic mme a fana ka mohopolo oa hore insulin ke eng. Ho ile ha sebelisoa lilemo tse fetang 20 ho etsa lipatlisiso tse ling, 'me ka mor'a tlhahiso ea insulin ea indasteri ea 1923. Kajeno, lihormone li ithutoa hantle ke mahlale. O nka karolo ho felleng ha lik'habohaedreite, tse ikarabellang bakeng sa metabolism le mafura.

Ke setho sefe se hlahisang insulin

Li-pancreas, moo li-conglomerates tsa lisele tsa B li leng teng, tse tsejoang ke lefats'e la saense e le lihlekehleke tsa Lawrence kapa lihlekehleke tsa pancreatic, li sebetsa e le karolo e hlahisang insulin. Matla a khoheli a lisele a nyane ebile a etsa 3% feela ea boima ba manyeme. Ho hlahisoa ha insulin ke lisele tsa beta hoa etsahala, karolo e ka tlase ea proinsulin e bolokiloe ke hormone.

Subtype ea insulin ha e tsejoe ka botlalo. Hormone ka boeona, pele e nka sebopeho sa hoqetela, e kena ka har'a sele ea Golgi, moo e phetheloang ho ea ho boemo ba lihormone tse felletseng. Ts'ebetso eo e fela ha hormone e kenngoa ka masenke a khethehileng a manyeme, moo a bolokiloeng ho fihlela motho a e-ja. Mehloli ea lisele tsa B e haelloa ebile e felisoa kapele ha motho a sebelisa lijo tse nang le phepo ea 'mele tse bobebe, e leng sesosa sa lefu la tsoekere.

Insulin ea "hormone" ke eng? Kantle ho eona, tsoekere e kenang 'meleng ka lijo e ke ke ea kena seleng. Hormone e eketsa phokotso ea membrane ea lisele, ka lebaka leo glucose e kenella 'meleng oa sele. Ka nako e ts'oanang, lihormone li khothaletsa phetoho ea glucose ho glycogen, polysaccharide e nang le polokelo ea matla, e sebelisoang ke 'mele oa motho ha ho hlokahala.

Mesebetsi ea insulin e fapana. E fana ka ts'ebetso ea sele ea mesifa, e amang lits'ebetso tsa protheine le metabolism ea mafura. Hormone e bapala karolo ea motlalehi oa boko, eo ho latela li-receptors e khethang tlhokahalo ea lik'habohaedreite tse potlakileng: haeba ho na le boholo ba eona, boko bo etsa qeto ea hore lisele li bolaoa ke tlala 'me ho hlokahala ho theha pokello. Matla a insulin 'meleng:

1. E thibela li-amino acid tsa bohlokoa hore li se ke tsa silafatsoa habonolo.
2. E ntlafatsa synthetiki ea mantlha - motheo oa bophelo.
3. Ha e lumelle liprotheine tse ka har'a mesifa ho senyeha, li thibela atrophy ea mesifa - athari ea anabolic.
4. E fokotsa ho bokelloa ha 'mele ea ketone, e ngata haholo e bolaeang batho.
5. E khothalletsa ho tsamaisoa ha potasiamo le ion ea magnesium.

Karolo ea insulin 'meleng oa motho

Khaello ea hormone e amahanngoa le lefu le bitsoang lefu la tsoekere. Ba nang le lefu lena ba qobelloa ho kenya litekanyetso tse eketsehileng tsa insulin maling. Tse ling tse mpe ke ho fetella hoa lihormone, hypoglycemia. Lefu lena le lebisa keketseho ea khatello ea mali le ho fokotseha ha methapo ea kutlo.Ho eketsa keketseho ea secretion ea insulin ke glucagon ea hormone e hlahisoang ke lisele tsa alpha tsa li-isanc tsa pancreatic tsa Langerhans.

Lisele tse itšetlehileng ka insulin

Insulin e khothalletsa tlhahiso ea protheine ka har'a mesifa, ntle le ha eona mesifa ea mesifa e sa khone ho e nts'etsapele. Ho etsoa ha lisele tsa adipose, tseo hangata li etsang mesebetsi ea bohlokoa, ho ke ke ha khoneha ntle le hormone. Bakuli ba qalang lefu la tsoekere ba tobana le ketoacidosis, e leng mofuta oa bothata ba metabolic moo ho tšosang ho bang teng tlala ea sekhahla.

Litla-morao tsa insulin ea motho

Hypoglycemia (pallor ea letlalo, ho fufuleloa ho eketsehileng, mokhathala, ho thothomela, ho thothomela, ho nyekeloa, ho hlatsa, tachycardia, palpitations, tlala, ho ferekana, ho tšoenyeha, presthesia molomong, ho opeloa ke hlooho, ho otsela, ho hlobaela, tšabo, ho hlonama) , boits'oaro bo sa tloaelehang, ho se tsitsinyehe ha motsamao, pherekano, ho senyeha ha puo le pono, ho akheha, kelello, lefu), posthypoglycemic hyperglycemia (ketsahalo ea Somogy), insulin ho hanyetsa (tlhoko ea letsatsi le letsatsi e feta 20 0 likarolo), edema, ho senyeha ha pono, ho hlaseloa ke lintho tse ling (ho hlohlona, ​​lekhopho la letlalo, ho hlohlona ka sekhahla, ho hema hanyane, ho hema ha moea, dyspnea, mofufutso o feteletseng, ho eketseha ha sekhahla sa pelo, hypotension, anaphylactic) post-ente lipodystrophy, e tsamaeang le ho kenella ha insulin, nts'etsopele ea bohloko ha khatello ea sepakapaka e fetoha).

Insulin ea mali

Mesebetsi ea insulin e kenyelletsa ho tšehetsa tekanyo e nepahetseng ea tsoekere maling, ho laola metabolism ea mafura le liprotheine, ho fetola limatlafatsi hore e be mesifa. Boemong bo tloaelehileng ba lintho, ho latela lintho tse latelang:

• Protein
• tekanyo ea metabolism le catabolism e bolokiloe,
• e tsosa motsoako oa glycogen, e eketsang mamello le nchafalo ea lisele tsa mesifa,
• li-amino acid, tsoekere e ngata, potasiamo e kena liseleng.

Motsoako oa insulin o lekantsoe ho µU / ml (0,04082 mg ea ntho ea kristale e nkuoa e le yuniti e le 'ngoe). Batho ba phetseng hantle ba na le letšoao le lekanang le 3-25 ho li-unit tse joalo. Bakeng sa bana, ho fokotseha ho fihlela 3-20 μU / ml ho lumelloa. Ho basali ba baimana, ho tloaelehileng ho fapane - 6-27 mkU / ml, ho batho ba baholo ba fetang 60 pontšo ena ke 6-35. Ho fetoha hoa maemo ho supa ho ba teng ha mafu a tebileng.

Ho phahamisitsoe

Ho fetella hoa insulin ka nako e telele ho sokela liphetoho tse ke keng tsa fetoloa tsa pathological. Boemo bona bo hlaha ka lebaka la ho theoha ha tekanyo ea tsoekere. U ka utloisisa ho ata ha insulin ka lipontšo: ho thothomela, ho fufuleloa, ho hlapaola, litlhaselo tsa tšohanyetso tsa tlala, ho nyekeloa, ho akheha, komello. Matšoao a latelang a ama ho eketseha ha litekanyetso tsa li-hormone:

• ho ikoetlisa ka matla,
• khatello ea maikutlo e sa foleng
• mafu a sebete le manyeme,
• botenya
• tlolo ea khatello ea lisele ho lik'habohaedreite,
• ovary ea polycystic,
• ho hloleha ha tšebetso ea pituitary gland,
• mofets'e le makhopho a mabetso ea tšoelesa ea adrenal.

E theotsoe

Ho fokotseha ha mahlaseli a insulin ho etsahala ka lebaka la khatello ea maikutlo, ho ikoetlisa ka matla haholo, mokhathala o matla, tšebeliso ea letsatsi le leng le le leng la lik'habohaedreite tse ntlafalitsoeng. Ho haella ha insulin ho thibela phallo ea tsoekere, ho eketsa khatello ea mali. Ka lebaka leo, ho na le lenyora le matla, matšoenyeho, litlhaselo tsa tlala, ho se ts'oanehe, ho rota khafetsa. Ka lebaka la matšoao a tšoanang a insulin e tlase le e phahameng, tlhahlobo ea mafu e etsoa ke lithuto tse khethehileng.

Ke insulin e etselitsoeng batho ba lefu la tsoekere

Taba ea lisebelisoa tse tala bakeng sa tlhahiso ea li-hormone e thabisa bakuli ba bangata. Insulin 'meleng oa motho e hlahisoa ke manyeme,' me mefuta e latelang e fumanoa ka maiketsetso:

1. Kolobe kapa bovine - e tsoang liphoofolong. Bakeng sa ho etsa likhohlopo tsa liphoofolo tse sebelisitsoeng.Ho hlophisoa ha lihlahisoa tsa nama ea kolobe e na le proinsulin, e ke keng ea arohana, ea fetoha mohloli oa lintho tse sitisang ho fetoha.
2. Li-biosynthetic kapa nama ea kolobe e fetotsoe - ho hlophisoa ha halofo-ea maiketsetso ho fumanoa ka ho nkela liamino acid. Har'a melemo ke ho tsamaellana le 'mele oa motho le ho ba sieo ha mefuta ea lintho tse kulang. Litsietsi - khaello ea lisebelisoa tse tala, ho rarahana ha mosebetsi, litšenyehelo tse phahameng.
3. Boenjiniere ba genetic recombinant - bo bitsoa "insulin ea motho" ka tsela e 'ngoe, hobane bo tšoana hantle le lihimo tsa tlhaho. Ntho ena e hlahisoa ke li-enzyme tsa mofuta oa tomoso le mofuta o fetotsoeng liphatsa tsa lefutso.

Litaelo tsa ts'ebeliso ea insulin

Mesebetsi ea insulin e bohlokoa haholo bakeng sa 'mele oa motho. Haeba o na le lefu la tsoekere, o tla fetisetsoa ho ngaka le lengolo la ngaka ho latela hore na meriana eo e fuoa mahala mahala litlolong tsa bongaka kapa lipetlele. Maemong a tlhokahalo e potlakileng e ka rekoa ntle ho lengolo la ngaka, empa litekanyetso li lokela ho bonoa. Ho qoba ho fetelletsa litaba tse ngata, bala litaelo tsa tšebeliso ea insulin.

Matšoao a ho sebelisoa

Ho latela litaelo tse kentsoeng ka har'a sephutheloana se seng le se seng sa tšebetso ea insulin, matšoao a ts'ebeliso ea eona ke mofuta oa 1 lefu la tsoekere (hape o bitsoa insulin-mme) maemong a mang, mofuta oa lefu la tsoekere la 2 lefu la tsoekere. Lintho tse joalo li kenyelletsa ho hloka mamello ho li-agents tsa hypoglycemic tsa molomo, nts'etsopele ea ketosis.

Tsamaiso ea insulin

Ngaka e fana ka litlhare kamora ho hlahloba le ho hlahloba mali. Bakeng sa kalafo ea lefu la tsoekere sebelisa lithethefatsi tsa mefuta e fapaneng ea nako: nakoana le nako e telele. Khetho e itšetlehile ka ho teba ha nako ea bokuli, boemo ba mokuli, lebelo la ho qala ha ts'ebetso ea moriana:

1. Litokisetso tse nkang nako e khuts'oane li reretsoe tsamaiso e potolohang, e pakeng kapa ea methapo. E na le phello e potlakileng, e khuts'oane ea tsoekere e theolelang tsoekere, e fuoa metsotso e 15-20 pele ho lijo makhetlo a 'maloa / ka letsatsi. Tšusumetso e etsahala halofo ea hora, boholo - ka lihora tse peli, lihora tse ka bang tse tšeletseng feela.
2. Ketso ea nako e telele kapa ea nako e telele - e na le phello e tšoarellang lihora tse 10-36, e ka fokotsa palo ea letsatsi le letsatsi ea liente. Litšitiso li tsamaisoa ka mokhoa o potang kapa ka tšohanyetso, empa eseng ka tsela e kenang.

Li-syndinge li sebelisetsoa ho nolofatsa ho kenella le ho latela litekanyetso. Karolo e le 'ngoe e tsamaisana le palo ea likarolo tse itseng. Melao ea kalafo ea insulin:

• boloka litokisetso ka sehatsetsing, mme tse qalileng ka mocheso oa kamore, futhumatsa sehlahisoa pele se kenella ho sona, hobane se pholileng se fokola.
• Ho molemo ho kenella homone e nkang nakoana ka tlasa letlalo la mpa, - ho kenngoa leqaqaqaqaqaqailana kapa kaholimo ho lehetla,
• moriana o nkileng nako e telele o kenngoa lereng le letshehali kapa le letona,
• etsa ente ka ngoe sebakeng se fapaneng,
• ka ente ea insulin, hapa karolo eohle ea karolo ea 'mele - kahoo o ka qoba ho opeloa ke letsoai le lithibelo,
• khutlela hole le ente ea ho qetela bonyane 2 cm,
• se ke ua tšoara letlalo ka joala, le senya insulin.
• haeba mokelikeli o tsoa, ​​nale e kentsoe ka mokhoa o fosahetseng - o hloka ho e tšoara ka angle -40- degrees.

Theko ea insulin

Litsenyehelo tsa insulin li latela mofuta oa moetsi, mofuta oa lithethefatsi (nako e khuts'oane / e telele ea ts'ebetso, fepa) le bophahamo ba pokello. Theko ea 50 ml ea drug Insulinum ke li-ruble tse ka bang 150 ho la Moscow le St. Petersburg. Insuman e nang le pente ea syringe - 1200, Protafan e emisitsoeng e na le theko ea li-ruble tse 930. Boemo ba k'hemiste bo boetse bo ama bokae ba insulin.

Insulin ea motho ke sesebelisoa se sebetsang se etselitsoeng ho phekola bakuli ba mefuta ea pele le ea bobeli ea lefu la tsoekere. Ke sehlahisoa se entsoeng ka liphatsa tsa lefutso se qhibilihang ka mokhoa o feteletseng ka lino. E amohetsoe hore e sebelisoe leha e le moimana.

Actrapid, Humulin, Insuran.

INN: Semi-synthetic insulin ea motho ea qhibilihang.

Mofumahali

Tekanyo ea ho kenngoa ha insulin hangata e itšetlehile ka hore na ntho e sebetsang e sebelisitsoe joang. Boholo bo bakoa ke tekanyetso ea ho qetela, kakaretso ea "insulin" tharollong ea ente le sebakeng sa ente se haufi. Lithane li ajoa ka ho se lekane. Insulin ha e khone ho kena ka har'a mokoallo o sirelletsang oa placenta.

E ka senngoa ka tsela e itseng ke insulinase e khethehileng ka ho khetheha ka har'a sebete. E hlahisoa haholo-holo ka ho tsilatsila ho renal. Bofelo ba halofo ea bophelo ha bo fete metsotso e 10. Palo e phahameng ea insulin e maling e bonoa nakong ea hora kamora ts'ebetso ea eona e tobileng. Tšusumetso e ka nka lihora tse 5.

Mokhoa oa ho nka insulin

Tekanyetso le tsela ea tsamaiso e otlolohileng e khethoa feela motheong oa tsoekere e tloaelehileng ea mali, ebe lihora tse peli kamora lijo. Ntle le moo, kamohelo e itšetlehile ka ho teba ha nts'etsopele ea glucosuria.

Hangata, tsamaiso ea subcutaneous. E etse metsotso e 15 pele ho lijo tse ka sehloohong. Ho diabetes acute ketoacidosis kapa komisi, "insulin" e kenang e kenngoa ka bongata, kamehla kahare kapa ka har'a mesifa ea gluteus, pele ho etsoa opereishene.

Ho khothalletsoa ho fana ka moriana bonyane makhetlo a 3 ka letsatsi. Bakeng sa ho qoba litla-morao tsa molomo, ho ke ke ha khoneha ho tsuba lithethefatsi kamehla sebakeng se le seng. Ebe dystrophy ea mafura a subcutaneous ha e bonoe.

Karolelano ea litekanyetso tsa batho ba baholo ka kakaretso ke li-unit tse 40, 'me ho bana ke likarolo tse 8. Tloaelo ea tsamaiso ke makhetlo a 3 ka letsatsi. Haeba ho na le tlhoko e joalo, o ka fumana insulin ho fihlela makhetlo a 5.

Litaelo tse khethehileng

Pele u bokella tharollo ka kotloloho ho tsoa botlolong, kannete o lokela ho e hlahloba hore e bonahale. Haeba moriana o hlaha, moriana o joalo ha oa lokela ho nooa.

Tekanyetso ea insulin e fetoloa bakeng sa li-pathologies tse joalo:

• mafu a tšoaetsanoang
• ts'ebetso e sa sebetseng hantle ea tšoelesa ea qoqotho.
• Lefu la Addison
• hypopituitarism,
• lefu la tsoekere ho batho ba baholo.

Khafetsa ho ba le lipontšo tsa hypoglycemia e mpe. Tsena kaofela li ka ts'oaroa ke ts'oaetso e feteletseng, phetisetso e matla ea "insulin" e tsoang molemong oa motho, tlala, le lets'ollo, ho hlatsa le matšoao a mang a botaoa. Hypoglycemia e bonolo e ka emisoa ka ho nka tsoekere.

Haeba matšoao a fokolang a hypoglycemia a hlaha, o lokela ho ikopanya le setsebi hang-hang. Maemong a bonolo, ho fetola litekanyetso ho ka thusa. Maemong a matla haholo, kalafo ea detoxification ea matšoao e lokela ho sebelisoa. Khafetsa, ho tlosoa ka botlalo ha moriana oa bongaka kapa pheko e ncha hoa hlokahala.

Ho lokela ho hopoloa hore sebakeng sa tsamaiso e tobileng, dystrophy ea mafura a subcutaneous a ka hlaha. Empa sena se ka qojoa ka ho fetola sebaka sa liente.

Sebelisa nakong ea bokhachane le pelehi

Ho laola boemo ba tsoekere 'meleng oa mosali oa moimana ho bohlokoa. Ka trimester ea pele, tlhoko ea insulin e hloekileng e fokotseha hanyane, mme qetellong ea nako e eketseha.

Nakong ea kanyeso, mosali a ka hloka phetoho e itseng ea insulin le lijo tse khethehileng.

MP ha e na litla-morao tsa mutagenic le liphatsa tsa lefutso 'meleng.

Ho sebelisana le lithethefatsi tse ling

Tharollo ea "insulin" e kopantsoeng e thibetsoe ka thata ho kopana le tharollo ea ente e meng. Phello e ka sehloohong ea hypoglycemic e eketseha feela ha e sebelisoa hammoho le sulfonamides, li-inhibitors tsa MAO, le li-anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine le tse ling tsa beta-blockers le tsona li matlafatsa sephetho sa ho sebelisa lithethefatsi.

Matla a hypoglycemic a fokola ha a nkuoa ka lihormone tse kholo tsa kemolo, lithibela-mafu, tsoekere, estroinse, heparin, li-audiathomimetics tse ling, li-antidepressants, antagonists tsa calcium, morphine le nicotine.

Ka tsela e makatsang e ama insulin mabapi le ho monya ha glucose beta-blocker, reserpine le pentamidine.

Mefuta ea insulin

Insulin e qalile ho etsoa ka makhopho a lintja. Selemo hamorao, lihormone li se li sebelisitsoe ka mokhoa o sebetsang. Ho ile ha feta lilemo tse ling tse 40, 'me ho ile ha e-ba bonolo ho kopanya insulin ka lik'hemik'hale.

Kamora nako e itseng, lihlahisoa tse phahameng tsa tlhoekiso li ile tsa etsoa. Kamora lilemo tse ling tse 'maloa, litsebi li ile tsa qala nts'etsopele ea insulin ea motho. Ho tloha ka 1983, insulin e qalile ho hlahisoa ka sekhahla sa indasteri.

Lilemong tse 15 tse fetileng, lefu la tsoekere le ile la phekoloa ka lihlahisoa tse entsoeng ho tsoa ho liphoofolo. Matsatsing ana, e ntse e thibetsoe. Lifekthering, o ka fumana litokisetso tsa boenjiniere ba liphatsa tsa lefutso, tlhahiso ea lichelete tsena e ipapisitse le phetisetso ea sehlahisoa sa gene seleng ea microorganism.

Bakeng sa morero ona, ho sebelisoa mofuta oa tomoso kapa mofuta o sa sebeliseng pathogenic oa libaktheria tsa Escherichia coli. Ka lebaka leo, likokoana-hloko li qala ho hlahisa insulin bakeng sa batho.

Phapang pakeng tsa lisebelisoa tsohle tsa bongaka tse fumanehang kajeno ke:

• ka nako ea ho pepesa, ho nka nako e telele, ho etsa li-insulin tse khutšoane le ho sebetsa ka nakoana insulin.
• ka tatellano ea amino acid.

Ho boetse ho na le lithethefatsi tse kopaneng tse bitsoang "motsoako", li na le "insulin" e telele le e sebetsang haufinyane. Mefuta eohle e 5 ea insulin e sebelisetsoa morero oa eona.

Ho sebetsa ka nakoana insulin

Li-insulin tse nkang nakoana, ka linako tse ling tsa ultrashort, ke litharollo tsa "crystalline zinc-insulin" e thata le mofuta oa pH o sa jeleng paate. Lichelete tsena li na le phello e potlakileng, leha ho le joalo, phello ea lithethefatsi e phela ha nakoana.

Ha e le molao, lithethefatsi tse joalo li tsamaisoa ka mokhoa o sa tsitsang metsotso e 30-45 pele ho lijo. Meriana e tšoanang e ka tsamaisoa ka methapo le kahare, hammoho le insulin ea nako e telele.

Ha moemeli oa ultrashort a kenella mothapong, tsoekere ea plasma e theoha haholo, phello e ka bonoa kamora metsotso e 20-30.

Haufinyane, mali a tla hlakoha ho lithethefatsi, 'me lihormone tse kang catecholamine, glucagon le STH li tla eketsa bongata ba tsoekere e be boemong ba pele.

Ka tlolo ea tlhahiso ea lihormone tsa li-contra-hormonal, boemo ba tsoekere ea mali ha bo eketsehe lihora tse 'maloa ka mor'a ho enteloa sehlahisoa sa meriana, hobane bo na le phello' meleng le kamora ho tlosoa maling.

Hormone e sebetsang ka nako e khuts'oanyane e tlameha ho kenngoa mothapong:

1. nakong ea tlhokomelo e matla le tlhokomelo e matla,
2. bakuli ba lefu la tsoekere la ketoacidosis,
3. haeba 'mele o fetola tlhoko ea insulin kapele.

Ho bakuli ba nang le mokhoa o tsitsitseng oa lefu la tsoekere, meriana e joalo hangata e nkuoa hammoho le litlamorao tsa nako e telele le nako e telele ea bohato.

Ultrashort insulin ke setlhare se ikhethang seo mokuli a ka bang le sona sesebelisoa se khethehileng sa metering.

Ho tjhaja thepa, ho sebelisoa lihlahisoa tse buffered. Sena ha se lumelle insulin ho lla ka tlas'a letlalo ho catheter nakong ea tsamaiso e liehang.

Kajeno, hormone ea tšusumetso e khutšoane e hlahisoa ka mokhoa oa hexamers. Limolek'hule tsa ntho ena ke lipolanete. Li-hexamers li kenngoa butle, tse sa lumelle ho fihla boemong ba ho kenella ka insulin ka plasma ea motho ea phetseng hantle kamora ho ja.

Boemo bona e bile qalo ea tlhahiso ea litokisetso tsa maiketsetso tse emelang:

Ho ile ha etsoa liteko tse ngata tsa kliniki ka lebaka leo, lisebelisoa tse sebetsang ka ho fetisisa, mabitso a ba tummeng haholo

Mefuta ena ea "insulin" e kenoa ka tlas'a letlalo ka makhetlo a 3 ka potlako ha e bapisoa le insulin ea motho. Sena se lebisa tlhokomelong ea hore boemo bo phahameng ka ho fetisisa ba insulin maling bo fihlella kapele, 'me pheko ea ho fokotsa tsoekere e potlakile.

Ha ho qala boitokisetso ba semisynthetic metsotso e 15 pele ho lijo, litlamorao li tla tšoana le ka ente ea "insulin" bakeng sa motho metsotso e 30 pele ho lijo.

Lihormone tsena tsa tšusumetso e potlakileng haholo li kenyelletsa lyspro-insulin. Ke ntho e nkiloeng ka insulin ea motho e fumanoeng ka ho fapanyetsana liprotheine le lysine liketaneng tse 28 le 29 B.

Joalo ka insulin ea motho, litokisetsong tse entsoeng, lyspro-insulin e teng ka sebopeho sa hexamers, leha ho le joalo, kamora hore moemeli a kene kahare ho 'mele oa motho, o fetoha monomers.

Ka lebaka lena, lipro-insulin e na le phello e potlakileng, empa phello e nka nako e khuts'oane. Lipro-insulin e atleha ho bapisoa le lithethefatsi tse ling tsa mofuta ona bakeng sa lintlha tse latelang:

• e etsa hore ho be le monyetla oa ho fokotsa tšokelo ea hypoglycemia ka 20-30%,
• ho khona ho fokotsa palo ea hemoglobin ea A1c glycosylated, e bontshang kalafo e sebetsang ea lefu la tsoekere.

Ha ho etsoa insulin, "karolo ea bohlokoa e fanoa sebakeng sa phetoho" ha "aspartic acid" e nkeloa sebaka ke Pro28 ka ketane ea B. Joalo ka lyspro-insulin, sethethefatsi sena, se kenang 'meleng oa motho, haufinyane se aroloa hore e be li-monomers.

Pharmacokinetic thepa ea insulin

Ho tsoekere ea lefu la tsoekere, likarolo tsa insulin li ka fapana. Nako e phahameng ea maemo a insulin ea plasma le phello e kholo ea ho theola tsoekere e ka fapana ka 50%. Boholo ba ho feto-fetoha ha maemo ho joalo ho latela tekanyo e fapaneng ea tekanyo ea moriana ho tsoa liseleng tse tlase. Leha ho le joalo, nako ea insulin e telele le e khuts'oane e fapane haholo.

Litlamorao tse matla ke li-hormone tsa nako e mahareng le phello ea nako e telele. Empa haufinyane tjena, litsebi li fumane hore lithethefatsi tse sebetsanang le nako e khuts'oane li na le thepa e tšoanang.

Ho latela insulin, ho hlokahala hore kamehla ente ea lihormone e kenelle liseleng tse ka tlasana. Sena se sebetsa le ho bakuli ba sa khoneng ho fokotsa bongata ba tsoekere ho plasma ka lebaka la lijo le lithethefatsi tse tsoekere e tlaase, hammoho le basali ba nang le lefu la tsoekere nakong ea kemolo, bakuli ba nang le lefu le bolaeang ka lebaka la pacreatectomy. Mona re ka re ha se kamehla ba fanang ka sephetho se lebelletsoeng.

Phekolo ea insulin e hlokahala bakeng sa mafu a kang:

1. hyperosmolar coma,
2. lefu la tsoekere ketoacidosis,
3. kamora ho buoa bakuli ba nang le lefu la tsoekere,
4. ha kalafo ea "insulin" e thusa ho fetisa palo ea tsoekere ka plasma,
5. Ho felisoa ha methapo e meng ea metabolic.

Sephetho se setle ka ho fetisisa se ka fumaneha ka mekhoa e rarahaneng ea kalafo:

Tlhokahalo ea letsatsi le letsatsi ea insulin

Motho ea nang le bophelo bo botle le 'mele o tloaelehileng o hlahisa likarolo tsa 18-40 ka letsatsi, kapa likarolo tsa 0,2-0,5 / kg ea insulin ea nako e telele. Hoo e ka bang halofo ea moqolo ona ke secretion ea ka mpeng, tse ling kaofela li qotsuoa ka mor'a ho ja.

Hormone e hlahisoa likarolo tsa 0.5-1 ka hora. Kamora hore tsoekere e kene maling, tekanyo ea secretion ea li-hormone e nyoloha ho isa lihlopheng tse 6 ka hora.

Batho ba nonneng haholo mme ba na le insulin ea hanyetsanang le lefu la tsoekere ba na le makhetlo a 4 a tlhahiso e potlakileng ea insulin kamora ho ja. Ho na le khokahano ea hormone e thehiloeng ke portal system ea sebete, moo karolo e le 'ngoe e sentsoeng mme e sa fihle maling.

Ho bakuli ba mofuta oa 1 mellitus oa lefu la tsoekere, tlhoko ea letsatsi le letsatsi ea insulin e fapana:

1. Ha e le hantle, lets'oaetso lena le fapana ho tloha ho 0,6 ho isa ho li-0.7 unit / kg.
2. Ka boima bo bongata, tlhoko ea insulin e eketseha.
3. Ha motho a hloka li-unit tsa 0,5 / kg feela ka letsatsi, o na le tlhahiso e lekaneng ea lihormone kapa boemo bo botle ba 'mele.

Tlhokahalo ea insulin ea li-hormone ke ea mefuta e 'meli:

Hoo e ka bang halofo ea tlhoko ea letsatsi le letsatsi ke ea foromo ea basal. Hormone ena e kenella ho thibela ho phatloha ha tsoekere maling.

Ka foromo ea morao-rao, litlhoko tsa letsatsi le letsatsi li fanoa ka liente pele ho lijo.Hormone e kenella ho hoengweng ha limatlafatsi.

Hang ka letsatsi, mokuli o fuoa ente ea insulin ka nako e telele ea ts'ebetso, kapa ho tsamaisoa moemeli ea kopanyang insulin ea nako e khuts'oane le hormone ea nako e telele. Sena se kanna sa lekana ho boloka glycemia e le boemong bo tloaelehileng.

Ebe moriana oa kalafo o sebelisoa ka mokhoa o rarahaneng, moo insulin ea nako e telele kapa insulin e nkang nakoana kapa insulin e sebetsanang le nako e khuts'oanyane e sebelisoa hammoho.

Hangata mokuli o phekoloa ho latela mofuta o tsoakaneng oa kalafo, ha a fana ka ente e le 'ngoe nakong ea lijo tsa hoseng le e' ngoe nakong ea lijo. Hormone ntlheng ena e na le insulin ea nako e khuts'oane le ea nako e telele.

Ha u fumana tekanyetso ea mantsiboea ea hormone NPH kapa insulin, teipi ha e fane ka tekanyo e hlokahalang ea glycemia bosiu, joale ente e arotsoe likarolo tse peli: pele ho lijo tsa mantsiboea, mokuli o kenngoa ka ente ea insulin e potlakileng, le pele a robala, o fuoa inshorense ea NPH kapa insulin.

Actrapid HM (Actrapid HM), Actrapid HM penfill (Actrapid HM penfill), Berlsulin H peni e tloaelehileng (Berlinsulin H tloaelehileng peni), Berlsulin H tloaelehileng U-40 (Berlinsulin H tloaelehileng U-40), Insuman ka potlako (Insuman kapele), Homorap 40 (Homorap 40), Homorap 100 (Homorap 100).

Ho sebelisana ha insulin ea motho le lintho tse ling

Phello ea hypoglycemic ea insulin ea motho e fokotsoa ke glucocorticoids (dexamethasone, betamethasone, hydrocortisone, prednisone le ba bang), amphetamines, li-adrenocorticotropic hormone, flucrocortisone, li-calcium Channel blockers, li-estrogens, baclofen, heparin, levrogenroxine sine, gyprogen, ligraini ea hepatrogen. diuretics (hydrochlorothiazide, indapamide le ba bang), amprenavir, danazol, isoniazid, diazoxide, lithium carbonate, chlorprotixen, sympathomimetics, nicotinic acid, beta-adrenergic agonists (mohlala, ritodrin, salbutamol, terbutaline le ba bang), li-antidepressants tsa tricyclic, epinephrine, glucagon, morphine, clonidine, somatotropin, phenytoin, li-phenothiazine. Ho ka hlokahala ho eketsa tekanyetso ea insulin ea lefutso la biphasic ha e sebelisoa hammoho le lithethefatsi tsena.
Phello hypoglycemic ea ka insulin batho amplify metformin, sulfonamides, repaglinide, androgens, molomo hypoglycemic mahlahana, testosterone, anabolic steroid, bromocriptine, disopyramide, guanethidine, monoamine dihydrobenzophenanthridine inhibitors, angiotensin II receptor ba khahlanong le lōna, le k'habone inhibitors anhydrase, fluoxetine, carvedilol, fenfluramine, angiotensin fetola potlakisang tsebetso ea lik'hemik'hale inhibitors (captopril , enalapril le ba bang), li-tetracyclines, octreotide, mebendazole, ketoconazole, lithethefatsi tse khahlanong le ho ruruha, salicylates, cyclophosphamide, pyridoxine, beta-blockers (betaxolol, metoprolol, pindolol, sotalol, bisoprolol, timolol le tse ling) (maske matšoao a hypoglycemia, ho kenyeletsa tachycardia, khatello e phahameng ea mali), ethanol le ethanol. Ho ka hlokahala ho fokotsa tekanyetso ea insulin ea methapo ea motho ea likarolo tse peli ha e sebelisoa hammoho le meriana ena.
Beta-blockers, clonidine, reserpine e ka pata ponahatso ea matšoao a hypoglycemia.
Khahlano le semelo sa atenolol (ho fapana le beta-blockers e seng khetho), litlamorao ha li eketsehe haholo, ho hlokahala hore ho hlokomelise mokuli hore ka nts'etsopele ea hypoglycemia, tachycardia le ho thothomela ho ka ba teng, empa ho hloka botsitso, tlala, ho nyekeloa hoa pelo ho lokela ho phehella, mme ho fufuleloa le ho feta.
Keketseho ea "insulin" ea motho maling e eketseha (ka lebaka la ho potlaka ha ho kenella) lithethefatsi tse nang le nikotine le ho tsuba.
Khahlano le semelo sa octreotide, reserpine, phetoho ho phello ea hypoglycemic e ka etsahala (ho phahamisa le ho fokolisa), e hlokang phetoho ea insulin.
Khahlano le semelo sacacithromycin, sekhahla sa timetso sea fokotseha mme, maemong a mang, phello ea insulin e ka eketseha.
Khahlano le semelo sa diclofenac, litlamorao tsa lithethefatsi, ha li sebelisoa hammoho, ho hlokahala ho laola maemo a tsoekere ea mali.
Khahlano le semelo sa metoclopramide, e potlakisang ho omella, ho ka hlokahala ho fetola litekanyetso kapa mofuta oa tsamaiso ea insulin.
Insulin ea batho ha e lumellane ka litlhare le litharollo tsa litlhare tse ling.
Haeba ho hlokahala ho sebelisa lithethefatsi tse ling ho kenyelletsa insulin ea motho, ho hlokahala hore o buisane le ngaka.

Ho tsamaisana le joala

Ho nka insulin ha ho tsamaellane le ho noa joala. Matšoao a botahoa a ntse a eketseha, 'me phello ea lithethefatsi e fokotsehile haholo.

Ho na le lintlha tse 'maloa tsa mantlha:

• Berlinsulin N Ntle,
• Diarapid CR,
• E ts'oarehile
• Insulin Actrapid,
• Insuman Rapid,

Maemo a polokelo ea moriana

E bolokiloe ka mocheso o sa feteng 25 + C sebakeng se sireletsehileng ho bana ba banyenyane. Ho eletsoa ho qoba khanya ea letsatsi ka kotloloho.

Hoa hlokahala ho netefatsa hore tharollo ha e lahleheloe ke ho pepeseha, hape ha ho liforomo tse tlase. Haeba sena se etsahetse, sethethefatsi se ke ke sa sebelisoa.

Moetsi

Hona le mekhatlo e 'maloa e hlahisang insulin ea motho:

• Sanofi (France),
• NovoNordisk (Denmark),
• EliLilly (USA),
• Hoffmann OJSC (Russia),
• National Biotechnology OJSC (Russia).

Karolo ea insulin 'meleng ha e utloahale ho feta tekano. Tekanyo efe kapa efe ea khaello ea insulin e tletse le lefu le tebileng la endocrine - lefu la tsoekere. Lilemong tse 40 tse fetileng, batho ba nang le lefu la tsoekere ha ba sa phela lilemo tse fetang 10-15.

Motsoako oa sejoale-joale o sebelisa insulin e sebetsang hantle ka ho fetesisa ea liphatsa tsa lefutso ho etsa hore maemo a tsoekere ea mali a fokotsehe. Ka lebaka la lithethefatsi tsena, lefu la tsoekere le khaolitse ho ba polelo, ho fa bakuli monyetla oa bophelo bo felletseng le bo telele.

Contraindication

• hypoglycemia,
• ho se mamellehe ha motho ka mong kapa hypersensitivity ho likarolo tsa moriana.

Ts'ebetso ena ea litlolo e tlameha ho nahanoa pele ho qala kalafo.

Mokhoa oa ho nka insulin

Tekanyetso le tsela ea tsamaiso e otlolohileng e khethoa feela motheong oa tsoekere e tloaelehileng ea mali, ebe lihora tse peli kamora lijo. Ntle le moo, kamohelo e itšetlehile ka ho teba ha nts'etsopele ea glucosuria.

Hangata, tsamaiso ea subcutaneous. E etse metsotso e 15 pele ho lijo tse ka sehloohong. Ho diabetes acute ketoacidosis kapa komisi, "insulin" e kenang e kenngoa ka bongata, kamehla kahare kapa ka har'a mesifa ea gluteus, pele ho etsoa opereishene.

Ho khothalletsoa ho fana ka moriana bonyane makhetlo a 3 ka letsatsi. Bakeng sa ho qoba litla-morao tsa molomo, ho ke ke ha khoneha ho tsuba lithethefatsi kamehla sebakeng se le seng. Ebe dystrophy ea mafura a subcutaneous ha e bonoe.

Karolelano ea litekanyetso tsa batho ba baholo ka kakaretso ke li-unit tse 40, 'me ho bana ke likarolo tse 8. Tloaelo ea tsamaiso ke makhetlo a 3 ka letsatsi. Haeba ho na le tlhoko e joalo, o ka fumana insulin ho fihlela makhetlo a 5.

Litla-morao tsa insulin ea motho

Ha e sebelisoa, lintho tse latelang tse mpe li fetoha:

• lipontšo tsa allergic: urticaria, edema ea Quincke,
• ho hema haholo, ho theoha khatello ka tšohanyetso,
• hypoglycemia: mofufutso o eketsehileng, letlalo le tetebang, ho thothomela le tlala ho ea pele, tlala e sa khaotseng, ho akheha ho hoholo, ho hloka boroko, migraines, ho teneha ho hoholo le mokhathala, pono e sa sebetseng le puo, mesifa ea sefahleho,
• hypoglycemic coma,
• hyperglycemia le acidosis: molomo o sa feleng o omileng, tahlehelo e matla ea takatso ea lijo, bofubelu ba letlalo la sefahleho,
• ho akheha
• pono e fokotsehileng
• ho hlohlona le ho ruruha sebakeng seo meriana e sebelisitsoeng ho sona,
• ponahalo ea ho ruruha ha sefahleho le maoto le matsoho, tlolo ea molao oa ho hana.

Boitšoaro bo joalo ke ba nakoana ebile ha bo hloke phekolo e itseng ea lithethefatsi. Li feta butle kamora ho hlakoloa ha chelete.

Tšusumetso ho bokhoni ba taolo ea methapo

Ka kalafo ea insulin, tlolo ea karolo e itseng ea karabelo e itseng ea psychomotor le pherekano e bonahalang e khonahala. Ka hona, ho molemo ho qoba ho itšenyetsa mechini e meholo.

Litaelo tse khethehileng

Pele u bokella tharollo ka kotloloho ho tsoa botlolong, kannete o lokela ho e hlahloba hore e bonahale. Haeba moriana o hlaha, moriana o joalo ha oa lokela ho nooa.

Tekanyetso ea insulin e fetoloa bakeng sa li-pathologies tse joalo:

• mafu a tšoaetsanoang
• ts'ebetso e sa sebetseng hantle ea tšoelesa ea qoqotho.
• Lefu la Addison
• hypopituitarism,
• lefu la tsoekere ho batho ba baholo.

Khafetsa ho ba le lipontšo tsa hypoglycemia e mpe. Tsena kaofela li ka ts'oaroa ke ts'oaetso e feteletseng, phetisetso e matla ea "insulin" e tsoang molemong oa motho, tlala, le lets'ollo, ho hlatsa le matšoao a mang a botaoa. Hypoglycemia e bonolo e ka emisoa ka ho nka tsoekere.

Haeba matšoao a fokolang a hypoglycemia a hlaha, o lokela ho ikopanya le setsebi hang-hang. Maemong a bonolo, ho fetola litekanyetso ho ka thusa. Maemong a matla haholo, kalafo ea detoxification ea matšoao e lokela ho sebelisoa. Khafetsa, ho tlosoa ka botlalo ha moriana oa bongaka kapa pheko e ncha hoa hlokahala.

Ho lokela ho hopoloa hore sebakeng sa tsamaiso e tobileng, dystrophy ea mafura a subcutaneous a ka hlaha. Empa sena se ka qojoa ka ho fetola sebaka sa liente.

Sebelisa nakong ea bokhachane le pelehi

Ho laola boemo ba tsoekere 'meleng oa mosali oa moimana ho bohlokoa. Ka trimester ea pele, tlhoko ea insulin e hloekileng e fokotseha hanyane, mme qetellong ea nako e eketseha.

Nakong ea kanyeso, mosali a ka hloka phetoho e itseng ea insulin le lijo tse khethehileng.

MP ha e na litla-morao tsa mutagenic le liphatsa tsa lefutso 'meleng.

Sebelisa bakeng sa ts'ebetso ea renal e senyehileng

Haeba mokuli a na le methapo ea methapo ea meno, ho ka hlokahala hore o fetole litekanyetso tsa insulin.

Kopo ea ts'ebetso ea sebete e sa sebetseng

Ka hloko, batho ba nang le li-pathologies tsa sebete ba lokela ho nka moriana. Liphetoho tse nyane haholo tsa sampole ea sebete, ho kgothaletsoa ho fetola tekanyetso.

Bongata

Matšoao a sebelisang overdose a ka hlaha khafetsa:

• hypoglycemia - bofokoli, ho fufuleloa ho feteletseng, letlalo le boreleli, ho thothomela ha lipheletso, leleme le thothomelang, tlala,
• hypoglycemic coma e nang le methapo ea maikutlo.

Phekolo e bonahala haholo. Hypoglycemia e bonolo e ka feta kamora ho ja lijo tse tsoekere tse nang le tsoekere.

Glucagon e tsoekere e kenngoa ho emisa matšoao a boloi bo bongata. Ketsahalong ea komello ka tšohanyetso, ho fihlela 100 ml ea tharollo ea "dextrose" e kenyellelitsoeng e kenngoa ka mokokotlong ho fihlela mokuli ea matla a tsoa mokokotlong.

Ho sebelisana le lithethefatsi tse ling

Tharollo ea "insulin" e kopantsoeng e thibetsoe ka thata ho kopana le tharollo ea ente e meng. Phello e ka sehloohong ea hypoglycemic e eketseha feela ha e sebelisoa hammoho le sulfonamides, li-inhibitors tsa MAO, le li-anabolic steroids. Androgens, tetracyclines, bromocriptine, ethanol, pyridoxine le tse ling tsa beta-blockers le tsona li matlafatsa sephetho sa ho sebelisa lithethefatsi.

Matla a hypoglycemic a fokola ha a nkuoa ka lihormone tse kholo tsa kemolo, lithibela-mafu, tsoekere, estroinse, heparin, li-audiathomimetics tse ling, li-antidepressants, antagonists tsa calcium, morphine le nicotine.

Ka tsela e makatsang e ama insulin mabapi le ho monya ha glucose beta-blocker, reserpine le pentamidine.

Ho tsamaisana le joala

Ho nka insulin ha ho tsamaellane le ho noa joala. Matšoao a botahoa a ntse a eketseha, 'me phello ea lithethefatsi e fokotsehile haholo.

Ho na le lintlha tse 'maloa tsa mantlha:

• Berlinsulin N Ntle,
• Diarapid CR,
• E ts'oarehile
• Insulin Actrapid,
• Insuman Rapid,

Lipehelo tsa khefu ea Pharmacy

Insulin ea motho e ka rekoa feela likhoebong tse ikhethileng.

A na nka reka ntle le lengolo la ngaka?

E rekisoa ka risepe e khethehileng.

Lits'enyehelo li ipapisitse le marang-rang a k'hemiste le palo ea libotlolo tse sekoahelong. Theko e tloaelehileng e tsoa ho li-ruble tse 500 ho isa ho tse 1700.

Maemo a polokelo ea moriana

E bolokiloe ka mocheso o sa feteng 25 + C sebakeng se sireletsehileng ho bana ba banyenyane. Ho eletsoa ho qoba khanya ea letsatsi ka kotloloho.

Hoa hlokahala ho netefatsa hore tharollo ha e lahleheloe ke ho pepeseha, hape ha ho liforomo tse tlase. Haeba sena se etsahetse, sethethefatsi se ke ke sa sebelisoa.

Letsatsi la ho felloa ke nako

Boloka botlolo e bulehile matsatsi a 30 feela. Kamora nako ena, moriana o lahloa.

Moetsi

Hona le mekhatlo e 'maloa e hlahisang insulin ea motho:

• Sanofi (France),
• NovoNordisk (Denmark),
• EliLilly (USA),
• Hoffmann OJSC (Russia),
• National Biotechnology OJSC (Russia).

Karolo ea insulin 'meleng ha e utloahale ho feta tekano. Tekanyo efe kapa efe ea khaello ea insulin e tletse le lefu le tebileng la endocrine - lefu la tsoekere. Lilemong tse 40 tse fetileng, batho ba nang le lefu la tsoekere ha ba sa phela lilemo tse fetang 10-15.

Motsoako oa sejoale-joale o sebelisa insulin e sebetsang hantle ka ho fetesisa ea liphatsa tsa lefutso ho etsa hore maemo a tsoekere ea mali a fokotsehe. Ka lebaka la lithethefatsi tsena, lefu la tsoekere le khaolitse ho ba polelo, ho fa bakuli monyetla oa bophelo bo felletseng le bo telele.

Hobaneng insulin e bitsoa "genetically engineer"

Bakuli ba bang ba tšohile ha ba re "ba entsoe ka liphatsa tsa lefutso, 'ba ba hopotsa ka" li-GMO tse mpe. "

Ebile, e ne e le qibollo ea sethethefatsi sena se pholositseng bophelo ba batho ba limilione.

Qalong, lingaka li ne li sebelisa insulin e arohaneng le liphoofolo (boholo ba likolobe le likhomo). Leha ho le joalo, lihormone tsena e ne e se tsa batho ba tsoang linaheng tse ling, empa hape li ile tsa kena hang-hang maling, tsa baka tsitsipano ea tsoekere mme ea baka mathata a mangata.

Ho ile ha qaptjoa insulin ea insulin molemong oa ho nahanisisa ka litlhoko tsohle tsa mokuli ea nang le lefu la tsoekere, a etsa hore ho be le lintho tse ngata tse fapaneng tse fapaneng. Kamora ho qeta ts'ebetso ea eona, e ikhula ho li-amino acid tse tloaelehileng mme e tsoa 'meleng.

Melemo ea mantlha ea pharmacological

Soluble human insulin e bua ka lithethefatsi tse nkang nakoana insulin.

Hammoho le cell wall receptor, sethethefatsi se etsa mofuta oa "insulin" receptor o tsosetsang ts'ebetso ea methating:

1. Ho itšehla thajana ka botlalo bakeng sa ts'ebetso e felletseng le ho monya ha tsoekere ke lisele,
2. Keketseho ea lipalangoang tse makatsang le ho ts'oaroa ha glucose,
3. Tekanyetso e theohileng ea sebopeho sa glycogen sebeteng,
4. Ho susumetsa tlhahiso ea liprotheine le mafura.

Ka tsamaiso ea subcutaneous, moriana o qala ho sebetsa kamora metsotso e 20-30, o fihla o fihla ka nako ea lihora tse 1-3, o nka lihora tse ka bang 5-8.

Setlhare sena se ajoa ka tsela e fapaneng lithong: mohlala, ha se kenelle ka har'a sethopo sa placental ebile ha se fetele ka lebeseng la matsoele. Kamora ho qeta ts'ebetso ea eona, insulin ea motho e epuoa ho tsoa lipelong (hoo e ka bang 80%) kamora ho felisoa ha eona ke insulinase.

Matšoao a ho sebelisoa

Hangata, lingaka li fana ka insulin e qhibilihang maemong a:

Contraindication

Setlhare sena hangata se mamelloa hantle ke 'mele, kaha ha se fapana le enzyme ea tlhaho ea pancreatic.

Contraindicated bakeng sa ts'ebeliso ea insulin ho:

• Ho fokotsa tsoekere ea mali (hypoglycemia),
• Ho eketsa matla a kutlo a mmele ho insulin.

Khetho le ts'ebeliso ea litekanyetso

Tekanyetso le mokhoa oa tsamaiso ea insulin ea motho o lula o khethoa ka mokhoa o fapaneng ke endocrinologist, ho nahanela matšoao a hlokahalang a tsoekere ea mali le moroto oa mokuli.

Setlhare sena se fanoa ka lefu la tsoekere ka mekhoa e mengata: subcutaneously (s / c), intramuscularly (i / m) kapa intravenously (i / v). Hangata, insulin e tsamaisoa ntle ho tšenyo ea nako. Ho etsa sena, sebelisa sebaka:

Hangata lithethefatsi li fanoa ka methapo e matla maemong a hlobaetsang a bakoang ke lefu la tsoekere: ketoacidosis, lefu la tsoekere.

E eletsoa ho tsamaisa insulin metsotso e 15-30 pele ho lijo, makhetlo a 3 ka letsatsi. Ka linako tse ling ho laoloa lithethefatsi tse le 'ngoe tsa 5-6.

Tekanyetso ea insulin hangata e baloa ka tekanyo ea likarolo tsa 0.5-1 ka boima ba kilo e le ngoe. Haeba insulin e fanoa ka makhetlo a fetang 0,6 mg ka boima ba 'mele ka nako eo, moriana o lokela ho fuoa bonyane makhetlo a 2 ka letsatsi. Ka karolelano, litekanyetso tsa letsatsi le letsatsi li ka ba 30-40 unit (ho bana, likarolo tsa 8).

Bakhachane ba tloaetseng ho fuoa tekanyetso ea boima ba 'mele ea 0,6 PESCES. Lijana hangata li hlahisa makhetlo a 3-5 ka letsatsi, ho latela palo ea lijo.

Hangata, insulin e sebetsang ka potlako e kopantsoe le insulin e nkang nako e telele.