Karin insulin, basal da bolus: menene?

Glucose shine babban tushen samar da makamashi ga jiki baki daya. Tare da karancin glucose, mutum zai iya fuskantar rauni mai rauni, aikin kwakwalwa mai rauni da haɓaka matakin acetone a cikin jini, wanda ke haifar da ci gaban ketoacidosis.

Babban adadin carbohydrates da mutum ya karba tare da abinci, cin 'ya'yan itace, kayan marmari, hatsi daban-daban, gurasa, taliya da, ba shakka, Sweets. Koyaya, carbohydrates suna sha da sauri kuma sabili da haka, a tsakanin abinci, matakan glucose a cikin jiki ya fara raguwa kuma.

Don hana raguwar sukari mai yawa a cikin jini, mutum yana taimakawa hanta, wanda ke fitar da wani abu na musamman glycogen, wanda idan ya shiga jini, sai a canza shi zuwa glucose mai tsabta. Don ƙoshinta na yau da kullun, ƙwanƙwasa kullun yana samar da ƙaramin insulin, wanda ke taimakawa kiyaye ma'aunin kuzari a jiki.

Irin wannan insulin ana kiranta da basal, ƙwaƙwalwar ƙwayar cuta ta ɓoye shi a cikin adadin 24-28 raka'a kowace rana, watau kusan 1 raka'a. awa daya. Amma ta wannan hanyar wannan yana faruwa ne kawai a cikin mutane masu lafiya, a cikin marasa lafiya da ciwon sukari mellitus, basal insulin ko dai ba a ɓoye shi kwata-kwata, ko kuma ba a tsinkaye da ƙwayayen ciki sakamakon ci gaban insulin juriya.

Saboda wannan, masu ciwon sukari suna buƙatar allura na yau da kullun na basal insulin don taimakawa sha glycogen da hana haɓaka sukari na jini. Abu mafi mahimmanci shine zaɓi madaidaicin sashin insulin na basal da daidaita amfaninsa tare da ɗaukar matakan insulins da gajeru.

Abubuwan da aka shirya na insulin basal

Basal ko, kamar yadda ake kiran su, insulins na baya sune magunguna na matsakaici ko tsawaita aiki. Akwai su a matsayin dakatar da aka yi nufin allurar subcutaneous kawai. Roaddamar da insulin basal a cikin jijiya yana da rauni sosai.

Ba kamar insulins-gajere ba, insulins marasa ma'ana kuma suna kama da ruwa mai girgije. Wannan ya faru ne saboda gaskiyar cewa suna ɗauke da abubuwa masu rauni iri-iri, kamar zinc ko protamine, waɗanda ke caccaka cikin hanzarin ƙwayar insulin don haka ya tsawaita aikin.

Lokacin yin ajiya, waɗannan ƙazaman na iya haifar da hazo, don haka kafin allura dole ne a haɗe su da sauran abubuwan maganin. Don yin wannan, mirgine kwalban a cikin tafin hannunka ko juya shi sama da ƙasa sau da yawa. An haramta girgiza maganin.

Mafi yawan magungunan zamani, waɗanda suka haɗa da Lantus da Levemir, suna da daidaitattun daidaito, tunda ba su da ƙazantawa. Ayyukan waɗannan insulins an tsawanta saboda canje-canje a cikin tsarin ƙwayar ƙwayar ƙwayar cuta, wanda baya ba da damar su sha da sauri.

Shirye-shiryen insulin basal da tsawon lokacin aikinsu:

Yawan inje na insulin na basal kowace rana ya dogara da nau'in maganin da marasa lafiya ke amfani da shi. Don haka lokacin amfani da Levemir, mara lafiya yana buƙatar yin allura biyu na insulin kowace rana - da dare da kuma karin lokaci tsakanin abinci. Wannan yana taimakawa wajen kula da matakan insal ɗin cikin jiki.

Shirye-shiryen insulin na baya mai tsawo, kamar Lantus, na iya rage yawan allura zuwa allura guda daya kowace rana. A saboda wannan dalili, Lantus shine mafi mashahuri magani a cikin masu ciwon sukari. Kusan rabin mutanen da ke fama da cutar sankara suna amfani da ita.

Yadda za'a kirkiri kashi na insulin basal

Insulin na Basal yana taka muhimmiyar rawa a cikin nasarar sarrafa ciwon sukari. Rashin insulin asalin shine yakan haifar da rikice-rikice a jikin mai haƙuri. Don hana ci gaban yiwuwar cututtukan cututtukan ƙwayar cuta, yana da mahimmanci a zaɓi madaidaicin sashi na maganin.

Kamar yadda aka fada a sama, kashi na yau da kullun na insulin basal yakamata ya kasance daga raka'a 24 zuwa 28. Koyaya, sashi daya na asalin insulin da ya dace da duk masu dauke da cutar sankara basa wanzu. Kowane mai ciwon sukari dole ne ya ƙayyade mafi yawan adadin ƙwayoyi don kansa.

A wannan yanayin, dole ne a la'akari da abubuwa daban-daban da yawa, irin su shekarun haƙuri, nauyi, matakin sukari na jini da kuma shekaru nawa yake fama da cutar sankara. A wannan yanayin, duk jiyya na maganin cutar sankara zai zama da gaske tasiri.

Don yin ƙididdigar yawan adadin insulin na basal, dole ne mai haƙuri ya fara tantance ma'aunin kayan jikinsa. Za'a iya yin wannan ta amfani da wannan tsari: Alamar taro = nauyi (kg) / tsawo (m²). Don haka, idan ci gaban mai ciwon sukari ya kasance 1.70 m kuma nauyi shine kilogiram 63, to, adadin jikin jikinsa zai kasance: 63 / 1.70² (2.89) = 21.8.

Yanzu mara lafiya yana buƙatar yin lissafin madaidaicin nauyin jikinsa. Idan ma'aunin ainihin jikinsa yana cikin kewayon daga 19 zuwa 25, to don yin ƙididdigar yawan taro, kuna buƙatar amfani da jigon 19. Wannan dole ne a yi shi bisa ga ka'idar da ke biye: 1.70² (2.89) × 19 = 54.9≈55 kg.

Tabbas, don yin ƙididdigar yawan insulin na basal, mai haƙuri na iya amfani da nauyin jikinsa na ainihi, duk da haka, wannan ba a so ne saboda dalilai da yawa:

• Insulin yana nufin steroids anabolic, wanda ke nufin yana taimakawa wajen ƙaruwa da lafiyar mutum. Sabili da haka, mafi girma sashi na insulin, da ƙarfi mai haƙuri na iya murmurewa;
• Yawancin insulin masu yawa sunada hatsari fiye da rashi, saboda zai iya haifar da matsanancin rashin bacci. Sabili da haka, yana da kyau a fara da ƙananan sashi, sannan a hankali ƙara musu.

Za'a iya yin lissafin sashin insulin basal ta hanyar amfani da tsari mai sauki, wato: Fitaccen jikin mutum × 0.2, i.e. 55 × 0.2 = 11. Saboda haka, kashi na yau da kullun na insulin baya ya zama raka'a 11. Amma irin wannan dabara ba sa'ar da masu cutar sukari ke amfani da ita, tunda tana da babban kuskure.

Akwai wani karin tsari mai rikitarwa don lissafin kashi na asalin insulin, wanda ke taimakawa samun ingantaccen sakamako. A saboda wannan, dole ne mai haƙuri ya fara lissafin sashi na duka insulin na yau da kullun, duka basal da bolus.

Don gano adadin jimirin insulin da mara haƙuri ke buƙata a cikin rana ɗaya, yana buƙatar ninka nauyin jiki na kwarai da yanayin daidai da tsawon lokacin rashin lafiyarsa, watau:

1. Daga shekara 1 zuwa shekaru 5 - mai aiki na 0.5;
2. Daga shekara 5 zuwa shekaru 10 - 0.7;
3. Sama da shekaru 10 - 0.9.

Don haka, idan madaidaicin nauyin jikin mai haƙuri shine kilogiram 55, kuma ya kasance yana fama da cutar sankara har tsawon shekaru 6, sannan don yin lissafin kashinsa na yau da kullun yana zama dole: 55 × 0.7 = 38.5. Sakamakon da aka samu zai dace da mafi kyawun kashi na insulin a kowace rana.

Yanzu, daga jimlar insulin, ya zama dole don ware sashin da yakamata ya kasance akan insulin basal. Wannan ba shi da wahala a yi, domin kamar yadda ka sani, duk girman insulin basal ya kamata ya wuce kashi 50% na yawan abubuwan insulin. Kuma koda mafi kyawu idan zai zama 30-40% na ma'aunin yau da kullun, sauran 60 za su karɓi insulin.

Saboda haka, mai haƙuri yana buƙatar yin ƙididdigar masu zuwa: 38.5 ÷ 100 × 40 = 15.4. Ididdigar yawan sakamakon da aka gama, mai haƙuri zai sami mafi kyawun gwargwado na insulin basal, wanda shine raka'a 15. Wannan baya nufin wannan maganin baya buƙatar gyara, amma yana kusanci da buƙatun jikinsa.

Yadda za a daidaita kashi na insulin basal

Don bincika sashi na insulin na asali yayin aikin ciwon sukari na 1, mai haƙuri yana buƙatar yin gwajin basal na musamman. Tunda hanta tana ɓoye glycogen a kusa da agogo, dole ne a bincika adadin insulin dare da rana.

Ana yin wannan gwajin ne kawai a kan komai a ciki, don haka a lokacin mai haƙuri ya kamata gaba ɗaya ya ƙi ci, ko karin kumallo, alƙawura ko abincin dare. Idan hawa da sauka a cikin sukari na jini yayin gwajin bai samar da mm sama da 1.5 mmol kuma mara lafiya bai nuna alamun hypoglycemia ba, to ana ɗaukar irin wannan sigar na insulin basal.

Idan mai haƙuri yana da digo ko ƙaruwa a cikin sukari na jini, sashi na insulin na baya yana buƙatar gyara da gaggawa. Orara ko rage sashi zai zama a hankali ba biyu ba. a lokaci kuma babu fiye da sau 2 a mako.

Wata alamar da ke nuna cewa mai haƙuri yana amfani da tsinkayyar insulins a cikin madaidaicin sashi shine sukari mai ƙarancin jini yayin binciken sarrafawa safe da maraice. A wannan yanayin, bai kamata su wuce iyakar babba na 6.5 mmol ba.

Yin gwajin basal da daddare:

• A wannan ranar, mai haƙuri ya kamata ya ci abincin dare da wuri-wuri. Zai fi kyau idan abinci na ƙarshe ya faru ba da 6 ba da yamma. Wannan ya zama dole saboda a lokacin gwaji, aikin gajeren insulin, wanda aka gudanar a abincin dare, ya ƙare. A matsayinka na mai mulkin, wannan yana ɗaukar akalla awanni 6.
• Da ƙarfe 12 na safe, ya kamata a ba da allura ta hanyar gudanar da matsakaici (Protafan NM, InsumanBazal, Humulin NPH) ko insulin (Lantus) mai tsayi.
• Yanzu kuna buƙatar auna sukari na jini kowane sa'o'i biyu (a 2:00, 4:00, 6:00 da 8:00), lura da hawa da sauka. Idan ba su wuce 1.5 mmol ba, to an zaɓi kashi daidai.
• Yana da mahimmanci kada a rasa mafi girman aikin insulin, wanda a cikin kwayoyi masu matsakaici suna faruwa bayan kimanin awa 6. Tare da madaidaicin sashi a wannan lokacin, mai haƙuri bai kamata ya sami raguwa sosai a matakan glucose da haɓakar haɓakawar jini ba. Lokacin amfani da Lantus, ana iya tsallake wannan abun, tunda ba shi da babban aiki.
• Ya kamata a soke gwajin idan, kafin ya fara, mai haƙuri yana da hyperglycemia ko matakin glucose ya tashi sama da 10 mmol.
• Kafin gwajin, a kowane yanayi yakamata kuyi injections na gajeriyar insulin.
• Idan yayin gwajin ya kasance mai haƙuri ya sami hare-haren hypoglycemia, dole ne a dakatar da shi, kuma ya kamata a dakatar da gwajin. Idan sukari na jini, ya yi akasin haka, ya hauhawa cikin haɗari, kuna buƙatar yin ƙaramin allurar gajeren insulin kuma jinkirta gwajin har gobe.
• Gyara daidai na insulin basal mai yiwuwa ne kawai kan irin waɗannan gwaje-gwaje guda uku.

Gudanar da gwajin basal yayin rana:

• Don yin wannan, mai haƙuri yana buƙatar dakatar da cin abinci gaba ɗaya da safe kuma a maimakon ɗan gajeren insulin, saka allurar-matsakaiciyar matsakaici.
• Yanzu mara lafiya yana buƙatar bincika matakin sukari na jini kowane awa kafin abincin rana. Idan ya fadi ko ya karu, to yakamata a daidaita yawan maganin, idan ya kasance matakin ya kasance, to sai a sanya shi iri daya.
• Kashegari, mai haƙuri ya kamata ya ɗauki karin kumallo na yau da kullun kuma ya yi injections na gajere da matsakaitan insulin.
• Abincin rana da kuma wani ɗan gajeren insulin ya kamata a tsallake. 5 hours bayan karin kumallo, kuna buƙatar bincika sukarin jininka da farko.
• Bayan haka, mai haƙuri yana buƙatar bincika matakin glucose a cikin jiki kowane sa'a har sai abincin dare. Idan ba'a lura da wasu karkatacciyar karkacewa ba, maganin ya zama daidai.

Ga marasa lafiya da ke amfani da insulin Lantus don ciwon suga, babu buƙatar gudanar da gwajin yau da kullun. Tun da Lantus dogon insulin ne, yakamata a yiwa mara lafiya sau daya a rana, kafin lokacin bacci. Sabili da haka, yana da mahimmanci don bincika isasshen ƙwaƙwalwar sa kawai da dare.

Bayanai game da nau'ikan insulin a cikin bidiyon a cikin wannan labarin.