Tsarin insulin na ɗan adam mai narkewa tare da sakamako mai tsawo (wanda ya haifar da haɗin kai mai ƙarfi na ƙwayoyin detemir insulin a cikin yanki na gudanarwa da hulɗa da kwayoyin ƙwayoyi tare da albumin ta hanyar tuntuɓar sashin haɗin acid-fat mai acid) tare da bayanin martaba na aiki (mara ƙaranci idan aka kwatanta da insulin glargine da isofan) .
Idan aka kwatanta da insulin-isofan, sannu a hankali insulin detemir ya tarwatse a cikin kyallen takaddun makasudin, wanda ke tabbatar da yawan aiki mai mahimmanci da tasiri na wakili. Anyi ma'amala mai kyau tare da mai karɓar ƙwayar sel ta waje wanda aka sani.
Har ila yau, maganin yana haifar da hadaddun insulin-receptor wanda ke kunna ayyukan da ke faruwa a cikin sel, ciki har da shi yana ƙarfafa aikin wasu enzymes masu mahimmanci (alal misali, glycogen synthetase).
Rage yawan sukarin jini yana faruwa ne ta:
- karuwa a cikin sufuri a cikin sel;
- kunnawa na glycogenogenesis, lipogenesis;
- ƙarancin narkewar ƙwayar cuta;
- raguwa a cikin yawan samar da glucose ta hanta.
Bayan allurar miyagun ƙwayoyi (raka'a 0.2-0.4 / kg 50%), ana samun ingantaccen ingantaccen ƙarfi bayan sa'o'i 3-4 kuma yana zuwa 14 hours. Tsawon lokacin sakamako har zuwa 1 rana.
TCmax - daga 6 zuwa 8 hours. Css, idan ana sarrafa shi sau biyu kullun, ana iya cimma shi bayan allura ta biyu. Tsarin shine 0.1 l / kg.
Metabolism yana kama da metabolism na insulin ɗan adam, duk metabolites da aka kafa suna wucewa. T1 / 2 daga 5 zuwa 7 hours.
Yin hulɗa tare da wasu hanyoyi
Actionarfafa matakin motsa jiki yana ba da gudummawa ga:
- Magungunan da ke ɗauke da ethanol;
- cututtukan hypoglycemic (na baka);
- Li +;
- MAO masu hanawa;
- fenfluramine,
- ACE masu hanawa;
- cyclophosphamide;
- carbonic anhydrase inhibitors;
- theophylline;
- marasa zaɓi na beta-blockers;
- pyridoxine;
- bromocriptine;
- mebendazole;
- sulfonamides;
- ketonazole;
- wakilan anabolic;
- Clofibrate;
- karafarini.
Hypoglycemic kwayoyi
Nicotine, rigakafin (na baka), corticosteroids, phenytoin, hormones thyroid, morphine, thiazide diuretics, diazoxide, heparin, allunan tashar alli (jinkirin), tricyclic antidepressants, clonidine, danazole da tausayi suna rage tasirin cutar.
Salicylates da reserpine suna iya haɓaka ko rage tasirin abin da detemir ke ɗaukar insulin. Lanreotide da octreotide suna haɓaka ko rage yawan insulin.
Kula! Beta-blockers, saboda abubuwan da suka mallaka na musamman, sau da yawa suna rufe alamun bayyanar cututtukan jini da jinkirta maido da matakan glucose na yau da kullun.
Magungunan Ethanol da ke dauke da kwayoyi suna haɓakawa da haɓaka tasirin insulin. Magungunan ba su dace da kwayoyi dangane da sulfite ko thiol (an lalata insulin detemir). Hakanan, maganin ba zai iya haɗuwa da mafita na jiko ba.
Umarni na musamman
Ba za ku iya shiga cikin ciki ba, kamar yadda mummunan nau'in hauhawar jini zai iya haɓaka. Kulawa mai zurfi tare da maganin ba ya bayar da gudummawa ga tarin ƙarin fam.
Idan aka kwatanta da sauran insulins, insulin detemir yana rage haɗarin hauhawar jini da daddare kuma yana ba da gudummawa ga mafi yawan zaɓin sashi wanda aka ƙaddara don cimma daidaituwar taro na sukari a cikin jini.
Mahimmanci! Dakatar da magani ko kuma yawan maganin da ba daidai ba, musamman ga nau'in ciwon sukari na I, yana ba da gudummawar bayyanar cututtukan hyperglycemia ko ketoacidosis.
Alamar farkon cutar hyperglycemia galibi tana faruwa ne a matakai. Suna bayyana cikin fewan awanni ko kwanaki. Bayyanar cututtukan hyperglycemia sun hada da:
- ƙanshi na acetone bayan ƙarewa;
- ƙishirwa
- rashin ci;
- polyuria;
- jin bushewa a cikin rami na baka.
- tashin zuciya
- bushe fata
- gagging;
- hyperemia;
- m barci.
Kwatsam da motsa jiki, da kuma rashin daidaituwa yayin cin abinci na yau da kullun suna taimakawa wajen haifar da ƙin jini.
Koyaya, bayan sake dawowar metabolism metabolism, alamomin halayyar da ke nuna alamun hypoglycemia na iya canzawa, don haka likitan halartar ya kamata a sanar da shi. Alamar cututtuka na yau da kullun na iya rufe idan akwai masu ciwon sukari na tsawan lokaci. Hakanan cututtukan da ke tare da su kuma suna kara bukatar insulin.
Canja wurin mara lafiya zuwa wani sabon nau'in ko insulin, wanda wani masana'anta ya kera shi, koyaushe ana aiwatar dashi karkashin kulawar likita. Game da canji a masana'anta, sashi, nau'in, nau'in ko hanyar samar da insulin, sau da yawa ana buƙatar daidaita sashi.
Marasa lafiya da aka canjawa wuri zuwa magani wanda ake amfani da detemir insulin sau da yawa suna buƙatar daidaita sashi idan aka kwatanta da ƙimar insulin da aka gudanar a baya. Bukatar canza kashi ya bayyana ne bayan bayyanar allurar farko ko cikin mako ko watan. Hanyar ɗaukar ƙwayoyi a cikin yanayin gudanarwar intramuscular yana da sauri idan aka kwatanta da sc gwamnati.
Detemir zai canza salon aikinta idan aka cakuda shi da sauran nau'ikan insulin. Haɗuwarsa tare da insulin aspart zai haifar da bayanin ayyukan aiki tare da ƙarancin, dakatar da iyakar tasiri idan aka kwatanta da madadin gudanarwa. Bai kamata a yi amfani da insulin na insulin a cikin famfan insulin ba.
Zuwa yau, babu bayanai game da amfani da maganin a lokacin daukar ciki, lactation da yara a ƙarƙashin shekaru shida.
Ya kamata mai haƙuri ya yi gargaɗi game da yiwuwar hyperglycemia da hypoglycemia akan aiwatar da tuki mota da hanyoyin sarrafawa. Musamman, yana da mahimmanci ga mutanen da ke da alamu masu laushi ko waɗanda basu halarci ba waɗanda ke ɗauke da cutar hypoglycemia.
Alamu don amfani da sashi
Ciwon sukari (mellitus) shine babbar cuta wacce aka nuna alamar maganin.
Ana aiwatar da shigarwar a cikin kafada, rami na ciki ko cinya. Dole ne a riƙa canza wuraren da ake allurar insulin allurar rigakafin. Sashi da kuma yawan allurar an kafa su daban-daban.
Lokacin da aka allura sau biyu don inganta yawan glucose, yana da kyau a gudanar da kashi na biyu bayan awa 12 bayan na farko, lokacin cin abincin yamma ko kafin zuwa gado.
Ana iya buƙatar daidaita sashi da lokacin gudanarwa idan mai haƙuri ya canza shi daga tsawan insulin da magani mai matsakaici zuwa insulin.
Side effects
Sakamakon sakamako masu illa na yau da kullun (1 cikin 100, wani lokacin 1 cikin 10) sun haɗa da hypoglycemia da duk alamomin masu halarta: tashin zuciya, ƙyallen fata, haɓaka ci, disorientation, yanayin juyayi har ma da rikicewar kwakwalwa wanda zai iya haifar da mutuwa. Hakanan halayen gida (itching, kumburi, hyperemia a wurin allura) suma zasu yuwu, amma suna ɗan lokaci kuma sun ɓace yayin jiyya.
Rashin sakamako masu illa (1/1000, wani lokacin 1/100) sun haɗa da:
- allurar lipodystrophy;
- kumburi na wucin gadi wanda ke faruwa a farkon maganin insulin;
- bayyanar rashin lafiyan (raguwa a cikin karfin jini, urticaria, palpitations da wahala a cikin numfashi, itching, malfunction na narkewa kamar fili, hyperhidrosis, da dai sauransu);
- a matakin farko na ilimin insulin, cin zarafi na wucin gadi na tunani yana faruwa;
- maganin ciwon sukari.
Game da maganin retinopathy, kulawa mai tsawo na glycemic yana rage yiwuwar haɓaka ƙwaƙwalwar ƙwayar cuta, amma ƙwaƙwalwar insulin mai zurfi tare da karuwa kwatsam a cikin ƙwayar metabolism zai iya haifar da rikitarwa na ɗan lokaci na yanayin cututtukan cututtukan cututtukan zuciya.
Da wuya sosai (1/10000, wani lokacin 1/1000) sakamako masu illa sun haɗa da neuropathy na yanki ko kuma ciwon mara mai ƙarewa, wanda yake juyawa ne koyaushe.
Yawan damuwa
Babban alamar cutar yawan ƙwayar cuta shine hypoglycemia. Marasa lafiya na iya kawar da wani nau'in sikari na hypoglycemia a kashin kansu ta hanyar cin abinci na glucose ko abinci na carbohydrate.
A cikin yanayin s / c mai tsanani, ana / m ana gudanar da 0.5-1 mg na glucagon ko kuma maganin dextrose a / in. Idan bayan mintina 15 bayan shan glucagon, mara lafiyar bai sake murmurewa ba, to ya kamata a gudanar da maganin dextrose. Lokacin da mutum ya sake tunani don dalilai na hanawa, ya kamata ya ci abincin da yake cike da carbohydrates.
