Isofan insulin aha ahia, mmetụta ya, analogs, usoro nke ihe, contraindication, egosi, nnyocha na nkezi ọnụahịa

Nchịkwa nri na ọgwụ nke U.S. (FDA) kwadoro Tresiba / Tresiba (insulin degludec maka injection) na Ryzodeg / Ryzodeg 70/30 (insulin degludec / insulin aspart for injection) na Septemba 25 iji mee ka nchịkwa shuga dị ọbara na ndị okenye nwere ọrịa shuga.

Dabere na erslọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa, ihe dị ka nde mmadụ 21 na United States na-arịa ọrịa shuga. Ka oge na-aga, ọrịa shuga na-amụba ohere nke nnukwu nsogbu, gụnyere ọrịa obi, ikpu ìsì, mmebi nke usoro akwara, yana ọrịa akụrụ. Controlkwalite njikwa shuga dị n'ọbara nwere ike inye aka belata ihe egwu nke ụdị ọrịa a.

«Ogologo insulin na-arụ ọrụ dị mkpa na ọgwụgwọ nke ndị ọrịa nwere ụdị shuga dị elu na ọrịa shuga II, ”ka Dr. Jean-Marc Gettyer, Onye isi na thelọ Ọrụ Metabolic na Endocrinological nke FDA Center maka Nnyocha na Ọgwụ. Anyị na-agbakarị mmepe na mbido ọgwụ iji nyere aka ịlụso ọrịa shuga ọgụ. ”

Ọgwụ Tresiba Eme insulin analog na-arụ ọrụ ogologo oge iji meziwanye njikwa glycemic na ndị okenye nwere ụdị nke m na ụdị shuga II. A họrọ usoro ị theụ ọgwụ ahụ n'otu n'otu n'ọnọdụ nke ọ bụla. A na-elekọta Tresiba subcutaneously otu ugboro n'ụbọchị n'oge ọ bụla n'ụbọchị.

Arụmọrụ na nchekwa A na-enyocha Tresiba maka ndị ọrịa nwere ụdị ọrịa shuga na insulin ọnụ maka nri, na-enyocha ya n'ime izu abụọ 26 na otu izu-52 na-arụsi ọrụ ike na-ejide ndị ọrịa 1 102.

Arụmọrụ na nchekwa A na-enyocha Tresiba maka ndị ọrịa nwere ọrịa shuga II na ọgwụ ọnụ na-egbochi ọrịa shuga na izu anọ 26-izu na izu abụọ 52 na-arụsi ọrụ ike na-emetụta ndị ọrịa 2 702. Ndị niile sonyere were ọgwụ nnwale.

N'ime ndị ọrịa nwere ụdị nke m na ụdị ọrịa shuga II nke nwere ezughị oke nchịkwa ọbara ọbara na mmalite nke ọmụmụ, ojiji nke Treshiba kpatara mbelata nke HbA1c (haemoglobin A1c ma ọ bụ glycogemoglobin, onye na-egosi shuga ọbara), yana ihe ndị ọzọ na-eme insulin na-eme ogologo oge. nke akwadoro na mbụ.

Ọgwụ Ryzodeg 70/30 bụ ọgwụ a jikọtara ọnụ: insulin-degludec, insulin analogue na-arụ ọrụ ogologo oge + insulin aspart, analogue insulin na-agba ọsọ. Ezubere Ryzodeg iji meziwanye nchịkwa glycemic na ndị okenye nwere ọrịa shuga.

Arụmọrụ na nchekwa Ryzodeg 70/30, maka ndị ọrịa nwere ụdị nke ọria mamịrị ya na insulin a na-ede ede maka nri, ka enyochare n'ọmụmụ ihe nyocha izu iri abụọ na isii n'ime ndị ọrịa 362.

A na-enyocha nrụpụta na nchekwa nke Ryzodeg 70/30 maka nchịkwa 1-2 ugboro n'ụbọchị site n'aka ndị ọrịa nwere ọrịa shuga II na nyocha izu anọ izu 26 26 metụtara ndị ọrịa 998. Ndị niile sonyere were ọgwụ nnwale.

N'ime ndị ọrịa nwere ụdị nke m na ụdị ọrịa shuga II nke na-enwechaghị ike ịchịkwa shuga ọbara na mmalite nke ọmụmụ ahụ, ojiji nke Raizodeg 70/30 mere ka mbelata nke HbA1c yiri nke ahụ nwetara na insulin na-arụ ọrụ ogologo oge ma ọ bụ insulin agwakọrịrị.

Njikere Tresiba na Ryzodeg contraindicated na ndị ọrịa nwere oke ketone ozu n'ime ọbara ma ọ bụ mmamịrị (ọrịa mamịrị ketoacidosis). Ndị dọkịta na ndị ọrịa kwesịrị iji nlezianya nyochaa ọkwa glucose ọbara ha n'oge ọrụ insulin. Tresiba na Ryzodeg nwere ike ịkpata mbelata ọbara shuga (hypoglycemia) - ọnọdụ na-eyi ndụ egwu. Ekwesịrị itinyekwu nlezianya mgbe ị na-agbanwe usoro insulin, ojiji nke ọgwụ ndị ọzọ na -ebelata glucose, mgbanwe na nri, mmega ahụ, yana ndị ọrịa nwere akụrụ ma ọ bụ enweghi nsogbu ma ọ bụ enweghị ume hypoglycemia.

Iji insulin ọ bụla nwere ike ibute mmeghachi omume nfụkasị ahụ na-egbu ndụ, gụnyere anafilaisis, mmeghachi ahụ anụ ahụ na-ahụkarị, angioedema, bronchospasm, hypotension na ujo anụ ahụ.

Nsonaazụ ndị kachasị emetụta Tresiba na ọgwụ Risedeg achọpụtara n'oge nnwale ụlọ ọgwụ bụ hypoglycemia, mmeghachi ahụ nfụkasị ahụ, mmeghachi omume na saịtị ntụtụ, lipodystrophy (mfu nke abụba subcutaneous) na ntanetị ahụ, nchapu akpụkpọ ahụ, nhụjuanya, ọzịza na uru ahụ.

Pharmacodynamics na pharmacokinetics

Insulin bụ ezigbo homonụ nke, ya na glucagon, na-emetụta shuga ọbara. A na-etolite homonụ ahụ n’ime sel-sel (mkpụrụ ndụ beta) nke pancreas - agwaetiti nke Langerhans. Ọrụ bụ isi nke insulin bụ njikwa glycemic.

Ọnwe insulin zuru ezu na-eduga na mmepe nke ụdị ọrịa shuga mellitus 1 - ọrịa autoimmune. Ọ bụ ezie na enwere ụdị insulin na-ebute ọrịa ahụ, a na-ahụ erughi insulin kpamkpam, ọrịa shuga na-abụghị insulin bụ nke a na-eji ụkọ hormone dị.

Ihe mkpali maka ịtọhapụ ụmụ irighiri ọgwụ insulin bụ ọ̀tụ̀tụ̀ shuga dị n'ọbara nke 5 mmolọlọ nke lita ọbara. Ọzọkwa, amino acid dị iche iche na abụba abụba na-enweghị ihe ọ bụla nwere ike ime ka mwepụta nke mmiri ọgwụ hormonal: secretin, GLP-1, HIP na gastrin. Polypeptide glucose na-adabere glucose na-akpali mmepụta nke insulin mgbe i richara nri.

Analog insulin na-ejikọ ya na ndị na-anabata insulin kpọmkwem ma na-eme ka mkpụrụ ndụ glucose banye n’ime mkpụrụ ndụ. Mkpụrụ ndụ akwara na akwara nwere ọnụ ọgụgụ dị ukwuu nke ndị na-anabata ihe. Ya mere, ha nwere ike ị nweta nnukwu glucose na obere oge ma chekwaa ya ka ọ bụrụ glycogen ma ọ bụ gbanye ya n'ike.

Ihe ngosi na contraindications

A mụọ banyere ọgwụ a na-atụle ihe karịrị mmadụ 3,000. Ọtụtụ ọmụmụ pere mpe ma bụrụ ndị na-ezughị ezu.

N'ọmụmụ nyocha buru ibu, nyochara ọtụtụ, lyspro insulin na nwa elekere. 1,008 ndị nwere ọrịa shuga na-akpata insulin nọ n’ọmụmụ ihe ae mepere emepe, bụ́ nke were ọnwa 6. A na-emeso ha niile dabere n'ụkpụrụ nke usoro ọgwụgwọ nke bolus. E nyere ọgwụ a ozugbo tupu nri, yana insulin oge niile nkeji iri atọ ruo iri anọ na ise tupu nri. Mgbe ị na-eji lyspro, ọkwa nke monosaccharides n'ọbara mụbara nke ukwuu mgbe ị risịrị nri karịa insulin nkịtị, ogo glucose dị n'ọbara mgbe ị risịrị nri bụ 11.15 mmol / L nwere insulin nkịtị, 12.88 mmol / L nwere lyspro. Banyere glycosylated haemoglobin (HbA c) na ọnụ ọgụgụ glucose na-ebu ọnụ, enweghị ọdịiche pụtara ìhè n'etiti nhọrọ ọgwụgwọ abụọ ahụ.

Na nyocha emere, a nyochakwara ịdị irè nke ọgwụ a na 722 ndị nwere ọrịa shuga na-enweghị ọgwụ insulin. Enwekwara mmụba shuga dị n'ọbara nke ukwuu mgbe ị risịrị nri. Na ngwụsị nke ọmụmụ ahụ, ọkwa glucose dị 1.6 mmol / L dị ala na isofan awa 2 mgbe nri gasịrị karịa nke lyspro. Glycated haemoglobin belatara nke ọma na otu usoro ọgwụgwọ abụọ.

Nnwale ọzọ na-enweghị usoro kọrọ banyere mmadụ 336 nwere ọrịa shuga nke m na 295 nwere ọrịa shuga na-enweghị insulin. Ndị ọrịa na-ewere ma ọ bụ lispro ma ọ bụ isofan. Ọzọ, enyere ogwu ahu tupu nri, na lispro 30-45 nkeji tupu nri. Ọzọkwa na ọmụmụ ihe a, nke were ọnwa iri na abụọ, isofan gosipụtara mbelata ogo glucose postprandial ma e jiri ya tụnyere ọgwụ ndị ọzọ. Typedị ọrịa shuga m, Isofan nwetagoro mbelata ihe ndekọ ahụ na haemoglobin glycated (ruru 8.1%). N'ime ndị nwere ụdị ọrịa shuga II, enweghị ọdịiche n'etiti otu ndị na-ahụ maka ọgwụgwọ na nke a.

Nsonaazụ

Hypoglycemia bụ nsogbu kachasị mkpa nke ọgwụgwọ insulin. Imirikiti ọmụmụ ejirila ọrịa hypoglycemic nke ọrịa ma ọ bụ saccharides ọbara n'okpuru 3.5 mmol / L iji chọpụta ọdịdọ hypoglycemic. N'ime omumu abuo buru ibu, oria Sympoomatic na asymptomatic hypoglycemia di obere karia ndi oria were buru isofan, a kacha kwuputa ihe di iche n’abali a.

N'ime ọmụmụ n'ime ndị nwere ọrịa shuga na-akpata ọrịa shuga, hypoglycemia mere na ọkara 6 kwa ọnwa. Na ntụnyere nwere okpukpu abụọ n'etiti lispro na isophane, ọdịghị ọdịiche dị n'etiti hypoglycemia ugboro ugboro. Mgbe ị na-eji ọgwụ mbụ, ihe ize ndụ nke hypoglycemia kacha elu ihe dị ka awa 1-3 mgbe ọ gbasịrị, yana iwebata homonụ insulin mmadụ na-etinye mgbe awa 3-12 gasịrị.

Ebe ọ bụ na lyspro nwere njikọ jikọrọ insulin dị ka etolite etolite (IGF-I), ọ dabere na ndị na-anabata IgF-I karịa insulin oge niile. Na usoro ọgwụgwọ, mmetụta IGF-I dị ka nke ọma nwere ike itinye aka na mmepe nke nsogbu microvaskụla ma ọ bụ, n'ihi ahụmịhe na insulin ọzọ yiri nke ahụ, na-ebutekwa ọrịa carcinogenic.

Hypoglycemia na-eme ma ọ bụrụ na onye ọrịa ahụ enye nnukwu ọgwụ ahụ, drinksụọ mmanya, ma ọ bụ riri obere nri. Mmega ahụ karịrị akarị nwere ike ibute mmeghachi omume hypoglycemic mgbe ụfọdụ.

Ihe mgbaàmà kachasị bụ:

• Hyperhidrosis,
• Tremor
• .Bawanye ụba
• Ọhụụ.

Enwere ike ịgwọ hypoglycemia ngwa ngwa site na dextrose ma ọ bụ ihe ọ drinkụ sweetụ dị ụtọ (ihe ọ appleụ appleụ apụl). Ya mere, ọrịa mamịrị kwesịrị iburu shuga na ya mgbe niile. Site na hypoglycemia ugboro ugboro na ọrịa shuga ogologo oge, enwere ihe ize ndụ na onye ọrịa ahụ ga-adaba na mmiri. Ọgwụ, ọkachasị ndị na - egbochi beta, nwere ike kpuchie mgbaàmà nke hypoglycemia.

Hyperglycemia na-etolite mgbe a na-agụta ọnụ ọgụgụ nri na insulin n'ụzọ ziri ezi. Ọrịa na ụfọdụ ọgwụ nwekwara ike ibute hyperglycemia. N'ime ụdị ndị ọrịa mamịrị 1, ụkọ insulin na-eduga n'ihe a na-akpọ ketoacidosis - acidity nke anụ ahụ. Nke a nwere ike ibute mwepu kpamkpam (ọrịa mamịrị coma), na n'ọnọdụ kachasị njọ, ọnwụ. Ketoacidosis bụ ọnọdụ ahụike mberede ọ bụrụ dọkịta kwesịrị ịgwọ ya mgbe niile.

• Ogbugbu na vomiting
• Urination ugboro ugboro
• Ike ike
• Acetone

Usoro onunu ogwu na ịdoụbiga mmanya ókè

Dabere na ntuziaka maka ojiji, a na-ejikarị ọgwụ ọgwụ subcutaneously - banye anụ ahụ adibi subcutaneous. Ebe a họọrọ ahịrị dị mma bụ apata dị n'okpuru na apata ụkwụ. A ogwu ogwu ya na mkpa di nkpa ma di mkpụmkpụ n’obara akpụkpọ ahụ. Uru otu mkpịsị ode akwụkwọ bụ na onye ọrịa nwere ike ịhụ etu ego ọgwụ a nyere. Ọ bụ dọkịta ka a na-ekpebi ị dailyụ ya kwa ụbọchị.

Igwe insulin nwere obere agịga dị mkpụmkpụ. N'elu aka ahụ bụ ngwaọrụ rotary. Onu ogugu uzo gha eme mee n’ikpebi etu insulin n’enye n’ime ogwu igba.

Nfuli insulin dị obere, ihe ndị na-achịkwa elektrik na-arụ ọrụ na nfuli nke a na-eyi n'ahụ wee nyefee insulin ahaziri ya n'otu n'otu na-etinye anụ ahụ site na ọkpọ rọba.

Igwe insulin na-adabara ndị na-arịa ọrịa shuga na-enwekarị usoro ndụ. Ọ bụrụ na glycemia na-agbanwe mgbe niile ọbụlagodi na ịjeụ insulin ugboro ugboro, ihe mkpuchi insulin bụ ihe dị mma ma dịkwa mma.

Mmekorita

Ogwu nwere ike imekorita ya na ogwu nile nwere mmetuta ya na glycemia.

Isi analogues nke ọgwụ:

Echiche nke dọkịta na onye ọrịa.

Ofdị insulin nke mmadụ bụ ọgwụ dị mma ma gosipụtara nke ejirila ọrịa shuga kemgbe ọtụtụ iri afọ. Ka osila dị, tupu iji ya, ọ dị mkpa iji dozie usoro ọgwụ a.

Kirill Alexandrovich, diabetologist

Anọwo m na-a theụ ọgwụ ahụ ruo afọ 5 ma ọ nweghị mmetụta adịghị njọ ọ bụla. Ọ bụrụ n ’rie ihe, ọ na-ama jijiji, isi gị na - ese, obi gị wee malite ịsọ ọsọ. Obere shuga zọpụtara ọnọdụ ahụ. Mwakpo anaghị adịkarị, n'ihi ya enwere m obi ụtọ na ọgwụ ahụ.