ʻO KA INSULIN POKOLE: KA LOILOI A ME NĀ INOA O NĀ LĀʻAU MAIKAʻI LOA

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Hōʻike ka insulin o ke kanaka i nā hormones i hana i ka pancreas. Hoʻohana ʻia e mālama ia i ka maʻi diabetes. E hoʻoponopono i kahi hana maʻamau o ka pancreas, ua hopu ʻia ka mea maʻi me ka insulin.

hopena pōkole;
hoʻomohala mau loa;
ka lōʻihi maʻamau o ka hana.

Hoʻoholo ʻia ke ʻano o ka lāʻau lapaʻau ma luna o ka pono o ka mea maʻi a me ke ʻano o ka maʻi.

Nā ʻano o insulin

Ua hana mua ʻia ka Insulin mai ka pancreas o nā ʻīlio. I hoʻokahi makahiki ma hope, ua hoʻokomo ʻia ka hormone i hoʻohana ʻia. ʻO 40 mau makahiki i hala aku nei, a lilo i hiki ke hoʻokaʻawale ʻana i ka insulin chemically.

Ma hope o kekahi manawa, ua hoʻolōʻihi ʻia nā huahana hoʻomaʻemaʻe kiʻekiʻe. Ma hope o kekahi mau makahiki, hoʻomaka ka poʻe loea i ka hoʻomohala ʻana o ka synt synt o ke kanaka. Mai ka makahiki 1983, hoʻomaka ka hana 'ana i ka insulin ma luna o ka' oihana.

ʻO 15 mau makahiki i hala aku nei, ua mālama ʻia ka maʻi diabetes me nā huahana i hana ʻia mai nā holoholona. I kēia manawa, papa ʻia. Ma loko o nā lāʻauʻai, hiki ke loaʻa wale nā mākaukau o ka ʻenehana genetic, ka hana ʻana o kēia mau kālā i ka neʻe ʻana o ka huahana gen i loko o ka pū o kahi microorganism.

No ka pahuhopu o kēia, hoʻohana wale ʻia a he manu ʻole-pathogenic o nā bacteria o Escherichia coli. I ka hopena, hoʻomaka nā microorganism e hana i ka insulin no nā kānaka.

ʻO ka ʻokoʻa ma waena o nā lāʻau lapaʻau a pau i loaʻa i kēia lā:

i ka manawa o ka hoʻolaha ʻana i ka wā lōʻihi, nā hana lōʻihi, nā insulins ultra-pōkole a me insulin.
i ka pauku amino wina.

Aia pū kekahi i nā lāʻau lapaʻau i kapa ʻia ʻo "mixes", ʻike lākou i ka hana lōʻihi a me nā insulin like ʻole. Hoʻohana ʻia nā ʻano nui o 5 i ka manaʻo i ka manaʻo no lākou.

ʻO ka hana pōkole hana pōkole

ʻO nā insulins pōkole e hana i kekahi manawa, he ultrashort, he mau ʻikepili i ka nui o ka hopena i loko o ka pūlima i loko o ka paʻakikī me kahi ʻano pH ole kūleʻa. ʻO kēia mau kālā kahi wikiwiki, akā naʻe, ka pōkole ka hopena o nā lāʻau.

Pēlā e mālama ai ia kālā kālā subcutaneously 30-45 mau minuke ma mua o kahi pāʻina. Hiki ke lawelawe ʻia nā lāʻau like like intramuscularly a me ka intravenously, a me ka insulin o ka lōʻihi o ka hana.

Ke komo ka mīkini a ultrashort ma kahi vein, i emi iki ka nui o ke kōpaʻa plasma, hiki ke mālama ʻia ka hopena ma hope o 20-30 mau minuke.

ʻAʻole liʻuliʻu, hoʻomaʻemaʻe ke koko i ka lāʻau lapaʻau, a me nā hormones e like me catecholamines, glucagon a me STH e hoʻonui i ka nui o ka glucose i ka pae kumu.

Me nā kue ʻana i ka hana o nā hormones contra-hormonal, ʻaʻole e hoʻonui nui ʻia ka nui o ke kōpaʻa koko i nā hola he nui ma hope o ka loaʻa ʻana o ka lāʻau lapaʻau, no ka mea he hopena ia i ke kino a ma hope o ka hemo ʻana mai ke koko.

Pono e hoʻopaʻa ʻia ka hormone hana pōkole i loko o kahi vein:

i ka wā o ka resuscitation a me ka mālama koʻikoʻi;
nā mea maʻi me ka ketoacidosis maʻi maʻi;
inā e loli wikiwiki ke kino i ka pono o ka insulin.

I nā maʻi me ka papa paʻa o ka maʻi mellitus, ʻo ia mau lāʻau e mālama pū ʻia me nā hopena lōʻihi a me ka lōʻihi o ka hana.

ʻO ka hana manuahi e hana ai i waho ka maʻi i ka hana ʻona e hiki ai i ka mea maʻi ke loaʻa iā ia i loko o kahi polokalamu dispensing kūikawā.

I mea e hoʻopiʻi ai i nā ʻāpana kuahi, hoʻohana ʻia nā huahana buffers. ʻAʻole kēia e ʻae i ka crystallize ma lalo o ka ʻili i loko o ka catheter i ka wā o ka hoʻokō ʻana.

I kēia lā, ua hōʻike ka hormone o ka mana pōkole i ke ʻano o nā hexamers. ʻO nā molekui o kēia ʻano he polimele. Hoʻomaʻamaʻa ka hexamers, ʻaʻole ia e ʻae i ka pae o ke kaila o ka insulin i ka plasma o kahi kanaka olakino ma hope o ka ʻai ʻana.

ʻO kēia kūlana ka hoʻomaka ʻana o ka hana ʻana o nā māla semi-synthetic e hōʻike ai:

dimers;
monomers.

Nui nā hoʻokolohua lapaʻau e mālama, ʻoiai, ʻo nā mea hana pono e hoʻohana ʻia, nā inoa o nā mea kaulana loa

ʻAmelika insulin;
ʻO Lizpro-insulin.

Hoʻomaopopo ʻia kēia mau insulin i lalo o ke kino 3 mau manawa e hoʻohālikelike ʻia i nā insulin kanaka. Ke alakaʻi nei kēia i ka ʻike ua kiʻekiʻe ka kiʻekiʻe o ka insulin i ke koko, a ʻoi aku ka wikiwiki o ka hoʻolaʻa ʻana no ka hoʻohaʻahaʻa i ka glucose.

Me ka hoʻomaka ʻana o ka hoʻomākaukau semishnthetic 15 mau minuke ma mua o ka ʻai ʻana, e like ka hopena e like me ka inikini insulin no kahi kanaka 30 mau minuke ma mua o ka pāʻina.

Kēia o nā ulu ʻana o ka wikiwiki e komo ai i ka inane-lyspro-insulin. ʻO kēia kahi mea i loaʻa i ka insulin o ke kanaka i loaʻa e ka hoʻopiliʻana i ka penil a me ka lysine i nā kaulahao 28 a 29 B.

E like me ka insulin kanaka, i loko o nā hoʻomākaukau i hana ʻia, loaʻa ka lyspro-insulin i ke ʻano o ka hexamers, akā naʻe, ma hope o ke komo ʻana o ke aʻai i ke kino o ke kanaka, e lilo ia i monomers.

No kēia kumu, he hopena wikiwiki ka lipro-insulin, akā i ka manawa pōkole ka hopena. Ua lanakila ka Lipro-insulin i ka hoʻohālikelike ʻana me nā lāʻau ʻē aʻe o kēia ʻano no kēia mau mea:

hiki ke hoʻemi i ka hoʻoweliweli ʻana o ka hypoglycemia ma ka 20-30%;
hiki ke hōʻemi i ka nui o nā hemoglobin A1c glycosylated, kahi e hōʻike ana i ka mālama pono ʻana o ka maʻi maʻi maʻi diabetes.

I ka hana ʻana o insulin insulin, kahi ʻāpana koʻikoʻi e hāʻawi i ka mea i hoʻololi ʻia ke kākohu aspartic e Pro28 i loko o ke kaulahao B. E like me loko o ka lyspro-insulin, kēia lāʻau lapaʻau, ke komo ʻana i ke kino o ke kanaka, ke wā koke i ka monomers.

Pharmacokinetic waiwai o ka insulin

I loko o ka maʻi mellitus, hiki ke loaʻa i nā ʻano lāʻau pharmacokinetic o ka insulin. ʻO ka manawa kiʻekiʻe o ka pae plasma o ka wī a me ka hopena nui o ka hoʻohaʻahaʻa i ke kō, hiki ke hoʻololi ʻia ma 50%. ʻO ke kiʻekiʻe o kēlā mau fluctuations e pili ana i ka ʻokoʻa o ka assimilation o ka lāʻau mai ka subcutaneous tissue. ʻOiai, ʻokoʻa ka manawa no ka lōʻihi o ka insulin a me ka pōkole.

ʻO nā hopena ikaika loa he mau hormones o ka lōʻihi lōʻihi a me ka hopena lōʻihi. Akā i kēia manawa, ua ʻike ka poʻe loea i nā lāʻau lapaʻau pōkole ka mea i like.

Wahi a ka insulin, pono ia e hoʻoʻau pinepine mau i ka hormone i loko o ka kiko subcutaneous. Pili pū kēia i kēlā mau maʻi nā mea hiki ʻole ke hōʻemi i ka nui o ka glucose i ka plasma ma muli o kahi meaʻai a me nā lāpana e hoʻemi ana i ke kō, a me nā wahine me ka maʻi maʻi i ka wā hāpai, nā poʻe maʻi e loaʻa kahi maʻi ma muli o ka pacreatectomy. Eia hoʻi hiki iā mākou ke ʻōlelo i nā kīpē e hōʻemi i ke kōpaʻa koko, ʻaʻole hāʻawi mau i ka hopena i manaʻo ʻia.

Pono ʻia ka insulin no nā maʻi e like me:

koma ʻaole hāmū;
diabetes ketoacidosis;
ma hope o ka pau ʻana no ka poʻe maʻi me ka maʻi maʻi maʻi maʻi,
ʻOiai ke kōkua nei ka insulin i ka hoʻōla i ka nui o ke kō i loko o ka plasma,
na hoopau ana mai na aoao metabola o na palela.

Hiki ke loaʻa ka hopena maikaʻi loa me nā kaʻina mālama paʻakikī.

wili;
hoʻoikaika kino;
mea ʻai.

Pono kēlā me kēia lā i ka insulin

ʻO kahi kanaka me ke olakino olakino a me ke kino maʻamau e hana iā 18-40 mau paona i kēlā me kēia lā, aiʻole 0.2-0.5 mau ʻāpana / kg o ka insulin lōʻihi. Ma ka hapalua o kēia punetēnē he mea huna ʻili, a hoʻihoʻi ʻia ke koena ma hope o ka ʻai ʻana.

Hana ʻia ka hormone 0.5-1 mau ʻāpana i kēlā me kēia hola. Ma hope o ke kau i ke kō, e piʻi ka nui o ka hoʻonaʻauao hāmeʻe i 6 mau papa no ka hola.

ʻO ka poʻe i kaupaona a loaʻa ke kū i ka insulin e ʻanemi ʻole mai i ka maʻi diabetes, he 4 mau manawa ka hana o ka insulin i ka wā e ʻai ai. Aia kahi pilina o ka hormone i hoʻokumu ʻia e ka pūnaewele portal o ka ate, kahi i luku ʻia kekahi ʻaoʻao a ʻaʻole i hiki i ke kahe koko.

I nā maʻi maʻi o ka maʻi mellitus type 1, ʻokoʻa ka pono o kēlā me kēia lā no ka insulin hormone:

Hiki, hoʻokumu kēia hōʻailona mai ka 0.6 i ka 0.7 mau ʻāpana / kg.
Me ka nui o ke kaumaha, nui ka pono no ka insulin.
I ka manawa e pono ai ke kanaka i nā pāʻina 0.5 wale nō / lā i kēlā me kēia lā, lawa ia ka nui o ka hoʻoulu ʻana i ka hormone a i ʻole ke ʻano kino.

ʻO ka pono o ka insulin hāmeʻa o 2 mau ʻano:

pou-prandial;
basal.

Ma ka hapalua o kēlā me kēia lā e pono ai ke ʻano basal. Hoʻopili kēia hormon i ka pale ʻana i ka hemo o ka hilo i loko o ka ate.

Ma ke ʻano post-prandial, hoʻolako ʻia ka pono i kēlā me kēia lā e nā inikini ma mua o ka papaʻaina. Hoʻokomo ka hormone i ka hoʻopili ʻana o nā mea kanu.

I kahi lā, hāʻawi ʻia ka mea maʻi i kahi injinine o ka insulin me ka lōʻihi o ka hana, a lawelawe ʻia kahi hui hoʻohui e hui pū i ka insulin me ka manawa pōkole a me ka hormone medium-lōʻihi. No ka mālama ʻana i ka glycemia i kahi pae maʻamau, ʻaʻole lawa kēia.

A laila ʻoi aku ka paʻakikī o ka lāʻau mālama, kahi e hoʻohana ai ia i kahi paʻakikī o nā insulin medium-duration me ka hana o ka insulin lōkole a hana paha i ka hana lōʻihi me ka insulin.

Hoʻomaʻamaʻa pinepine ka mea maʻi e like me ke ʻano lāʻau lapaʻau like ʻole, ke lawelawe ʻo ia i kahi maʻi hoʻokahi i ka ʻaina kakahiaka, a hoʻokahi hoʻi i ka wā ʻaina. ʻO ka hormone i kēia hihia ke i ka insulin o ka lōʻihi pōkole a me ka lōʻihi lōʻihi.

Ke loaʻa nei i ke ahiahi ahiahi o ka hormone NPH a i ole insulin, ʻaʻole i hāʻawi ka pahu i ka nui o ka glycemia e koi ʻia ana i ka pō, a laila ua mahele ʻia ke kuhi ʻia i nā ʻāpana he 2: ma mua o ka ʻaina, ua hopu ʻia ka mea maʻi me ka inikua hana puʻupuʻu pōkole, a ma mua o ka hiamoe, hāʻawi ʻia lākou i ka insulin NPH a i ʻole faapomi insulin.

Kuhi ʻia ka waiwai o ka insulin i kēlā me kēia, kahi kau i ke kiʻekiʻe o ke kō i loko o ke koko. Me ka hiki ʻana o nā glucometer, ʻoiaiʻo ia ka mea e maʻalahi e ana i ka nui o ka gogemosin glycosylated i loko o ka plasma, a ua ʻoi aku i mea maʻalahi e hoʻoholo i ka nui o ka hormone, e hilinaʻi ana i kēlā mau kumu: