Kubungabunga Insuline n'Imiti Itera Ubushuhe Ata Gukonjesha¶

Kuba mw’ihema ata n’aho wikingira, kuryama mu modoka idafise amashanyarazi yo ku nkombe, gushikirwa n’aho amashanyarazi azimye imisi myinshi atari mu nzira, canke guca mu bushuhe bukaze no mu bihe vy’ubukonje bwo mu rushana, bituma imiti y’amazi ikiza ubuzima ishobora gusenyuka ningoga kubera ubushuhe. Amahomoni y’amaproteine ​​n’imiti y’ibinyabuzima, cane cane insuline, imiti igabanya ubushobozi bwo kwakira GLP-1, imiti itera epinephrine (EpiPens), imiti igabanya ubudahangarwa bw’umubiri, n’imiti y’ibinyabuzima y’abana**, ni ibihimba vy’umubiri bifise uburebure butatu. Iyo ivyo binyobwa bikonje bikomeye ku bushuhe bwa 0 degre Celsius (degre 32 Fahrenheit) canke bikabikwa mw’ihema canke mu modoka iri hejuru ya degre 30 Celsius (degre 86 Fahrenheit), iminyororo yavyo y’amaproteine ​​irafunguka ata gusubira inyuma maze igaterana hamwe. Gutera insuline yononekaye n’ubushuhe canke yari yarakonjejwe mbere bitanga igikorwa co kugabanya isukari mu maraso, bikaba vyihuta gutuma umuntu apfa Diabète Ketoacidose (DKA) canke Igihugu c’isukari nyinshi (HHS).

Ntukeneye frigo y’igikoni ikoreshwa n’umuyagankuba canke ibipande vy’urubura kugira ngo insuline n’imiti ishobora gutuma ubushuhe bibe vyiza hanze mu kiringo c’amayinga menshi. Nkako, gushiramwo insuline ata guca ku ruhande ku mifuko y’urubura canke ku mifuko y’amazi yakonjeshejwe ni kimwe mu bintu bikunze gutuma umuntu akonjera mu mpanuka kandi akagira amaviyo yononekaye. Mu gutahura idirisha ry’ubushuhe bwo mu cumba ry’iminsi 28 gushika ku misi 56 ry’insuline zo muri iki gihe, gukoresha imifuko ikonjesha amazi (nk’amasakoshi ya FRIO canke ibikoresho bikonjesha vy’ibumba/impuzu zitose) mu bushuhe bwo mu ci, no gukoresha **ubushuhe bwo hafi y’urukoba birashobora kurinda ubushobozi bwawe bwo gufata imiti aho hose.

Ivyo ubikore ubu¶

1. Uce usuzuma ubwo nyene ko ata bimenyetso vy’indwara y’isukari (DKA) iyo isukari yawe iguma hejuru inyuma yo gutera insuline ibitswe hanze. Iyo ufise inyota idashobora kuzima, ukunda gusohoka, iseseme, uruka, ububabare bwo mu nda, impwemu ihumura nk’imbuto, insuline ishobora guhungabana, gukonja: hamagara inomero y'ivyihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) canke usuzume ivyacu . inomero z'ivyihutirwa directory maze ugende mu cumba c’ubuvuzi bwihutirwa kiri hafi.
2. Suzuma igikombe cawe c’imiti y’amazi canke igikapu cawe c’ikaramu mu rumuri rwinshi imbere y’uko ufata imiti yose. Insuline zigaragara (nk’iza Humalog, Novolog, Apidra, Lantus, Levemir, Toujeo, na Tresiba) na epinephrine bitegerezwa gusa n’ibigaragara 100 kw’ijana, bitagira ibara, kandi bifise amazi. Iyo insuline igaragara isa n’ibicu, ifise imirongo, ifise intete, ifise ibara ry’umuhondo gatoyi, canke ifise ibice vyera bifatanye n’ikiyo, canke iyo yigeze gukonja ikomeye, ntuyitere; uronke uwuzogusubirira vyihutirwa ubwo nyene.
3. Ntukigere ushira insuline, biologiques, canke EpiPens ku bipande vy’urubura, ku macupa y’amazi akonje, canke ku matafari y’ubururu. Gukorana n’ibarafu ry’ubushuhe bwa degre 0 (degre 32 Fahrenheit) bikonja amazi ari mu gitereko c’ibirahuri mu minota itarenga 20 inyuma y’aho akonjeje. n’ugusubira gushonga bikaba amazi asobanutse.
4. Koresha amazi akonjesha (atari ibikoresho bikonjesha vy’ipulasitike bipfutse) mu gihe c’ubushuhe bwo mu ci buri hejuru ya degre 30 Celsius (degre 86 Fahrenheit). Niwibike igikapu gikonjesha c’amabuye y’agaciro (nk’umufuko wo ku ruhande rwa FRIO) mu mazi asanzwe yo mu ruzi, mu minota 10 igitambaro co gumesa c’ipampa camanitswe mu gafuko k’urusenga gashobora guhumeka mu gitutu c’umuyaga ku buryo amazi ahinduka umwuka akuraho ubushuhe mu gitereko.
5. Shira amakaramu y’insuline, EpiPens, n’ibikoresho vyo guhumekera umusonga mu mufuko wo mu mutima, ubishire ku mubiri wawe ushushe mu gihe c’ubukonje. Igihe cose ubushuhe bwo hanze canke bwo mw’ihema bugabanutse bukagera kuri degre 2 za Celsius (degre 36 za Fahrenheit) canke hasi, ushire imiti yawe mu mufuko wawe canke mu gihe c’ubukonje. ku murango no mu mufuko wawe wo kuryamako uhagaze ku mubiri wawe ijoro ryose kugira ngo ubushuhe bw’umubiri wawe bufise ubushuhe bwa degre 37 (degre 98,6 Fahrenheit) bukurinde gukonja.
6. Ntukigere usiga umuti uwo ari wo wose imbere mu modoka ihagaze, mu ihema ry’umurango ryugarijwe, canke mu mufuko wo hanze w’umufuko w’inyuma uravye izuba. Ihema ry’amaganzu ry’imodoka canke ihema ry’inylon ryugarijwe rishika kuri 50 gushika kuri degre 60 z’ubushuhe (122 gushika kuri 140 z’umuco w’izuba) mu minota 25 y’umuco w’izuba n’amazi (nk’ivyo bita levotiroksini n’ivyo bita nitroglycérine).

flowchart TD
    A["Kubika imiti ishobora gushikirwa n'ubushuhe ata frigo"] --> B{"Ubushuhe Buri Hanze Ni Ubuhe?"}
    B -->|"Ibiringaniye (4°C gushika kuri 29°C / 40°F gushika kuri 85°F)"| C["Idirisha ry'ubushuhe bw'icumba ry'umutekano: Bigumye mu gipfuko gifise igitutu kizingiye kure y'izuba (Rikora imisi 28 gushika kuri 56)"]
    B -->|"Ikirere gishushe (>= 30°C / 86°F)"| D["Koresha Ugukonjesha kw'Umwuka: Nishire umufuko wa FRIO canke Ipampa ry'Itose mu Gitutu c'Umuyaga"]
    B -->|"Ikirere gikanye (<= 2°C / 36°F)"| E["Koresha Ubushuhe bw’Umubiri: Ujye utwara mu mufuko w’imbere w’ishati ku mubiri ku murango no mw’ijoro"]
    C --> F["Suzuma Vial Imbere y’Idoze Yose: Itegerezwa Kuba Idafise Ivyuma, Imbeho, canke Ibara Rihindutse"]
    D --> F
    E --> F
    F --> G{"Imiti yoba yarakonjeje, ihinduka ibicu canke ihagarika kugabanya isukari mu maraso?"}
    G -->|"Ego: Vyashizwe ku ruhande"| H["Ntukizere ku Vial Yononekaye: Genda mu Farumasi / FQHC / ER kugira ngo Uyisubirize vyihutirwa"]
    G -->|"Oya: Biragaragara kandi birakora neza"| I["Bandanya ukoresha gushika umusi w'iherezo ry'ubushuhe bw'icumba c'umuhinguzi (imisi 28 gushika kuri 56)"]

Imipaka yemewe y'ubushuhe bwo mu cumba ku bijanye n'insuline zisanzwe n'ivyo guterwa inshinge¶

Iciyumviro kitari co gikwiragiye cane mu barwayi no mu bakozi bo mu bibanza vy’uburaro ni uko ikaramu canke igikombe c’insuline yononekara mu masaha makeyi iyo kitabitswe muri frigo ikanye ku bushuhe bwa degre 2 gushika kuri 8 (degre 36 gushika kuri 46 Fahrenheit). Mu vy’ukuri, gukoresha frigo bisabwa gusa kugira ngo umuntu azigame ibintu bitafunguwe gushika kw’itariki y’iherezo ryavyo ry’imyaka myinshi. Igihe igikombe canke ikaramu bimaze gukoreshwa (canke bikabikwa nk’ivyo ukoresha ata frigo), ivyemezo vy’imiti biva muri U.S. Ikigo kijejwe ivy’ibifungurwa n’imiti (FDA), Ikigo c’Uburaya kijejwe imiti (EMA), na Ishirahamwe ry’Ubuzima kw’Isi (OMS) vyemeza ko hafi insuline zose zo muri iki gihe ziguma zifise ubushobozi 100 kw’ijana mu bushuhe busanzwe bwo mu cumba bushika kuri **25 gushika kuri 30 degrees Celsius it degrees 86h for52. imisi.

Kurokoka kw'ubushuhe bwo mu ci: gukonja kw'umwuka ata muyagankuba canke urubura¶

Iyo ubushuhe bw’ikirere co hanze burengeye degrees 30 gushika kuri 40 Celsius (86 gushika kuri 104 degrees Fahrenheit) mu gihe c’ubushuhe bwo mu ci, kubika insuline imbere mu gikoresho co gukonjesha canke mu gikoresho co gukonjesha ata isoko y’ubukonjesha amaherezo bifata ubushuhe bwo ku muhingamo imbere. Ku rundi ruhande, gutera insuline mu gikombe c’amazi y’urubura co mu maduka y’ibintu vy’agaciro canke kuyibohera ku gipapuro c’amazi y’urubura (gel) gikonje, biratuma iyo hormone ikonja maze ikayihonya.

Umuti w’inzahabu ukoreshwa n’abaganga bo mu bugaragwa, amavuriro yo mu mabarabara, n’amashirahamwe y’ubutabazi kw’isi yose ni ugukonjesha kw’umwuka. Iyo amazi ahindutse umwuka akaja mu kirere kigendagenda, uguhinduka kw’inzira kuva ku mazi gushika ku mwuka bifata inguvu z’ubushuhe (ubushuhe bwihishije bw’uguhinduka umwuka), bugakonjesha umufuko wo mu mutima 8 gushika ku 14 degrees Celsius (15 gushika ku 25 degrees Fahrenheit) munsi y’ubushuhe bw’igitutu ata n’umwe yigeze agabanya ubushuhe.

Uburyo bwa mbere: Amasakoshi y’ubudandaji akoreshwa n’amazi (amasakoshi y’ugukonjesha ya FRIO)¶

Niba ushobora gushika ku kigo c’ubuvuzi c’abarwayi b’igisukari, ku kigo c’imiti c’ubuvuzi bw’abatagira aho baba, canke amadolari 20 gushika ku 30, usabe igikapu c’amazi gikoreshwa n’amazi (kizwi cane kw’izina rya igikapu co gukonjesha insuline ca FRIO):

1. Uko ikora: Igikapu c’imbere c’ipampa gipfutse kirimwo amabuye y’agaciro yumye atagira ubumara yitwa polyacrylate. Iyo winjije umufuko w’imbere mu mazi asanzwe akanye canke afise ubushuhe bwo mu cumba ava mu gikarabiro cose co mu bwogero canke mw’isoko ryo kunywa mu minota 8 gushika kuri 12, izo nkoko zica zinywa amazi zigaca zivyimba zigahinduka igipande gikomeye co gukonjesha.
2. Uko woyikoresha: Ushire umufuko w’imbere utose n’igitambaro kugira ngo ntutonyanga, ushire amakaramu yawe canke amaviyo yawe ya insuline (imbere mu gipfukisho cawo c’imbere gitoya kidashobora guterwa n’amazi) mu mufuko, hanyuma ushire umufuko wo mu mutima imbere mu gipfukisho cawo co hanze c’urusenga gishobora guhumeka.
3. Itegeko rihambaye ry’ugutembera kw’umuyaga (Ntukigere ufunga umufuko w’umwotsi imbere mu gafuko k’ipulasitike canke mu mufuko w’umugongo udashobora gushikamwo umwuka): Gukonjesha umwuka bikora gusa iyo umwotsi w’amazi ushobora guhunga ukaja mu kirere. Iyo ushize umufuko wa FRIO utose imbere mu musaho wa Ziplock ukingiwe canke ukawuhamba munsi y’impuzu ziremereye hasi mu musaho wumye udashobora guterwa n’amazi, uguhinduka kw’umwuka kurahagarara burundu maze uwo musaho ugahinduka igikoresho co gutera ivyatsi gishushe kandi gifise ubukonje. Fata iyo saho ishobora guhumeka ku ruhande rw’inyuma rufise igitutu rw’isakoshi yawe canke uyimanike mu gitutu c’umuyaga imbere mu gipfukisho gifise uruhande rwuguruye, hanyuma wongere uyishire mu mazi yo mu ruzi iminota 5 buri amasaha 45 (imisi 2).

Uburyo bwa 2: Zero-igiciro DIY "Wet-Sock / Impuzu zo gumesa zikonjesha umwuka"¶

Nimba udafise aho wikinga muri iri joro mu gihe c’ubushuhe kandi udafise igikapu co gukonjesha co mu bucuruzi, urashobora kwubaka igikoresho co gukonjesha gikora neza nk’ico mu minota 2 ukoresheje ibintu vya misi yose:

1. Funga insuline yawe canke umuti wawe mu gasaho gatoyi, 100 kw’ijana ka Ziplock kadashobora guterwa n’amazi (ushiremwo umuyaga maze uwushire mu gasaho kabiri kugira ngo ubukonje ntibushobora kwonona amakete y’impapuro canke amabara y’ikaramu y’ubuhinga bwa none).
2. **Zingira igitambaro co gumesa c’ipampa gisukuye, igisosi c’ipampa gikomeye, canke umukanda w’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu y’impuzu.
3. Shira umuganda uzingiye mu mazi imbere mu musaho w’urusenga ushobora guhumeka (nk’isaho y’urusenga yo gumesa, umufuko w’urusenga w’ibitunguru/ibifungurwa, canke umufuko w’urusenga w’impuzu) hanyuma uwumanike mu gitutu cuzuye aho umuyaga ushobora kuwuhuha (nk’akarorero, umanike munsi y’igitutu co muri park, umuyaga w’umusaraba ufise igitutu munsi y’igitambaro kigaragaza umuco).
4. Subira gutobeka igitambaro c’ipampa amasaha 3 canke 4 yose mu gihe c’ubushuhe bwinshi ku muhingamo kugira ngo kigume gitose iyo ugikozeko.

Uburyo bwa 3: Inkono ya Zeer (Igikoresho co gukonjesha ibumba co mu nkono) c'amakambi ahagaze¶

Nimba uba mu nzu idahinduka, mu nzu yo mu ntara, canke mu nkambi y’igihe kirekire mu ci gishushe kandi c’umwuma, wubake igikoresho co gukonjesha Zeer Pot gisanzwe:

• Shira inkono ntoyi y’amashurwe y’ibumba ritagira ibara (ifise umwobo wayo wo hasi wo gusohora amazi upfutse n’ibishashara, umugozi canke igiti) imbere mu nkono nini y’ibumba ritagira ibara.
• Uzuza 2.5-centimeters (1-inch) gap hagati y’inkono zibiri z’ibumba umusenyi utose, usuke amazi akonje mu musenyi gushika yuzuye, ushire imiti yawe (imbere mu gitereko canke umufuko w’ipulasitike upfutse) imbere mu nkono y’ibumba y’imbere yumye, hanyuma ufunge hejuru igitambaro c’ipampa gitose. Uko amazi aca mu ruhome rw’inyuma rw’ibumba rufise utunogo maze akaja guhinduka umwuka mu muyaga, ni ko n’icumba co mu mutima kiguma gikonje umusi wose igihe cose usuka amazi mu musenyi incuro zibiri ku musi.

Uburyo bwa 4: Uko wokoresha neza amacupa y’amazi y’urubura canke y’amazi akonje (Itegeko ry’Ubushuhe)¶

Nimba uba mu modoka canke mu kirere c’ubushuhe gifise ubukonje bwinshi aho ubukonje bwinshi bugabanya umwuka kandi ukoresha igikoresho co gukonjesha ivyo kurya vy’umutaga gifise urubura ruva mw’isoko ry’ibifungurwa vyihuta canke icupa ry’amazi akonje, utegerezwa kwubaka Thermal Buffer Barrier kugira ngo insuline ntishobore gukonja:

flowchart TD
    A["Gukoresha Ice canke Frozen Gel Pack mu gikoresho gikonjesha"] --> B["NTUZOKWIGEZE UREKERA Umuti Ukore ku Barafu canke Amazi y'Ibarafu Utaziguye"]
    B --> C["Igipande ca 1: Shira Ibarafu mu Mufuko Udasohoka Hasi mu Gikonjesha"]
    C --> D["Igipande ca 2: Shiramwo igikoresho co gukingira ubushuhe (Igitambaro co mu minwe gipfutse canke 2.5 cm / 1 inch Ikarata/Ifu)"]
    D --> E["Igipande ca 3: Shira umuti mu gitereko c'ipulasitike gikomeye kidashobora guterwa n'amazi hejuru y'igitambaro"]
    E --> F["Gumana igipimo c’ubushuhe canke urutoke rwo kugerageza imbere mu gitereko (Iciyumviro 4°C gushika 15°C / 40°F gushika 59°F)"]

• Zingira umufuko w’urubura canke icupa ry’umukara mu igitambaro c’amaboko cyumye cane, ushire igipande c’i ikarata y’amaboko hejuru y’igitambaro, hanyuma ushire insuline yawe mu gikoresho c’ibifungurwa c’ipulasitike gikomeye (nk’agasanduku ka Tupperware) kizingiwe n’isosi yumye ku ruhande rumwe rw’igitambaro. Umuyaga ufunzwe mu gitereko c’ipulasitike gikomeye urakingira iyo nkono y’ikiyo ku buryo ikonjera buhoro buhoro gushika ku degre 8 gushika kuri 15 (degre 46 gushika kuri 59 za Fahrenheit) ata na rimwe ikora ku ruhande rw’urubura rufise degre 0.

Ubuzima bwo mu rushana buri munsi ya zero: gukingira gukonja kwa insuline, inhalateurs, na EpiPens¶

Gukonja birasenyura ningoga cane imiti y’amazi kuruta ubushuhe buringaniye bwo mu ci. Mu gihe igikombe c’insuline gishizwe ku bushuhe bwa degre 32 (degre 90 Fahrenheit) gitakaza gusa ibice bikeyi kw’ijana vy’ubushobozi bwaco mu misi myinshi, **igikombe c’insuline canke ikaramu y’insuline ikonja cane ku bushuhe bwa degre 0 (degre 32 Fahrenheit) mbere n’iminota 30 kw’ijana immediate1.

Kubera iki insuline yakonje n’ibikoresho vyo guhumeka bikonje bidakora neza mu rushana¶

• Ihinduka ry’imiterere y’amaproteine muri insuline n’ibinyabuzima: Iyo amabuye y’urubura ateye imbere mu gitereko c’insuline canke mu gitereko c’ikaramu, barafu iriko iragwira iracagura maze igacagura amabonde y’amaproteine y’ivyuma bita hexamer. Naho wosubira gushusha ikaramu yakonje mu biganza vyawe maze amazi agasubira gusa n’agatomoye, izo molecule z’imisemburo ziramenagurika kandi ntizikora. Gukonja kandi biratuma umubare w’amazi ugwira n’ibice 9 kw’ijana, ivyo bikaba bituma haba imivyimba itaboneka mu bipimo vy’ibirahuri vy’ibirahuri, bigatuma n’igikoresho co gutanga imiti gikoreshwa neza kiri mu bipimo vy’ibirahuri bihomba.
• Igabanuka ry’umuvuduko w’umwotsi mu bikoresho vyo guhumeka bikoreshwa n’umuvuduko (MDIs): Ivyo guhumeka vy’ugukiza asthma na COPD (nk’ibikoresho vyo guhumeka albuterol / salbutamol HFA) vyishingikiriza ku mazi y’amazi y’umuyaga (HFA) atera umuriro mu gazi ari mu gitereko c’imiti y’icuma kugira ngo ahindure atomize. Iyo igikoresho co guhumeka gisigaye mw’ihema canke mu gafuko k’ubukonje buri munsi ya degre 0 Celsius (degre 32 Fahrenheit), umuvuduko w’umwotsi w’ivyo bikoresho uragabanuka cane; gukanda kuri iyo kanini bituma haba umuyaga ugoyagoya kandi utose utera inyuma y’ururimi rwawe aho gushika mu nzira z’impwemu z’ibihaha.

Amasezerano "Against-the-urukoba" y'ibihe vy'ubukonje¶

Igihe cose ubushuhe bwo hanze bugabanutse bushika munsi ya degre 4 z’ubushuhe (degre 40 z’ubushuhe) (raba uburongozi bwacu ku Kurokoka ata nzu n'ugutoranya ibihe bikomeye).

1. Ntukigere ubika insuline, EpiPens, canke ibikoresho vyo guhumeka mu mufuko, mu mufuko wo hanze w’ikoti, canke hasi mw’ihema: Umufuko wo hanze wa parka canke mu mufuko wo mu mugongo wicaranye n’umuyaga uragwa munsi y’ubukonje mu minota 30.
2. Ambara umufuko w’imbere w’umugozi canke umufuko w’ishati munsi y’ibipande vyawe vy’ukwikingira: Shira ikaramu yawe y’insuline ikora, igipimo c’isukari mu maraso yawe n’ibikoresho vyo gupima, EpiPen yawe, n’igikoresho cawe co guhumekera albuterol imbere mu gafuko gatoyi gafise zipper kamanitswe ku mugozi ukikuje ijosi ryawe **under your t-shirt y’ibara ry’imbere (rero ntiyicara ku ruhu rufise ivyutsi hejuru ya degre 32 z’ubushuhe, ariko iguma ipfutse imbere mu mpuzu yawe isusurutse ku bushuhe bwa degre 22 gushika kuri 26 / degre 72 gushika kuri 79 za Fahrenheit).
3. Guma iyo saho imbere mu gafuko kawe ko kuryamamwo ijoro ryose: Imbere yo guzipa mu gafuko kawe ko kuryamamwo mw’ijoro, suzuma ko umufuko wawe w’umugozi wo gusinziramwo uri imbere mu gafuko kawe ko kuryamamwo hafi y’igikiriza cawe canke mu rukenyerero rwawe, kandi ntukigere uwushira hasi mw’ihema iruhande y’igitanda cawe.
4. Susurutsa umuti wo guhumekera umusonga ukonje mu biganza vyawe canke mu gikiriza cawe mu masegonda 60 imbere yo guhumeka: Nimba umuti wawe wo guhumeka witwa albuterol ukonjeje mu mpanuka, ushire iyo nkoko y’icuma mu gikiriza cawe c’ubusa canke uyizingirize n’inkomezi hagati y’ibiganza vyawe bishushe mu munota 1 wuzuye imbere yo guhumeka no guhumeka.

Gukingira ibipimo vy'isukari mu maraso, ibipimo, CGMs, n'imiti yumye yo mu kanwa¶

Ugukira umuntu arwaye diyabete hanze ntibivana n’insuline yawe gusa, ariko kandi bivana n’igikoresho cawe co gupima isukari mu maraso (glucometer), ibipimo vy’indwara y’igisukari, n’ibipimo vy’isukari mu kanwa** bihambaye cane.

Uko woronka insuline yo gusubirira mu buryo bwihutirwa maze ugasaba "Imiti y'Indwara y'Isukari Ihuye n'Ibarabara".¶

Iyo umufuko wawe wibwe mu gihe co gukubura mu nkambi, ibibindi vyawe vy’insuline bimenetse ku nzira, canke insuline yawe ikakonja cane mu gihe c’igihuhusi co mu rushana, kugenda amasaha arenga 12 gushika kuri 24 ata insuline y’ishimikiro (na cane cane mu ndwara y’igisukari yo mu bwoko bwa mbere) birashobora gutuma umuntu agira ketoacidose yica.

1. Inzira zo gusubirira insuline vyihutirwa vuba¶

• Genda mu kigo cose c’ubuvuzi gifise uburenganzira bwa Leta (FQHC) canke mu kigo c’ubuvuzi c’abatagira aho baba: Muri Leta Zunze Ubumwe za Amerika, amavuriro aterwa inkunga na HRSA aragira uruhara mu Programme y’Igiciro c’Imiti 340B kandi akabungabunga amavuriro yo ku kibanza atanga ubuntu canke amadolari 2 gushika ku madolari 5 yo gusubirira amakaramu y’insuline n’ibikoresho vy’ubuvuzi vyihutirwa, uncome walk-in ishimikiro.
• Ategeko ry'Imiti y'Ivyihutirwa ("Itegeko rya Kevin"): Intara zirenga 25 zo muri Leta Zunze Ubumwe za Amerika, intara zose zo muri Kanada, Ubwongereza (NHS 111 Emergency Repeur Myscription Service), na Australiya vyashizeho Amategeko y'Ivyihutirwa vyo Gusubiramwo Insuline yemerera umuganga w'abanyagihugu gutanga insuline ku musi w'Ivyihutirwa ntibashobora gushika ku muganga ababandikiye.
• Insuline y’umuntu (ReliOn / Humulin R & N) n’Ifashanyo y’Umurwayi: Muri Leta Zunze Ubumwe za Amerika (mu bihugu vyose kiretse Indiana), amacupa y’insuline y’abantu Regular (R) na NPH (N) agurishwa **ku giciro c’imiti ata n’umwe agura. amadolari ku nkono. *(Imburi: Ntukigere uhindura amakaramu y’ubuhinga bwa none nk’aya Humalog/Lantus ngo ukoreshe insuline y’abantu Regular/NPH utabajije umuganga canke umuganga wo mu bitaro amabwirizwa nyayo y’ingene woyifata, kuko Regular na NPH zishika ku masaha atandukanye cane kandi zishobora gutuma umuntu agira ingorane nyinshi zo kugwa mw’ijoro. na Sanofi) na bo nyene bakora Iporogarama z’Ibihembo vy’Ivyihutirwa / Ivyihutirwa biciye mu GetInsulin.org na InsulinAffordability.com.
• Ibisata vy’Ibitaro vy’Ivyihutirwa biri munsi ya EMTALA: Nimba ari mu gicugu ku musi w’Imana, insuline yawe iraheze, kandi isukari yawe iriko iraduga hejuru ya 14 gushika kuri 16.7 mmol/L (250 gushika kuri 300 mg/dL) ufise iseseme canke inyota, genda winjire mu bitaro vy’Ivyihutirwa biri hafi. Mu gihe ca EMTALA, ER izosuzuma ama ketone yo mu maraso yawe, iguhe insuline yo munsi y’urukoba canke yo mu maraso kugira ngo isukari yawe ihagarare, kandi isaba umukozi w’imibano wo gusohoka mu bitaro gutegura ikaramu yo gusubirira vyihutirwa imbere y’uko ugenda (raba ubuyobozi bwacu ku gukingira ibitaro gujugunywa mu nzira).

2. Basabe umuganga wawe "Uburyo bwo kuvura indwara y'igisukari buhuye n'ibarabara".¶

Gucungera indwara y’igisukari iyo utazi igihe canke ivyo uzofungura bisaba ubuhinga bwo kuvura butekanye kuruta gufata imiti isanzwe mu bitaro:

1. Shira imbere amakaramu y’insulini yuzuye rimwe gusa ku bikoresho vy’ibirahuri n’ibikoresho vy’ibirahuri: Ivyuma vy’ibirahuri biramenagurika bitagoranye iyo bitewe kuri beton, kandi gukura insuline mu bikoresho vy’urushinge vy’urushinge rurerure ku ntebe yo muri pariki bikwegera abapolisi canke ubuhungiro badashaka kandi biragoye mu mwiza. Amakaramu yuzuye mbere y’igihe (afise amabara yumvikana n’utudodo dutoduto tw’amakaramu tw’imilimetero 4) arakomeye, ntaboneka, arashobora guterwa n’ugutahura mu ihema ry’umwiza, kandi arashobora kubaho imisi 28 gushika ku 56 mu bushuhe bwo mu cumba.
2. Saba Insuline Basal Ikora Igihe kirekire cane (Tresiba / Toujeo) n'Imiti Ihuye n'Ifunguro:
   • Tresiba (insulin degludec) imara imisi 56 (indwi 8) mu bushuhe bwo mu cumba bushika kuri degre 30 za Celsius (degre 86 za Fahrenheit) kandi ifise idirisha ry’ibikorwa ry’amasaha 42, bisobanura ko iyo akajagari k’uburaro gatuma utera isukari yawe y’umubiri ku musi.
   • Irinde insuline zivanze zidahinduka (nk’iza 70/30) nimba ivyo ufungura bitamenyekana: Niwatera insuline 70/30 canke NPH mu gitondo kandi igikoni c’isupu kikaba kifunze ku muhingamo, isonga ry’insuline ryo hagati rizogutera mu coma y’ugutakaza isukari mu mubiri ku emp Ahubwo, nusabe ubuvuzi bwawe buguhe ikaramu y’imbere ikora igihe kirekire (ihinduwe gatoyi kugira ngo ntugwe hasi iyo wisonzesheje) ifatanijwe n’ikaramu ikora vuba cane mu gihe c’ifunguro uyitera GUSA iyo isahani y’ibifungurwa yicaye imbere yawe ku mubiri.
3. Utware Glucagon yo mu mazuru (Baqsimi) n’Imiti idashobora guterwa n’amazi yo kurwanya isukari mu maraso: Isukari nke mu maraso (isukari nke iri munsi ya 3.9 mmol/L canke 70 mg/dL) yica ningoga cane kuruta isukari nyinshi mu maraso. Imisi yose ushire umuyoboro w’amazi adashobora guterwa ibipande vy’isukari, utupapuro dutoduto 2 canke 3 amapaki y’ubuki canke y’isukari mu mufuko wawe wo mu mutima, kandi usabe umuganga wawe akundikire Baqsimi (umuti w’isukari wo mu mazuru w’ifu yumye), usaba ko udashira mu frigo, udakeneye gutera imishwarara umugenzi iyo upfuye kubera isukari iri hasi mu maraso.

Ibibazo bikunda kubazwa¶

Nomenya gute ata gukeka ko insuline yanje yacitse nabi kubera ubushuhe canke ubukonje?¶

Ubwa mbere, nusuzume n’amaso ku murango mwinshi: insuline zose zikora ningoga (Humalog, Novolog, Apidra) be n’insuline zose zikora igihe kirekire (Lantus, Basaglar, Semglee, Levemir, Toujeo, Tresiba) zitegerezwa kuba zisukuye nk’amazi 100 kw’ijana kandi zitagira ibara; iyo ubonye igicu, igihu, indodo zifise imirongo, utudodo tureremba canke amabuye y’agaciro afatanye n’ikiyo, birasenyuka. Ku bijanye n’insuline NPH canke 70/30 iri mu bicu, zunguruka iyo nkono hagati y’ibiganza vyawe incuro 20 (ntiwigere uyizunguruka cane): ikwiye guhinduka amazi amwe kandi ateye neza nk’amata; iyo ibirundo vyera bifatanye n’inkuta zo hasi canke z’ibirahuri, canke iyo amazi agatandukana ningoga n’ibizingiti vy’urubura ku biyo, birasenyuka. Ubwa kabiri, wizere igipimo c’isukari mu maraso yawe: kubera ko ubushuhe bukeyi bushobora kugabanya ubushobozi bwa insuline ataco buhindura amazi agaragara nk’igicu, iyo isukari yawe iguma hejuru ya 16,7 mmol/L (300 mg/dL) inyuma y’imiti ibiri yo gukosora ivuye mu gitereko cari gifise ubushuhe bwinshi canke ikirere gikonje,

Noshobora gusaba ikigo c’abatagira aho baba kubika amasandugu yanje y’insuline atafunguwe mu frigo yabo y’abakozi?¶

Ego, kandi hakurikijwe amategeko ya Leta y’Uburundi yerekeye uburaro bw’abamugaye, harimwo n’Itegeko ry’Abanyamerika bafise Ubumuga (ADA) n’Itegeko ry’Uburaro Bubereye muri Leta Zunze Ubumwe za Amerika, Itegeko ry’Uburinganire ryo mu 2010 mu Bwongereza, n’Itegeko ry’Uburenganzira bwa Muntu ryo muri Kanada, indwara y’igisukari ni ubumuga bwo ku mubiri burindwa. Naho uburaro bw’ishengero bwoba bufise itegeko rusangi ry’ukubuza kubika ivyokurya vy’abaturage canke ibintu vy’umuntu ku giti ciwe, gutanga umwanya wo kubikamwo frigo mu biro vy’abakozi canke mu frigo y’ubuvuzi ku masandugu y’insuline y’umuturage atafunguwe (kandi kwemerera umuturage kuguma afise ikaramu yiwe ikora, inshinge z’ikaramu, n’umuntu afise isukari y’ivyihutirwa) Icumbi ryiza. Ushireko neza neza akasandugu kawe katafunguwe n’izina ryawe n’itariki yawe imbere mu musaho wa Ziplock ukingiwe, kandi ugume ufise ikaramu yawe ikora ubu mu mufuko wawe.

None nkore iki ku nshinge z’ikaramu ya insuline n’amalanseti vyakoreshejwe iyo mba mu modoka canke mw’ihema ata n’igitereko c’ibikoresho bisongoye?¶

Ntukigere ujugunya inshinge canke amacumu yakoreshejwe mu gitereko c’imyanda ca bose canke ngo ubisige mu gafuko aho bishobora gutuma umuntu akomereka mu mpanuka. Ushobora gukora igikoresho co gutwara ibintu bisongoye kijanye n’amategeko ya FDA, kidashobora gutoborwa ku buntu ukoresheje icapa cose c’ubusa, gikomeye c’ipulasitike gikomeye gifise umupfundikizo w’ivyuma, nk’icupa ry’ipulasitike ryinshi ry’amazi yo gusukura, icupa ritoyi ry’ibara ry’agahama, canke igikombe c’amavuta y’ikawa gikomeye (ntiwigere ukoresha icupa ry’amavuta y’ikawa rikomeye). Wandike "SHARPS - DO NOT RECYCLE" ku cupa ukoresheje ikimenyetso, ugumize igipfukisho gipfutse neza imbere mu gafuko kawe, hanyuma ugihindure igitereko gishasha c'ubuntu ku farumasi iyo ari yo yose, porogarama yo guhindura urushinge / inshinge, canke ivuriro ry'ubuzima ry'abatagira aho baba.

Mbega vyoba vyiza nosubira gukoresha urushinge rw’insuline canke urushinge rw’ikaramu incuro nkeyi iyo ndiko ndabura ibikoresho?¶

Naho abahinguzi bavuga inshinge z’ikaramu n’inshinge nk’izokoreshwa rimwe gusa kugira ngo zibe zidashobora kuvyara umwana kandi zikaba zikomeye, abaganga bo mu mabarabara bakoresha uburyo bwo kugabanya ingorane iyo umurwayi atagira aho aba ashitse ku nshinge zibiri za nyuma imbere y’uko ivuriro rifungura ku wa mbere: ntukigere usangira urushinge canke ikaramu y’insuline n’uwundi muntu mu bihe vyose ( Hepatite B, Hepatite C, na SIDA naho woba uhinduye umutwe w’urushinge); ushire igipfukisho co hanze c’ipulasitike co gukingira ku rushinge rwawe bwite hagati y’inshinge; ntukigere uhanagura umutwe w’urushinge n’inzoga (ivyo bikaba bikuraho igipfukisho c’urushinge gitoyi cane maze kigatuma umutwe ugira urukoba rw’amarira n’amarira); kandi uce usubiriza urushinge ubwo nyene iyo rupfutse, rukora ku kindi kintu cose kirenze urukoba rwawe rusukuye, canke rukagira umutuku aho wateye urushinge.

Amasoko yasuzumwe¶

• TWEBWE. Ishirahamwe ry’Ibifungurwa n’Imiti (FDA, Leta Zunze Ubumwe za Amerika): Amakuru yerekeye Ugubika Insuline no Guhinduranya Ibintu mu gihe c’Ivyihutirwa (Amadirisho y’Ugushikama kw’Ubushuhe bwo mu Cumba ku bijanye na Lispro, Aspart, Glargine, Detemir, Degludec, n’Insuline z’abantu).
• Ishirahamwe mpuzamakungu ryitaho amagara y’abantu (OMS) n’abaganga batagira imbibe (MSF / Abaganga batagira imbibe, mpuzamakungu): Icigwa ca PLOS ONE ku bijanye n’ugukomera kw’insuline z’abantu n’iz’ibindi bihimba vy’umubiri mu gihe c’ubushuhe buhinduka n’imirongo ngenderwako y’ugukonjesha y’ibumba/iy’umuyaga.
• Isoko ry'ibitabu rya Cochrane (Impuzamakungu): Isubiramwo ry'uburyo bwa Cochrane ryo mu 2023: Ugushikama kw'ubushuhe n'ububiko bw'insuline y'umuntu ku bantu barwaye indwara y'igisukari mu bibanza bifise ubutunzi buke no mu bibanza bitagira amashanyarazi.
• Inama y’igihugu y’ubuvuzi bw’abatagira aho baba (NHCHC) n’ishirahamwe ry’abaganga b’abimukira (Leta Zunze Ubumwe za Amerika): Guhindura amabwirizwa y’ubuvuzi ku bijanye no kuvura indwara y’igisukari mu barwayi batagira aho baba: Ukworohereza imiti (Basal-Bolus), Ububiko bw’imiti, no kugabanya ingorane z’indwara y’isukari.
• Ishirahamwe ry’Abanyamerika ry’Indwara y’Isukari (ADA, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako zo kwitwararika indwara y’igisukari: Gutanga Insuline, Ububiko bwiza, n’Ugutoranya Ivyihutirwa kw’Indwara y’Isukari (DKA).

Inyobora zifitaniye isano¶

• Kurokoka ata nzu n'ugutoranya ibihe bikomeye
• Gukingira ibitaro gujugunywa mu nzira: akaruhuko k'ubuvuzi no kwitaho abakira
• Ubuvuzi bwo mw'ibarabara, ikirenge co mu mwobo, kwitaho ibikomere, n'ubuzima bwo mu nzu
• Inyungu za bose: SNAP, EBT, Medicaid, n’imfashanyo rusangi ata n’aho uba
• Polypharmacy, gufata imiti birenze urugero, gutakaza imiti, n'amakosa yo gutunganya imiti
• Inomero z'ivyihutirwa