Ukwitegurira Ivyago ku bakoresha ipompo ya insuline n’abarwayi ba dialyse: Guhindura inshinge z’amaboko n’ivyo kurya vy’ipotasiyumu¶

Iyo habaye igihuhusi, umwuzure, umuriro w’ishamba canke uruja n’uruza rw’amashanyarazi rw’imisi myinshi rusenyutse, abantu bafise indwara y’igisukari iterwa n’insuline canke indwara y’amafyigo iri mu rwego rw’iherezo, baca bashikirwa n’uguhungabana kw’imitsi mu masaha 12 gushika ku 72, bikaba bishobora gutuma bapfa. Iyo pompe ya insuline isadutse, igatakaza ubushobozi bwa bateri, canke igahera ibikoresho vyo gutera umuti mu gihe umuntu ariko arasohoka, isukari yo mu maraso iraduga cane igatuma umuntu apfa . indwara y'igisukari mu masaha 4 gushika ku 8 kiretse iyo umurwayi ashobora guhindukira ubwo nyene akaja ku gutera inshinge z’amaboko akoresheje umugambi wo gusubiza inyuma wanditswe imbere y’igihe. Muri ico gihe nyene, iyo amabarabara yuzuye amazi canke amashanyarazi azimye bifunze ibigo vy’ubuvuzi bw’amaraso mu kiringo c’imisi ibiri canke itatu, abarwayi b’amafyigo bashobora guhagarara umutima mu gacerere kubera potassium mu maraso yiyongera canke bagacika intege kubera amazi menshi cane kiretse baciye bafunga ibiribwa vy’amafyigo vyihutirwa vy’imisi 3. Imbere y’uko haba ikintu gikomeye, ubike umufuko w’ibintu vy’umubiri iruhande y’umubiri wawe . imiti ishobora guterwa n'ubushuhe, ufate mu mutwe ingene wovyifatamwo . fistule ya dialyse n'ivyihutirwa vy'amaraso menshi, hanyuma ubike ivy'aho uba inomero z'ivyihutirwa (911 muri Leta Zunze Ubumwe za Amerika no muri Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza) ku karata idashobora guterwa n’amazi.

Ivyo ubikore ubu¶

1. Sohora kandi ushireko ikarita yawe y’ubu y’imiterere y’ipompa ya insuline n’iya Bolus uno musi. Fungurira ipompa yawe y’insuline canke porogarama yo kuri telefone ngendanwa y’ugutanga insuline (AID) ubu nyene maze wandike urutonde rwawe rw’amasaha 24 y’insuline (ibice ku isaha ku gihe cose ukoresha), igitigiri cose c’insuline yawe ku musi- ubushobozi bwo gutahura canke bwo gukosora (ISF), n’intumbero yawe y’insuline ikora. Kopi imwe y’ibara ry’agahama uyishire mu gafuko kawe k’indwara y’igisukari, hanyuma uyishire mu gafuko kawe.
2. Ubike insuline y’imbere ikora igihe kirekire, inshinge z’insuline U-100, n’inshinge z’ikaramu imbere mu gikoresho cawe co gukoresha mu gihe c’ivyago. Ipompa ya insuline irimwo gusa insuline ikora ningoga (nk’iya lispro, aspart canke glulisine). Basabe umuganga wawe w’indwara z’imitsi y’umubiri akuronse umuti wo gufasha ikaramu canke ibikoresho vy’insuline bikora igihe kirekire (nk’insuline glargine canke insuline degludec), n’imiburiburi inshinge 30 z’insuline U-100 zitagira ubumara (0.3 mL canke 0.5 mL ubushobozi), na inshinge z’ikaramu z’imilimetero 4 canke 5 kugira ngo ushobore guhindukira ukaja ku gutera inshinge nyinshi ku musi (MDI) igihe pompe ivunitse canke itakaje ubushobozi.
3. Pakira igipimo ca kera c’isukari mu maraso, ibipimo 100, ibipimo vya ketone, na glucagon biteguye gukoreshwa. Ivyuma bipima isukari mu maraso (CGM) birananirwa iyo ibikoresho bitanga amakuru biheze, amatelefone agapfa, canke ivyuma bifatanya biva mu mazi y’umwuzure canke mu vyoya. Imisi yose ushiremwo igipimo c’isukari c’urutoke c’agaciro n’amabateri y’ibiceri vy’inyuma, amaraso canke amasobe ibipande vyo gupima ketone, igikoresho co mu mazuru canke co kwitera glucagon, n’amagarama 300 y’ibipimo vy’isukari bikora vuba canke ama gels.
4. Ku barwayi ba hemodialyse: Shira urupapuro rwawe rwo gusukura amaraso rwacapuwe "Run Sheet" n'Igikoresho co gusukura amaraso mu mitsi mu gafuko kadashobora guterwa n'amazi. Saba umuforoma wawe wo mu kigo c'ubuvuzi bwa dialyse akuhe kopi y'imiti yawe yerekana uburemere bwawe bwumye, igikoresho co gusukura amaraso n'amaraso, ivyimburwa vyo mu bwogero, n’ingero ya heparine. Pakira uru rupapuro iruhande y'ibipfukisho 3 vy'amacupa y'ipulasitike isukuye**, bitagiramwo ubumara 10 x 10 centimeter (4 x 4 inch) ibipande vy’impuzu, n’igikoresho co gufata umutsi w’amaraso.
5. Wubake isanduku y'ibifungurwa vy'ivyihutirwa vy'imisi 3 bifise potassium nke, bifise sodium nke, bifise amazi make. Bika igikarabiro c'ipulasitike gitandukanye canditsweko ngo "Dialyse w 3-Day Disaster Diet Only" irimwo ibifungurwa bifise potassium nke, bifise potassium nke, ibikombe vy’amapome, amapera canke amapera yo mu bikoni mu mutobe uvoma imbere y’uko urya, umuceri w’ibitoke, n’amagi yera ashobora gushirwa ku ruhande canke inyama z’ingurube zifise sodium nke) wongereko agakombe gatoyi ko gupima kugira ngo amazi yose umuntu afata ashobore kugera kuri 500 gushika kuri 700 militiro z’amazi ho 16 gushika kuri 424.
6. Baza umuganga wawe w’amafyigo ku bijanye n’ububiko bw’ivyago bw’amapaki y’ibifungurwa bifatanya potassium mu kanwa. Niwaba ufise ubufasha bwo gusukura amaraso, baza umuganga wawe w’amafyigo nimba ukwiye gutwara umuti w’iminsi 3 w’ivyihutirwa w’imiti ifatanya potassium yo mu kanwa y’ubuhinga bwa none (nk’iyi zi**patirocylo or) n’amabwirizwa yanditse yerekeye igihe co gutangura kuyifata iyo ivuriro ryawe ry’ubuvuzi bw’amaraso ripfutse mu gihe c’ivyago vyamenyeshejwe.

Igiti c'ingingo: Gusenyuka kw'ipompo ya insuline canke gufunga ivuriro ry'ubuvuzi mu gihe c'ivyago¶

Koresha iki gicapo c’urugendo rw’ugutoranya mu gihe c’umuco, mu gihe c’uguhunga, canke mu gihe c’igihuhusi gikomeye kugira ngo wirinde ketoacidose y’isukari, hypoglycémie ikaze, umutima uhagaze cane, n’uguhagarara kw’amahaha.

flowchart TD
    Start["Ivyago Bitera: Amashanyarazi Arazima, Arahunga, Canke Ivuriro Rirafunga"] --> PatientType{"Ni ubuhe buvuzi bukoreshwa?"}

    PatientType -->|"Ipompa ya insuline / Ukoresha CGM"| PumpCheck{"Mbega iyo pompe ya insuline iracariho, irafise umuriro, kandi ikaba iriko iratera ibindi bikoresho vy’inyuma?"}
    PumpCheck -->|"Ego, gukora neza"| PumpConserve["1. Shira pompe ishobora gusubirwamwo umuriro mu banki y’amashanyarazi y’iminwe ku 50% y’amashanyarazi; 2. Gukingira ibikoresho vy’insuline mu gipfuko gikoreshwa n’amazi (15C gushika 30C); 3. Ivyiyumviro vy’ifunguro CGM; Gumana igipimo c'urutoke n'isukari ku mubiri"]
    PumpCheck -->|"Oya: Ipompa yasadutse, itose, bateri yapfuye, canke ivuye mu bikoresho vyo gutera umuti"| PumpFail["GUHINDURA MU BIMENYETSO VYO GUTERA INJECTION Y’AMABOKO (MDI) UBWO nyene:; 1. Kura cannula y’ipompa ku ruhu kugira ngo ntihagire uwuvyura urujijo; 2. Kura ikarata yanditswe yo guhindura Pompe-ku-Siringe mu go-bag; 3. Ufise Insuline Basal Ikora Igihe kirekire (Glargine / Degludec)?"]

    PumpFail -->|"Ego, ufise Insuline y'Ibanze"| GiveBasal["Gutera umuti w’amasaha 24 ukora igihe kirekire ukoresheje ikaramu canke urushinge rwa U-100; + Gutera insuline ikora ningoga imbere y’uko ufungura no kugira ngo ukosore isukari nyinshi"]
    PumpFail -->|"Nta insuline y'ishimikiro iboneka"| RapidBridge["IKIRORO GIKORA VYIHUTIRE:; Inshinge iharuwe y’amasaha 3 gushika kuri 4 ingana n’iya Basal hakoreshejwe insuline ikora vuba; biciye ku rushinge rwa U-100 buri masaha 3 canke 4 ku murango n'ijoro + gupima ketones"]

    PatientType -->|"Umurwayi w'amaraso canke w'amaraso y'umubiri"| DialCheck{"Mbega ikigo canyu co gukoreramwo dialyse y’abarwayi bavuye mu bitaro kirafunguye canke kirashikira?"}
    DialCheck -->|"Ivuriro ryarafunze canke amabarabara ararengerwa n'amazi"| DialDiet["GUKORESHA IMISI 3 Y'UBUROKO BW'AMAFYIRO BW'IBIHUTIRA:; 1. Utangure ubwo nyene kurya ivyokurya vy’imisi 3 bifise Potassium nke (<1.500 mg/umusi); 2. Guhagarika amazi yose umuntu ashobora gufata kugera kuri 500 gushika kuri 700 mL (16 gushika kuri 24 oz) mu masaha 24; 3. Hamagara umurongo w’ubuvuzi w’ivyago / KCER kugira ngo ubone aho ikigo c’ubufasha gifunguye kiri; 4. Fata umuti w’ivyihutirwa wo gufatanya potassium iyo utegetswe n’umuganga w’amafyigo"]
    DialDiet --> RedFlags{"Hari ubugoyagoye bwo ku maguru, iminwa itera ububabare, umutima utera buhoro, canke guhema umwuka?"}
    RedFlags -->|"Ego"| CallEMS["HAMAGARE 911 / 112 / 999 UBWO nyene:; Gutangaza ‘Umurwayi w’Idialyse akekwa ko afise Hyperkalemie canke Edema y’Amahaha’; Icara uhagaze kuri degre 90 amaguru azunguruka hasi"]
    RedFlags -->|"Oya"| MonitorWeight["Pima buri musi (ushire inyungu kuri 0.5-1.0 kg/umusi) hanyuma ushire mu bitaro"]

Igice ca 1: Ipompa ya insuline n’ukwitegurira ibiza vya CGM (Igikoresho co gukira iyo ipompa idakora neza)¶

Abantu barenga ica kabiri c’abarwaye indwara y’igisukari yo mu bwoko bwa mbere be n’abandi benshi bafise indwara y’igisukari yo mu bwoko bwa kabiri iva kuri insuline, bizigira insuline ikomeza guterwa munsi y’urukoba (CSII) biciye ku mapompo y’imirongo canke amapompo y’imirongo atagira imirongo, afatanijwe n’igikoresho co gupima isukari (CGMAliver)** in uburyo bw’uruzitiro rwugarijwe. Naho ivyo bikoresho bitanga ubugenzuzi budasanzwe ku musi ku musi, birazana ibintu bine bishobora gusenyuka mu gihe c’ivyago:

1. Ugukoresha ubuhinga bwa elegitoronike n’amabateri: Amapompo menshi y’ubuhinga bwa none afise amatiyo n’amapompo y’ibipande akoresha amabateri y’imbere ashobora gusubirwamwo (canke amabateri yihariye ya litiyumu AA) apfa mu misi 2 gushika kuri 5 ata nguvu z’uruja n’uruza.
2. Ibikoresho vyo gutera insuline: Ntushobora gukura insuline mu gitereko c’ipompa yuzuye canke ngo uyiterere mu mubiri wawe kiretse ufise inshinge z’insuline U-100 zisanzwe (canke inshinge z’ikaramu z’ikaramu z’insuline). Iyo igikoresho cawe ca nyuma co gutera umuti c’ipulasitike gipfutse ku mukanda igihe uriko urashiramwo imodoka y’ugukura abantu, ipompo yawe iba ipulasitike itagira akamaro.
3. Kubura igice c’umubiri kiri munsi y’urukoba: Kubera ko amapompo atera gusa insuline ikora vuba cane (insuline lispro, insuline aspart, canke insuline glulisine) ishika ku rwego rwo hejuru mu minota 60 gushika ku 90, igahera mu masaha 3 gushika ku 5, guhagarika gutanga insuline y’amapompo bisiga umubiri ufise insuline y’inyuma3.
4. Igicu na Smartphone Lockout: Abakoresha benshi babika ibiharuro vyabo vy’ishimikiro, ibiharuro vy’ibirungo, n’ibintu vy’ugutahura gusa imbere mu rutonde rw’ipompa yabo canke urugi rw’igicu. Iyo igicapo c’ipompo kimenetse canke bateri ya telefone igapfa, yaba umurwayi canke umuganga wo mu bitaro vy’abarwayi vyihutirwa, nta n’umwe azi insuline umurwayi akeneye buri musi.

Intambwe ku yindi: Gutegura ikarata yawe yanditse yo guhindura ipompo ngo ibe inshinge¶

Umuntu wese akoresha ipompo ya insuline ategerezwa kwicarana n’umuganga wiwe w’indwara y’ibihaha canke umuhinga mu vy’ubuvuzi n’uburezi bw’indwara y’igisukari (CDCES) rimwe mu mwaka kugira ngo yuzuze Ikarata y’uguhindura iyo pompe idakora neza mu gihe c’ivyihutirwa. Ntukigere wibaza ingero z’insuline mu gihe c’amagorwa. Ikarata yawe itegerezwa kwandika neza iyi mibare itandatu:

Uko wova ku pompe ya insuline yananiwe ukaja ku gutera inshinge z’amaboko (Ibintu bibiri)¶

Iyo pompe yawe inaniwe, ikaja mu mazi y’umwuzure, canke ikabura ibikoresho vyo gutera, ku mubiri ufungure kandi ukureho igihimba ca kera c’ipompa canke igipande c’ipompo ubwo nyene kugira ngo umenye neza ko ata insuline itari yitezwe iriko irasohoka, hanyuma ukurikize ivyabaye bihuye n’ivyo ukoresha:

Ivyabaye A: Ufise Insuline Ikora Igihe Kirekire (Glargine, Detemir, canke Degludec) N’Insuline Ikora Vyihuta¶

Ubu ni bwo buryo bwo gukingira ibiza butekanye kuruta ubundi bwose, bushingiye ku rugero rw’inzahabu, bushimikijwe n’ishirahamwe ry’abarwayi b’igisukari ryo muri Amerika (ADA), Diabetes UK, n’ishirahamwe ry’abarwayi b’igisukari ryo muri Amerika (DDRC): 1. Uhe Insuline Basal Long-Acting Basal yawe ukoresheje ikaramu canke urushinge rwa U-100: Suzuma ikarata yawe yanditse yo guhindura umuganga wawe kugira ngo ubone ingero y’umubiri yaguharuye rimwe ku musi (canke kabiri ku musi). Kubera ko insuline basal ikora igihe kirekire ifata amasaha 2 gushika kuri 4 kugira ngo igere ku ngaruka zishitse inyuma y’urushinge rwa mbere nyene, umugambi wawe wanditse wo guhindura woshobora kugutegeka gutanga urugero rutoyi rw’amasaha 1 gushika kuri 2 rukora vuba ku gihe nyaco uciramwo pompe nimba isukari mu maraso yawe imaze gutera hejuru. 2. Gabanya insuline y’imbere n’ibice 10% gushika kuri 20% iyo ukora ibikorwa bikomeye vy’ivyago canke utanga ibifungurwa: Kwikorera imifuko y’umusenyi, kugenda ingendo ndende kugira ngo umuntu ave mu nzu, canke kurya ibifungurwa bitobito vy’ivyihutirwa bituma umuntu agira ubushobozi bwo gufata insuline. Muganire imbere y'igihe ku "Gugabanya Ibikorwa vy'Ivyago" (kenshi 80% vy'Ibikorwa vy'Ivyago) ku ikarita yawe yanditse imbere y'igihe. 3. Tanga Insuline ikora vuba imbere y’uko ufungura no ku bijanye no gukosora isukari nyinshi: Koresha imiti yawe yanditse ICR na ISF ukoresheje ikaramu ikora vuba canke urushinge rwa U-100 rukuwe mu gitereko gikora vuba c’ipompa yawe. Rindira nibura amasaha 3 gushika kuri 4 hagati y'imiti yo gukosora kugira ngo wirinde "insuline guteranira hamwe" (gutera imiti ya kabiri yo gukosora imbere y'uko umuti w'imbere ukora vuba uhera gukora, ivyo bikaba bituma umuntu agira isukari nyinshi mu mubiri zitevye cane).

Ivyabaye B: Pompe yawe yaravunitse kandi ufise GUSA igikombe cawe ca Insuline ikora vuba (Nta Insuline Basal ikora igihe kirekire)¶

Nimba wavuye mu nzu ufise gusa ipompo yawe be n’agacupa kayo k’insuline ikora ningoga (lispro, aspart canke glulisine) kandi udafise insuline y’ishimikiro ikora igihe kirekire: 1. Ushobora gukura insuline ikora vuba cane mu gitereko c'ibirahuri, mu gitereko c'ipompa y'ipulasitike, canke mbere mu gitereko c'imipira kiri ku mpera y'ikaramu ya insuline ikoreshwa rimwe gusa ukoresheje urushinge rwa insuline U-100 rusanzwe. 2. Ntukigere utera umuti wuzuye w’amasaha 24 ukoresheje insuline ikora vuba: Gutera insuline ikora vuba 20+ icarimwe bizotuma umuntu agira isukari nyinshi mu mubiri mu minota 90. 3. Kurikiza urutonde rw'amasaha 3 gushika kuri 4 rw'ibikorwa vyihuta vy'umubiri: Kubera ko insuline ikora vyihuta imara amasaha 3 gushika kuri 4 gusa munsi y'urukoba, utegerezwa gushinga inkengeri maze ugatera amasaha 3 canke amasaha 4 y'imiti yawe y'umubiri buri masaha 3 gushika kuri 4, ijoro), wongereko imfungurwa n’imiti yo gukosora, gushika ushitse mu farumasi canke mu kibanza c’ubuhungiro bwihutirwa gifise insuline ikora igihe kirekire. - Akarorero kavuye ku ikarita yawe yanditse: Nimba pompe yawe isanzwe itera 0.8 units/hour ijoro ryose, amasaha 4 y’ikiraro gikora vyihuta ni \(0.8 \incuro 4 = 3.2\text{ units}\) (kizungurutswe hasi mu buryo bubereye nk’uko umuganga wawe abitegetse ku 3 units ku rushinge rwa U-100) ruterwa amasaha yose 4.

Urutonde rw'imisi 14 y'indwara y'igisukari n'ivyago vya CGM¶

Ivyo bikoresho ubishire mu gafuko kazingiye, kadashobora guterwa n’amazi, kabitswe iruhande y’umuryango wawe w’imbere:

• Ikarata y’uguhindura Pompe-ku-MDI yanditswe mu mpapuro n’imiti yose yo mu kanwa y’imisi 14.
• Insuline ikora vuba + Insuline ikora igihe kirekire ibitswe mu gipfuko gishobora gufatwa bitagoranye, congereweko igikapu co gukonjesha gikoreshwa n’amazi kigumiza insuline hagati ya **\(15 degrees\text{C na }30 degrees C\) to {$59) gushika ku misi 28 ata muyagankuba canke urubura. Raba kubungabunga insuline n'imiti mu gihe umuyagankuba uzimye.
• Inshinge z’insuline U-100 zitagira ubumara 30 gushika kuri 50 (0.3 mL canke 0.5 mL ubunini) NA 30 inshinge z’ikaramu y’iminota 4 y’isi yose.
• Ibikoresho vyo gutera imiti mu mapompo 5 gushika ku 7, ibibumbano, canke ibikoresho vyo kwifatanya, hamwe n’ibikoresho vyo guhanagura urukoba n’urudodo rw’ubuvuzi.
• 2 gushika kuri 3 z’inyuma za CGM sensors n’umugozi wo gutanga amakuru, wongereko 20,000 mAh USB power bank ufise umugozi wo gushaja usabwa n’ipompa yawe n’ivyo kwakira (wongeyeko amabateri y’inyuma ya litiyumu AA nimba bishoboka).
• Igipima isukari mu maraso gikoreshwa n'urutoke, igikoresho co gutera, amabateri y'ibiceri (CR2032), n’ibipande 100 vyo gupima mu gitereko cabo gipfutse.
• Ivyuma vyo gupima Beta-Ketone mu maraso canke Ivyuma vyo gupima Ketone mu maraso kugira ngo umuntu asuzume ko afise indwara ya Ketoacidose y’isukari mu gihe cose isukari irenze \(13.9\text{ mmol/L}\) (\(250\text{ mg/dL}\)) canke mu gihe c’indwara.
• Ibikoresho bibiri vyo gukiza Glucagon bitarahera (ivyo gutera mu mazuru canke gutera amazi) hamwe n’300+ grams z’ibifungurwa vyoroshe bikora vuba (ibipimo vy’isukari, amapaki y’isukari, canke amapaki y’ubuki).
• Igikoresho co gutwara ibikoresho vy'urugendo (canke icupa ry'amazi y'impuzu ry'uruhome rwinshi ryanditsweko "BIOHAZARD SHARPS").

Igice ca 2: Gutegura ivyago vy’ugusukura amaraso n’ugusukura amaraso mu nda¶

Abarwayi bafise indwara y’amafyigo idakira y’inzira ya 5 (Indwara y’amafyigo y’inzira y’iherezo, canke ESRD) bafata ugusukura amaraso mu kigo incuro zitatu mu ndwi, gusukura amaraso mu rugo, canke ugusukura amaraso mu rugo (PD) ku musi ku musi, bari mu bantu bose bashobora gushikirwa n’ingorane z’ubuvuzi mu gihugu. Igihe kimwe co gusukura amaraso mu masaha 4 bisaba nk’amalita 120 gushika kuri 160 (amagaloni 32 gushika kuri 42) y’amazi asukuye cane n’ububasha bw’umuyagankuba buhoraho bufise inzira zitatu. Iyo inkubi y’umuyaga, umutingito, ubukonje bwo mu rushana canke imyuzure bikubita umuvuduko w’amazi canke amashanyarazi yo mu gisagara, amavuriro y’abarwayi bavurirwa hanze mu karere kose arashobora gufunga icarimwe mu kiringo c’amasaha 48 gushika ku 96.

Itegeko rya 1: Fata "Early Surge" Igihe co Gukora Diyalize Imbere y'Ivyago¶

Igihe cose igihuhusi, igihuhusi, canke umwuzure munini bivuzwe amasaha 48 gushika kuri 72 imbere y'igihe, abaganga bavura abarwayi bavuye mu bitaro barakoresha "Early Dialysis Surge Schedules" (gukora amasaha 24 kugira ngo bavure umurwayi wese imbere y'uko igihuhusi gitera). - Ntukigere usiba igihe co gusukura amaraso imbere y’igihuhusi kugira ngo ushire mu bipapuro canke ngo uve mu nzu utamenyeshejwe: Gusukura amaraso imbere y’igihuhusi biguha amasaha 48 gushika ku 72 y’ubuzima busukuye bufise potassium nke n’amazi menshi. - Niwaba wimukiye mu kindi gisagara, fata urupapuro rwawe rwo gukora dialyse rwacapuwe: Ikigo cose c'abashitsi canke igisata c'ibitaro vyihutirwa kiri mu karere kawe k'ukwimukira gikeneye Uburemere bwumye (ikilo/amapawundi) bwawe nyabwo, ubwoko bw'ugushika ku mitsi, uburyo bwo gukoresha heparys potagu andcossium (\(1\igisomwa{K}, 2\igisomwa{K},\igisomwa{ canke }3\igisomwa{K}\)) kugira ngo bagukoreshe dialyse vuba ataco bigutera gutera umutima canke gutera umutima.

Itegeko rya 2: Gufunga ibiribwa vy’imisi 3 vyihutirwa vy’amafyigo bifise potassium nke, bifise amazi make igihe habaye icago¶

Iyo umutingito utunguranye, umwuzure w’amazi, canke ukuzimira kw’umuriro bigubujije gushika ku nzira yo gusukura amaraso, ivyo ushira mu kanwa kawe mu masaha 72 akurikira nivyo bizogena nimba urokoka. Iyo ata gucungera amafyigo, hari ibintu bibiri vyica ningoga abarwayi batagira dialyse: 1. Potasiyumu yo mu vyo ufungura (K+): Itera potasiyumu mu maraso hejuru y’amadolari 6,0\text{ gushika kuri }7,0\text{ mmol/L}$, igatuma amaguru aduga, umutima ugahagarara bukwi na bukwi (ugutera ivyatsi canke asystole). 2. Amazi na Sodium (Na+): Mililitiro yose y’amazi unywa iguma mu mitsi y’amaraso yawe, igatuma umuvuduko w’amaraso uzamuka gushika ku rugero rw’ingorane, igatuma amahaha yawe yuzura amazi (acute flash pulmonary edema).

Kurikiza neza Ivyihutirwa vy’abanyagihugu vy’amafyigo (KCER), Ishirahamwe ry’igihugu ry’amafyigo (NKF), na Ivyokurya vy’amafyigo vyihutirwa vy’imisi 3 vya CDC gushika usubiye ku mashine yo gusukura amaraso:

Amategeko yihariye ku barwayi ba Dialyse (Gucungera Ivyo Bibazo Vyompi Hamwe)¶

Nk’ibice 40% gushika kuri 50% vy’abarwayi ba dialyse na bo nyene barafise indwara y’igisukari. Mu gihe c'ivyago, ingeso zibiri zisanzwe zirahuza biteye akaga: 1. NTUKIGEZE ukoresha umutobe w’umuceri, ibitoke, isokoroti, canke amata kugira ngo uvure isukari ntoyi mu maraso (hypoglycémie) iyo uri ku nzira y’ugusukura amaraso: Ikirahuri kimwe c’umutobe w’umuceri c’amadolari 240\text{ mL}$ (\(8\text{ oz}\)) kirimwo hafi **$500 yuzuye y’umutobe w’umuceri. Ahubwo, uvure indwara y’isukari mu mubiri (<3.9 mmol/L canke <70 mg/dL) gusa n’ibipimo vy’isukari isukuye, ibipimo vy’isukari, ibiseke vy’isukari ikomeye, ubuki, canke isukari yo ku meza ivanze n’akayiko 1 k’amazi, birimwo zero potassium n’amazi makeyi. 2. Irinde ivyo kurya vy’amakalori bikomeye/isukari biri mu rutonde rw’ivyo kurya vy’amafyigo bitagira indwara y’igisukari kiretse iyo uriko uravura n’umwete isukari iri hasi mu maraso canke upfutse ibiribwa birimwo ibinure n’insuline. Ahubwo, koresha amavuta ya elayo, amavuta ya kanola, amavuta atagira umunyu, canke iforomaje idafise umunyu ku bifungurwa bifise sodium nke n’umuceri mwera kugira ngo ubone ama calories menshi ataco ushizeko glucose canke potassium mu maraso.

Igice ca 3: Gukingira imitsi yawe no gutegura imitsi yo mu nzu mu gihe c'ingorane¶

1. Igikoresho co gufasha mu gihe c'ihungabana¶

Nk’uko vyavuzwe mu buryo burambuye mu gitabu cacu . dialyse fistule amaraso n'ubufasha bwa dialyse bwabuze, umurwayi wese akoreshwa hemodialyse ategerezwa kuguma afise ikintu co kumukingira gushika ku nkweto yiwe: - Ibikoresho vyo gucungera amaraso: Ipaki 3 ibipfukisho vy'amacupa vy'ipulasitike bisukuye, bitagiramwo ubumara 10 x 10 cm (4 x 4 in) ibipande vy’impuzu, n’igipande c’impuzu gihagarika amaraso. Iyo igisebe c’urushinge rwa fistule gicitse mu gihe co gukura umuntu mu nzu, ntiwigere uzingira ku kuboko igitambaro co kwoga gikomeye; kanda urutoke rumwe canke igipfukisho c’icupa ry’ipulasitike risukuye ushire ku mwobo w’ibara ry’agahama mu minota 15 gushika kuri 20 idahagarara mu gihe uriko uraduza ukuboko hejuru y’umutima maze ugahamagara abajejwe ivy’ubutabazi. - Iboneka ryinshi "NTA BP / NO IV / DIALYSIS ACCESS ARM" Umukanda wo ku kuboko w'ubuvuzi: Mu gihe c'ugutoranya canke gutabara abantu mu bibanza vy'akajagari, wambare umugozi w'ubuvuzi w'umutuku ukeye cane ku kuboko kwawe kugira ngo abaganga ntibazokwigere batera umuvuduko w'amaraso canke ngo bashire umurongo w'ubuzima mu mubiri wawe. - Igipfukisho c’imitsi yo hagati (Permcath) n’Ibipfukisho Bikingira Amazi: Niwaba uriko urakora dialyse biciye mu gipfukisho co mu gikiriza canke mw’izosi, ushiremwo igipfukisho c’imitsi c’ipulasitike gifise amababa ateye igomwe, ibipfukisho bishobora gukingira amazi bibonerana (Tegaderm), n’ibipfukisho bitagiramwo ubumara. Ntukigere wemera ko amazi y’umwuzure canke amazi yo mu ruzi atatetse akora ahantu catheter isohokera; iyo umuyoboro wa catheter usadutse canke igipfukisho kikagwa, ushire canke ushire umuyoboro hagati y’aho uvunitse n’igikiriza cawe hanyuma uryame ku ruhande rwawe rw’ibubamfu umutwe wawe uri hasi kugira ngo ntube ugira embolisme y’umuyaga yica.

2. Gukora Dialyse Peritoneale mu Rugo (PD) Mu gihe Umuyagankuba Uzimye¶

Abarwayi bakoresha imashini y’ugutwara amagare (APD / CCPD) ijoro ryose muhira barashobora kurokoka iyo umuyagankuba uzimye imisi myinshi iyo biteguye imbere y’igihe: - Bika imisi 7 gushika kuri 14 y’Ibikoresho vy’Imifuka Ibiri vy’Imifuko (Y-sets n’imifuko y’amazi) mu bubiko: Iyo umuyagankuba uhagaze kandi igikoresho cawe co gutwara ijoro gikora, uce uhindukira ubwo nyene ku **Ibikoresho vy’Imifuko y’Imifuko y’Imifuka (Continuous Ambulatory CAPD, Peritoneal Dialysis). Manika umufuko w’umuti hejuru y’uburebure bw’ibitugu hanyuma ushire umufuko w’amazi hasi kugira ngo uburemere bw’isi busohoke kandi buzuze inda yawe ata muyagankuba. - Uko woshushanya neza imifuko y’umuti wa PD ata muyagankuba canke micro-onde: Ntukigere ushiramwo amazi ya PD akonje nk’urubura, kandi ntiwigere usyusha umufuko wa PD mu micro-onde canke ngo ushire ivyuho vy’amapulasitike mu mazi yanduye (ivyo bikaba bitera indwara y’umutima yica). Ahubwo, zinga iyo saho y’inyuma yumutse yugarijwe mu igitambaro c’umye gisukuye iruhande y’ibikoresho vyo gushushanya ibiganza vy’imiti canke amacupa y’amazi ashushe (ugumize ubukonje bwose kure y’ibivuko), canke ufate iyo saho ku mubiri wawe munsi y’igitambaro gushika ishitse ku bushuhe bw’umubiri (\(37 degrees C / 98.6\) degrees). - Waterless Hand Antisepsis: Nimba amazi yo mu ruzi ari munsi y’itangazo ry’amazi abiri canke apfutse, n’ukoreshe 60% gushika kuri 80% y’inzoga, wambare igipfukisho co mu maso co kubaga, kandi uzime ama ventilateur imbere yo gufatanya PD transfer set yawe.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Mu gihe c’ivyago vyo mu karere, amashirahamwe y’ubuvuzi bw’amaraso n’amashirahamwe y’abarwayi b’igisukari arakoresha imirongo y’ubuvuzi y’ubuntu kugira ngo arungike abarwayi bavuye mu mazu yabo ku mavuriro yuguruye, ku bibanza vy’ububiko bw’insuline vyihutirwa, no ku bibanza vy’ubuvuzi:

• Leta Zunze Ubumwe za Amerika:
• Ivyihutirwa vy'ubuvuzi: Hamagara 911.
• Umurongo w’Igihugu w’Ivyihutirwa vy’Ifyigo (KCER): Hamagara 1-866-901-3773 kugira ngo ubone amavuriro y’ubuvuzi bw’amafyigo yuguruye.
• Umurongo w’imfashanyo w’ishirahamwe ry’igihugu ry’amafyigo (NKF): Hamagara kuri 1-855-NKF-CARES (1-855-653-2273) (umurongo w’ubufasha w’ivyihutirwa wa DaVita: 1-800-400-8331; umurongo w’ubufasha w’ivyago wa Fresenius: 29-81).
• Ishirahamwe ryitaho guhangana n'ivyago vy'indwara y'igisukari (DDRC) & ADA: Hamagara 1-800-Indwara y'igisukari (1-800-342-2383) canke usuzume Ubuvuzi bwiteguye (RxOpen.org) ku ma farmasi yuguruye.
• Kanada:
• Ibikorwa vy'ubutabazi: Hamagara 911. Baza ishirahamwe ry’amafyigo ryo mu ntara yawe (Ishirahamwe ry’amafyigo ryo muri Kanada: 1-800-361-7494) n’ishirahamwe ry’indwara y’igisukari ryo muri Kanada** (1-800-BANTING).
• Ubwami bw'Ubwongereza:
• Ibikorwa vy’ubutabazi: Hamagara 999 (canke 112), canke NHS 111 kugira ngo ubone gufata insuline yihutirwa canke guhuza ibikorwa vy’amafyigo. Iyandikishe imbere y’igihe ku Igitabo c’Ibikorwa vy’Imbere (PSR) c’amashirahamwe yawe y’amazi kugira ngo ubone amashanyarazi n’amazi vy’imbere.
• Ubumwe bw'Uburayi:
• Ibikorwa vy'ubutabazi: Hamagara 112. Twara Ishirahamwe ry’amafyigo ry’Uburayi (ERA) ikarita y’ivyago n’ikarita yawe y’ubwishingizi bw’amagara y’Uburaya (EHIC)** iruhande y’urupapuro rwawe rwo gukora dialyse rwacapuwe.
• Ostraliya na Nouvelle-Zélande:
• Ibikorwa vy’ubutabazi: Hamagara 000 muri Australiya canke 111 muri Nouvelle-Zélande. Baza Ubuzima bw’amafyigo muri Australiya (1800 454 363) canke Ubuzima bw’amafyigo muri Nouvelle-Zélande (0800 543 639), maze wiyandikishe nk’Umukiriya w’Ubuzima ku bigo vyawe vy’amashanyarazi n’amazi.
• Ubuhindi na Aziya-Pasifike:
• Ibikorwa vy’ubutabazi: Hamagara 112 mu Buhindi, 119 mu Buyapani, 995 muri Singapore, canke 999 muri Maleziya na Hong Kong. Bika kopi y’imiti yawe yo gusukura amaraso, ibisubizo vya Hepatite B, Hepatite C, n’ivy’agakoko gatera SIDA biherutse gusohoka, n’urutonde rw’insuline.

Ibibazo bikunda kubazwa¶

Ni kuki umuntu akoresha ipompo ya insuline adashobora gusa kurindira amasaha 12 gushika kuri 24 kugira ngo umuyagankuba canke ipompo yo kumusubirira bishike?¶

Ipompa y’insuline itera insuline ikora ningoga gusa, iyo insuline ikava mu maraso mu masaha 3 canke 5. Kubera ko ata insuline y’imbere ikora igihe kirekire ibitswe munsi y’urukoba, guhagarika gutanga insuline bituma umuntu abura insuline yose mu masaha 2 canke 3. Iyo ata insuline y’inyuma, igitigu gisuka glucose n’ibindi bihimba vy’umubiri bifise aside mu maraso, ivyo bikaba bituma umuntu arwara indwara y’igisukari (DKA) ishobora gutuma umuntu apfa mu masaha 4 gushika ku 8. Umuntu wese akoresha ipompo ategerezwa gutwara insuline basal ikora igihe kirekire, inshinge U-100, n’ikarata yanditswe yo guhindura kugira ngo ahite ahindura iyo pompe ipfuye.

Noshobora gukura insuline mu gipfukisho c’insuline canke mu gipfukisho c’ipompa nkoresheje urushinge rusanzwe rwitwa U-100 iyo ikaramu canke ipompa bivunitse?¶

Ego cane, igihe insuline iri mu karamu canke mu gitereko ari urugero rwa U-100 (ibice 100 kuri militiro). Iyo ikaramu y’insuline ipfutse canke ipompo imenetse kandi udafise inshinge z’ikaramu canke ibikoresho vyo gutera inzoga, ushire inzoga ku gipfukisho c’umupira kiri ku mpera y’ikaramu canke y’ikaramu ya U-100, ushiremwo urushinge rw’inshinge y’insuline U-100 mu rubavu, hanyuma ukuremwo urugero nyarwo rw’imiti yawe. Ntukigere ukura insuline zikomeye (U-200, U-300 canke U-500) mu nzira y’urushinge U-100 ata mabwirizwa y’umuganga yo guhindura.

Ni kuki ibintu bisubirira umunyu bifise potassium (nka NoSalt canke Lite Salt) bishobora kwica abarwayi ba dialyse mu gihe c’ivyago?¶

Ibintu vyinshi vy'ubudandaji bisubirira ibirungo "bifise sodium nke" bisubirira kloride ya sodium kloride ya potassium isukuye. Akayiko kamwe k’icayi k’umunyu usubirira umunyu wa potassium chloride karimwo miligarama 2.500 gushika ku 2.800 za potassium, ni ukuvuga hafi incuro zibiri z’imiligramu yose 1.500 y’ivyago vy’umunsi ku musi ku murwayi akoresheje ubuhinga bwa anuric hemodialyse. Gufata ibintu bisubirira umunyu wa potassium iyo dialyse itevye bishobora gutuma potassium mu maraso igera hejuru ya 6,5 ​​mmol/L mu masaha makeyi, bigatuma umutima uhagarara bukwi na bukwi.

Umuntu arwaye indwara y’igisukari n’iy’amafyigo yose ariko arakora dialyse yovura gute isukari iri hasi mu maraso (hypoglycémie)?¶

Ntukigere ukoresha umutobe w’umuceri, ibitoke, amata canke isokoroti kugira ngo uvure indwara y’isukari mu mubiri iyo uriko urakora dialyse, kuko umutobe w’umuceri n’ibitoke vyuzuyemwo potassium n’amazi biteye akaga. Ahubwo, ukurikize "Itegeko rya 15" ukoresheje amagarama 15 y'ibifungurwa bitagiramwo potasiyumu bikora vuba: ushire ibice 3 gushika kuri 4 vy'isukari isukuye, ushiremwo umurongo 1 w'isukari, umire akayiko 1 k'ubuki canke isukari yo ku meza, canke unywe isukari ikomeye mu maraso yawe. iminota.

Ni inyandiko izihe amavuriro y’abashitsi asaba imbere yo kuvura umurwayi w’abashitsi yavuye mu nzu?¶

Ivyumba vy’ubuvuzi bw’ivyihutirwa bikeneye urupapuro rwawe rwacapuwe rwerekeye uburemere bw’umubiri wipfuza, uburyo bwo gusukura amaraso, urugero rw’amaraso n’ivyo gusukura amaraso, urugero rwa potassium na calcium mu kwoga, urugero rwa heparine, urutonde rw’imiti uriko urafata, n’ibisubizo vya Hepatite B na Hepatite la. Kubika kopi y’ibara ry’agahama mu gafuko kawe k’urugendo birabuza guteba gutoranya.

Inyobora zifitaniye isano¶

• Kubungabunga insuline n’imiti igira ubushuhe mu gihe umuyagankuba uzimye
• Amaraso ya fistule ya diyalize (uburyo bwo gukoresha icupa) n'ivyihutirwa vy'ugusukura amaraso
• Indwara y'igisukari yitwa ketoacidose (DKA) n'indwara y'isukari nyinshi mu mubiri
• Ukwitegurira ivyihutirwa abamugaye n'abakeneye ubuvuzi

Amasoko n'ubuyobozi buzwi¶

• Ivyihutirwa vy’abanyagihugu vy’amafyigo (KCER) & Ibigo bijejwe kugenzura no kwirinda indwara (CDC, Leta Zunze Ubumwe za Amerika): Gutegurira ivyihutirwa: Inyobora y’abantu bari mu bikorwa vy’ubuvuzi bw’amafyigo (CMS Pub. No. 10150, Igitabo c’imisi itatu c’ivy’amafyigo vy’ivyihutirwa n’ivy’amafyigo).
• Ishirahamwe ry’igihugu ry’amafyigo (NKF, Leta Zunze Ubumwe za Amerika) & Ishirahamwe ry’amafyigo ryo mu Bwongereza (UKKA): Gutegura ivyihutirwa: Indwara y’amafyigo idakira n’ugucungera ukuntu umuntu ashobora gukoreshwa imiti y’amafyigo.
• Ishirahamwe ry’abarwayi b’igisukari (DDRC), Ishirahamwe ry’abarwayi b’igisukari ryo muri Amerika (ADA), & Endocrine Society: Itegeko ry’umurwayi ryo kwitegurira ibiza vy’igisukari no kuva ku pompe ya insuline ukaja ku gutera imiti myinshi ku musi (MDI).
• Ikigo ca Leta Zunze Ubumwe za Amerika kijejwe ivy'ibifungurwa n'imiti (FDA): Ipompa ya Insuline n'Igikoresho co Gukurikirana Isukari Ikomeza Gukingira Mu gihe c'Ivyago.
• Ishirahamwe mpuzamakungu ry'ubuvuzi bw'amaraso (ISPD): Ingingo ngenderwako za ISPD ku bijanye no kwirinda indwara ziterwa n'amaraso n'uguhanahana ibiza.