Ukulungiswa kweNtlekele kubasebenzisi bePump ye-insulin kunye neZigulana zeDialysis: Ukuguqulwa kweSiringe yeManual kunye nePotassium Diet¶

Amanani kaxakeka ayohluka ngokwamazwe. Eli phepha lisebenzisa u-911, inani laseMelika naseKhanada. Amanye amazwe amaninzi asebenzisa i-112, 999, okanye elinye inani. Fumana inombolo yelizwe lakho.

Xa isivunguvungu, umkhukula, ukukhutshwa komlilo, okanye igridi yombane yombane weentsuku ezininzi, abantu abaphila nesifo sikashukela esixhomekeke kwi-insulin okanye isifo sezintso ekupheleni bajongana ngokukhawuleza, ukungaphumeleli kwe-metabolism kwi-12 kwiiyure ze-72. Ukuba impompo ye-insulin iyaqhekeka, iphelelwa ngamandla ebhetri, okanye iphelelwe ziiseti zokufakelwa kwe-insulin ngexesha lokufuduswa, iswekile yegazi iyenyuka ibe yingozi. isifo seswekile ketoacidosis kwiiyure ezi-4 ukuya kwezi-8 ngaphandle kokuba isigulane sinokutshintshela ngokukhawuleza kwiinaliti zesirinji usebenzisa isicwangciso esibhaliweyo esibhalwe ngaphambili. Kwangaxeshanye, ukuba iindlela ezikhukulisekileyo okanye ukuphuma kombane kuvala amaziko e-hemodialysis angaphandle kangangeentsuku ezimbini okanye ezintathu, izigulane zezintso ze-anuric zijongana nokubanjwa kwentliziyo ethe cwaka ngenxa yokunyuka kwe-potassium yegazi okanye ukufuthaniselwa kukugcwala kolwelo olugqithileyo ngaphandle kokuba zitshixe ngokukhawuleza kwi-3-day ye-emergency yokutya okungxamisekileyo. Phambi kokuba kwenzeke unxunguphalo, gcina ibhegi ye-metabolic ezinikeleyo ecaleni kwakho amayeza anobushushu, khumbula indlela yokusingatha dialysis fistula kunye hyperkalemia likaxakeka, kwaye ugcine indawo yakho amanani kaxakeka (angama-911 eUnited States naseKhanada, ali-112 kulo lonke elaseManyano yaseYurophu, angama-999 eUnited Kingdom) ekwikhadi elingangeni manzi.

Yenza oku ngoku¶

Shicilela kwaye ulamine i-Insulin Pump Basal kunye nekhadi leSettings Card namhlanje. Vula impompo yakho ye-insulin okanye ukuhanjiswa kwe-insulin ngokuzenzekela (AID) app ye-smartphone ngoku kwaye ubhale iprofayile yakho ye-basal yeyure ezingama-24 ngqo (iiyunithi ngeyure ngalo lonke ixesha ibhloko), iyonke idosi ye-basal insulin yemihla ngemihla, i-insulin-to-carbohydrate ratios (ICR), uvakalelo lwakho lwe-insulin esebenzayo okanye ukulungiswa kwe-insulin (i-SF) Tape ikopi enye elaminethiweyo ngaphakathi kwi-diabetes go-bag kwaye ugcine ikopi yesibini kwi-wallet yakho.
Isitokhwe se-basal insulin esebenza ixesha elide, iisirinji ze-insulin ezi-U-100, kunye neenaliti zosiba ngaphakathi kwekhithi yakho yexesha likaxakeka. Impompo ye-insulin ine-insulin esebenza ngokukhawuleza kuphela (efana ne-lispro, aspart, okanye iglulisine). Buza i-endocrinologist yakho malunga ne-backup prescription ye-** iipeni ze-insulin ezisebenza ixesha elide okanye ii-vials** (ezifana ne-insulin glargine okanye i-insulin degludec), ubuncinane i-30 iisirinji ze-insulin ezizinyumba ezingama-30* (0.3 mL okanye 0.5 mL umthamo), kunye **4 millimeter okanye 5 millimeter pen iinaliti ** ukuze ukwazi ukutshintshela Multiple Daily Injections (MDI) mzuzu impompo igqabhuka okanye ilahlekelwe amandla.
Pakisha imitha yeglucose yesiqhelo, i-100 test strips, i-ketone strips, kunye neglucagon esele ikulungele ukusetyenziswa. I-continuous glucose monitor (CGM) izinzwa aziphumeleli xa ii-transmitters ziphelelwa yintlawulo, iifowuni zifa, okanye i-adhesive peels iphuma emanzini okanye ukubila. Ngalo lonke ixesha upakisha iglucometer yeminwe yesintu eneebhetri ze-coin-cell, igazi okanye umchamo imicu yovavanyo lweketone, impumlo okanye isitofu esizisebenzelayo glucagon, kunye neegram ezingama-300 zeepilisi okanye iijeli zeglucose ezisebenza ngokukhawuleza.
Kwizigulane ze-hemodialysis: Beka i-Hemodialysis yakho eprintiweyo "Run Sheet" kunye ne-Vascular Access Bleed Kit kwisingxobo esingangeni manzi. Cela umongikazi wakho wekliniki ye-dialysis akuphe ikopi ehlaziyiweyo yephepha lomyalelo wonyango obonisaubunzima obomileyo obujoliswe kuko, imodeli yesihluzo se-dialyzer, izinga lokuhamba kwegazi, i-dialysate potassium ne-calcium bath concentrations, kunye ne-heparin. Pakisha eli phepha ecaleni kwe-3 iminqwazi yebhotile yeplastiki ecocekileyo*, ayinyumba 10 x 10 centimeter (4 x 4 inch) i-gauze pads, kunye ne-venous catheter clamp.
klzzwxh:0077 Gcina i-tub yeplastiki ahlukileyo ebhalwe "I-Dialysis 3-Day Disaster Diet Only"** ifakwe kwi-shelf-stable, i-low-potassium cracks (i-crackers ezingenatyuwa, iipowutshi zerayisi ezimhlophe okanye iipetshi ezimhlophe ze-apile, i-apile efakwe kwi-peaches ye-apula ukutya, i-cereal yerayisi ekhukhumeleyo, kunye ne-shelf-stable whites okanye ityhuna ehlanjululweyo ene-sodium ephantsi) kunye nekomityi encinci yokulinganisa umlinganiselo wokuthatha ulwelo lulonke ukuya ku 500 ukuya kwi-700 millilitha (16 ukuya kwi-24 yee-ounces zolwelo) ngeeyure ezingama-24.
Buza ugqirha wakho we-nephrologist malunga nokugcinwa kwentlekele yeepakethi zomlomo ezibophelelayo ze-potassium. Ukuba ufumana i-hemodialysis yesondlo, cela ugqirha wakho wezintso ukuba ufanele uphathe unikezelo oluphuthumayo lweentsuku ezi-3 ze-oral gastrointestinal binder ye-potassium (efana ne **sodium zirconium cyclosilicate ** okanye **patiromer ** i-patiromer **) ngokuthatha imiyalelo ebhaliweyo ngexesha le-dialysis yakho.

Kutheni ukusilela kwempompo ye-insulin kubangela i-ketoacidosis yesifo seswekile kwiiyure nje ezi-4

Ngokungafaniyo nabantu abatofa i-insulin esebenza ixesha elide kanye ngemini, umsebenzisi wempompo ye-insulin ineziro idepho esebenza ixesha elide ye-insulin phantsi kwesikhumba. Ipompo ihambisa ii-micro-pulses ezincinci ze-insulin esebenza ngokukhawuleza rhoqo kwimizuzu embalwa. Ukuba iplastiki infusion cannula kinks, ikhupha ngexesha lokufuduka, okanye ibhetri yempompo iyafa, umzimba uphuma ngokupheleleyo kwi-insulin esebenzayo ngaphakathi ** 90 ukuya kwi-180 imizuzu **. Ngaphandle kwe-insulin, isibindi siqhekeza ngokukhawuleza amanqatha kwi-ketones e-acidic, ebangela ukusongela ubomi ** I-Diabetic Ketoacidosis (DKA) ** ngaphakathi ** 4 kwiiyure ze-8 **. Ukuba ipompo yakho iyeka ukusebenza kwaye ungenayo i-insulin ye-basal esebenza ixesha elide esandleni, kufuneka ujobe i-insulin esebenza ngokukhawuleza ngesandla nge-U-100 yesirinji okanye ipeni nganye ** ezi-3 ukuya kwiiyure ze-4 malunga newashi ** (njengoko ilawulwa yiplani yokulondoloza ebhaliweyo kagqirha) de ufumane i-basal insulin okanye ufike esibhedlele.

Umthi wesigqibo: Ukusilela kwempompo ye-insulin okanye ukuvalwa kwekliniki ye-dialysis ngexesha lentlekele¶

Sebenzisa le tshati yetriage ngexesha lobumnyama, ukukhutshwa, okanye isaqhwithi esinamandla ukukhusela i-ketoacidosis yesifo sikashukela, i-hypoglycemia enzima, ukubanjwa kwe-hyperkalemic cardiac, kunye ne-flash pulmonary edema.

flowchart TD
    Start["Uqhankqalazo lweNtlekele: Ukuphela koMbane, ukuPhuma, okanye ukuValwa kweKlinikhi"] --> PatientType{"Kokuphi ukuxhomekeka kwezonyango okusebenzayo?"}

    PatientType -->|"Impompo ye-insulin / Umsebenzisi weCGM"| PumpCheck{"Ngaba impompo ye-insulin ilungile, ihlawulisiwe, kwaye ifakelwe iiseti ezisecaleni?"}
    PumpCheck -->|"Ewe, ukusebenza ngokuqhelekileyo"| PumpConserve["1. Faka impompo etshajwayo kwibhanki yamandla ephathwayo ngentlawulo eyi-50%; 2. Khusela i-insulin i-vials kwi-pouch esebenza ngamanzi e-evaporative (15C ukuya kwi-30C); 3. Ukujongwa kwe-CGM kwesikrini; gcina imitha yeminwe kunye ne-glucose tabs emzimbeni"]
    PumpCheck -->|"Hayi: Impompo igqabhukile, imanzi, ibhetri efileyo, okanye iphumile kwiiseti zokugalela"| PumpFail["TJHITSHELA KWINKQUBO YOKUTOFA (MDI) INCWADANA YOMNTU NGOKUNGOKO NGOKO:; 1. Susa ipompo cannula esikhumbeni ukuthintela ukubhideka; 2. Tsala ikhadi elibhaliweyo lokuGuqulela iPump-to-Syringe kwigo-bag; 3. Une-Basal Insulin esebenza ixesha elide (Glargine / Degludec)?"]

    PumpFail -->|"Ewe, yiba ne-Basal Insulin"| GiveBasal["Ukutofa okumiselweyo iiyure ezingama-24 zedosi yeBasal eSebenza ngoMba okanye ngesirinji ye-U-100; + Tofa i-insulin esebenza ngokukhawuleza phambi kokutya kunye nokulungiswa kweglucose ephezulu"]
    PumpFail -->|"Ayikho i-Basal Insulin ekhoyo"| RapidBridge["IBHLOROYO ESEBENZA NGOKUXAXELEKAYO:; Tofa i-3-to-4-iyure ye-Basal elinganayo usebenzisa i-insulin ye-Rapid-Acting; ngesirinji ye-U-100 rhoqo kwiiyure ezi-3 ukuya kwezi-4 imini nobusuku + ii-ketones zovavanyo"]

    PatientType -->|"I-Hemodialysis okanye i-Peritoneal Dialysis Patient"| DialCheck{"Is your outpatient dialysis center open or accessible?"}
    DialCheck -->|"Clinic Closed or Roads Flooded"| DialDiet["ACTIVATE 3-DAY EMERGENCY RENAL SURVIVAL PROTOCOL:; 1. Start strict 3-Day Low-Potassium (<1,500 mg/day) Diet immediately; 2. Restrict TOTAL fluid intake to 500 to 700 mL (16 to 24 oz) per 24 hours; 3. Call clinic disaster hotline / KCER to locate open backup unit; 4. Take prescribed emergency potassium binder if instructed by nephrologist"]
    DialDiet --> RedFlags{"Any leg weakness, lip tingling, slow pulse, or gasping for air?"}
    RedFlags -->|"Ewe"| CallEMS["CALL 911 / 112 / 999 IMMEDIATELY:; Declare 'Dialysis Patient with Suspected Hyperkalemia or Pulmonary Edema'; Sit bolt upright at 90 degrees with legs dangling down"]
    RedFlags -->|"Hayi"| MonitorWeight["Weigh daily (limit gain to 0.5-1.0 kg/day) and evacuate to open hospital unit"]

Part 1: Insulin pump and CGM disaster preparedness (The Pump-Failure Survival Kit)¶

More than half of people with Type 1 diabetes and many with insulin-dependent Type 2 diabetes rely on continuous subcutaneous insulin infusion (CSII) via tethered tubed pumps or tubeless adhesive patch pumps, paired with a Continuous Glucose Monitor (CGM) in an Automated Insulin Delivery (AID) hybrid closed-loop system. While these devices provide exceptional day-to-day control, they introduce four fragile single points of failure during a disaster:

Electronic and Battery Dependency: Most modern tubed pumps and patch-pump controllers run on internal rechargeable lithium-ion batteries (or specialty lithium AA batteries) that die within 2 to 5 days without grid power.
Proprietary Infusion Hardware: You cannot draw insulin out of a proprietary pre-filled pump cartridge or inject it into your body unless you have standard U-100 insulin syringes (or pen needles for insulin pens). If your last plastic infusion set kinks on a belt buckle while loading an evacuation vehicle, your pump becomes useless plastic.
Absence of Subcutaneous Basal Depot: Because pumps infuse only rapid-acting insulin analogs (insulin lispro, insulin aspart, or insulin glulisine) that peak in 60 to 90 minutes and wear off in 3 to 5 hours, stopping pump delivery leaves the body with zero background insulin within 2 to 3 hours.
Cloud and Smartphone Lockout: Many users store their basal rates, carb ratios, and sensitivity factors only inside their pump's menu or a cloud portal. When a pump screen shatters or a phone battery dies, neither the patient nor an emergency shelter doctor knows the patient's daily insulin requirement.

Step-by-step: Preparing your Written Pump-to-Syringe Conversion Card¶

Every insulin pump user must sit down with their endocrinologist or Certified Diabetes Care and Education Specialist (CDCES) once a year to fill out a physical, waterproof Emergency Pump Failure Conversion Card. Never guess at insulin doses during a crisis. Your card must record these six numbers clearly:

Pump Setting Parameter	Where to Find It on Your Pump or App	How It Is Used When Switching to Manual Syringes / Pens
1. Hourly Basal Schedule (e.g., `12:00 AM - 6:00 AM: 0.8 U/hr`, `6:00 AM - 12:00 PM: 1.1 U/hr`, etc.)	Pump Menu $\rightarrow$ Basal Settings / Personal Profiles	Allows you to program a loaner replacement pump, or calculate a 3-to-4-hour manual rapid-acting bridge dose if no long-acting insulin is available.
2. Total Daily Basal Dose (TDBD) (Sum of all 24 hourly basal rates, e.g., `22.4 Units/day`)	Pump History $\rightarrow$ Daily Totals $\rightarrow$ Basal Insulin	Used by your doctor to set your once-daily Long-Acting Basal Insulin dose (glargine or degludec), typically equal to $100\%$ (or $80\%\text{ to }100\%$ during high physical exertion) of your pump's 24-hour basal total.
3. Insulin-to-Carbohydrate Ratio (ICR) (e.g., `1 Unit per 10 grams of carbohydrate`)	Pump Menu $\rightarrow$ Bolus Settings / Carb Ratios	Used to calculate your manual rapid-acting mealtime bolus before eating: $\text{Grams of Carbs Eaten} \div \text{ICR} = \text{Units of Rapid-Acting Insulin}$.
4. Insulin Sensitivity / Correction Factor (ISF) (e.g., `1 Unit lowers glucose by 2.8 mmol/L [50 mg/dL]`)	Pump Menu $\rightarrow$ Bolus Settings / Correction Factor	Used to calculate manual correction doses for high blood sugar: $(\text{Current Glucose} - \text{Target Glucose}) \div \text{ISF} = \text{Correction Units}$.
5. Target Blood Glucose (e.g., `6.7 mmol/L [120 mg/dL]` or Disaster Safe Target `8.3 mmol/L [150 mg/dL]`)	Pump Menu $\rightarrow$ Target Glucose	During a disaster with scarce food or heavy physical labor, diabetes disaster guidelines (such as the Diabetes Disaster Response Coalition [DDRC]) advise raising your target slightly to $7.8\text{ to }10.0\text{ mmol/L}$ ($140\text{ to }180\text{ mg/dL}$) to prevent life-threatening hypoglycemia.
6. Pump Serial Number, Manufacturer 24/7 Hotline, and Current Insulin Type	Back of pump case / App About screen	Required for warranty emergency air-drop replacement and shelter medical triage.

How to transition from a failed insulin pump to manual injections (Two Scenarios)¶

When your pump fails, gets submerged in floodwater, or runs out of infusion sets, physically unclip and peel off the old pump infusion cannula or patch pod immediately so you are certain no unexpected insulin is leaking in, then follow the scenario that matches your supplies:

Scenario A: You have Long-Acting Basal Insulin (Glargine, Detemir, or Degludec) AND Rapid-Acting Insulin¶

Le yeyona ndlela ikhuselekileyo, isemgangathweni yegolide yokugcina intlekele ekhuthazwa yi American Diabetes Association (ADA), Diabetes UK, kunye Isifo seDisaster Response Coalition (DDRC): 1. Lawula i-Basal Insulin yakho eSebenza ixesha elide emiselweyo ngepeni okanye isirinji ye-U-100: Qwalasela ikhadi lakho lokuguqula elibhaliweyo malunga nedosi ye-basal ebalwe kwangaphambili kagqirha wakho kanye ngemini (okanye kabini ngemini). Ngenxa yokuba i-basal insulin esebenza ixesha elide ithatha ** ezi-2 ukuya kwiiyure ezi-4** ukufikelela kwisiphumo esipheleleyo emva kwesitofu sokuqala, isicwangciso sakho senguqu esibhaliweyo sinokukuyala ukuba unike idosi encinci ye-1 ukuya kwi-2 yeyure esebenza ngokukhawuleza ebambeneyo ngalo mzuzu ukhululayo umpompo ukuba iswekile yakho yegazi sele inyukile. 2. Nciphisa i-basal insulin nge-10% ukuya kwi-20% ukuba wenza umsebenzi wentlekele enkulu okanye umlinganiselo wokutya: Ukuthwala iingxowa zesanti, ukuhamba imigama emide ukukhutshwa, okanye ukutya imixhesho emincinci engxamisekileyo kwandisa kakhulu uvakalelo lwe-insulin. Xoxa "ngoMsebenzi weNtlekele iBasal Reduction" (ngokuqhelekileyo i-80% ye-basal eqhelekileyo) kwikhadi lakho elibhaliweyo kwangaphambili. 3. Nika i-Insulin eSebenza ngokukhawuleza phambi kokutya kunye nezilungiso ezineglucose ephezulu: Sebenzisa iifomyula zakho ezibhaliweyo ethi ICR kunye ne ISF ngepeni esebenza ngokukhawuleza okanye isirinji ye-U-100 etsalwa kwibhotile esebenza ngokukhawuleza yempompo yakho. Linda ubuncinane ** ezi-3 ukuya kwiiyure ze-4 phakathi kweedosi zokulungisa ** ukunqanda "i-insulin stacking" (ukutofa idosi yesibini yokulungiswa ngaphambi kokuba ukudubula kwangaphambili okukhawulezileyo kugqibe ukusebenza, okubangela ukulibaziseka okukhulu kwe-hypoglycemia).

Imeko B: Impompo yakho yophukile kwaye une-vial/cartridge yakho KUPHELA ye-Insulin eSebenza ngokuKhawuleza (ayikho iBasal Insulin eSebenza ixesha elide)¶

Ukuba uphume ngempompo yakho kuphela kunye ne-vial ye-insulin esebenza ngokukhawuleza (i-lispro, i-aspart, okanye i-glulisine) kwaye awunayo i-insulin esebenza ixesha elide: 1. Unako ukuzoba i-insulin esebenza ngokukhawuleza ngokuthe ngqo kwivial yeglasi, kwisixhobo sempompo seplastiki, okanye nakwincam yepeni ye-insulin elahlayo usebenzisa isirinji ye-insulin eyi-U-100. 2. Ungaze utofe idosi ye-basal epheleleyo yeeyure ezingama-24 usebenzisa i-insulin esebenza ngokukhawuleza: Ukutofa iiyunithi ezingama-20+ ze-insulin esebenza ngokukhawuleza ngaxeshanye kuya kubangela i-hypoglycemia ebulalayo kwimizuzu engama-90. 3. Landela iShedyuli ye-3-to-4-Hour Rapid-Acting Micro-Basal Shedule: Ngenxa yokuba i-insulin esebenza ngokukhawuleza ihlala kwiiyure ezi-3 ukuya kwezi-4 kuphela phantsi kwesikhumba, kufuneka usethe i-alamu kwaye ujobe i-**3-iyure okanye i-4-iyure iqhekeza le-basal dose yakho rhoqo kwiiyure ezi-3 ukuya kwezi-4, iiyure ezingama-24 ngosuku (kubandakanywa kabini, kunye nokuvuka, kunye nokufikelela ebusuku kunye nokuvuka) ikhemesti okanye indawo yokuhlala engxamisekileyo ene-insulin esebenza ixesha elide. - Umzekelo okwikhadi lakho elibhaliweyo: Ukuba impompo yakho iqhele ukunyathela 0.8 units/hour ngobusuku, idosi yebhulorho esebenza ngeyure ezi-4 yeyure yi $0.8 amaxesha 4 = 3.2\text{ units}$ (ijikelezwe phantsi ngokuqiniweyo ngokwemiyalelo kagqirha wakho ukuba 3 units kwisirinji ye-U-100) etofwa rhoqo kwiiyure ezi-4.

Ungaze usebenzise isirinji yesiqhelo yonyango (mL/cc) okanye uxube iisirinji ze-U-100 kunye ne-U-500

Soloko utofa i-insulin ye-U-100 (iiyunithi ezili-100 ngemililitha nganye) usebenzisa i-orenji-capped U-100 isirinji ye-insulin ephawulwe nge-Iyunithi. Ukuba unyanzelekile ukuba usebenzise i-insulin egxininisiweyo (efana ne-U-200, i-U-300, okanye i-U-500) ngexesha lentlekele, ** ungalokothi udwebe i-insulin egxininisiweyo kwisirinji eqhelekileyo ye-U-100 ** ngaphandle kokuba iqondiswe ngokucacileyo ngugqirha okanye i-pharmacist, njengoko i-volume-to-unit miscalculations inokubangela ukuba i-2-fold-fold overdose i-5. Ngokuchaseneyo, ukuba i-insulin pen ye-insulin elahlayo i-jam yokudayela ngoomatshini, unokuncamathisela ngokukhuselekileyo inaliti yesirinji ye-insulin esemgangathweni ** U-100 inaliti yesirinji* ngqo kwinwebu yerabha kwincam ye- U-100 yepeni ye-insulin kwaye utsale inani elichanekileyo leeyunithi ezifunekayo.

I-14 yeentsuku zesifo seswekile kunye noluhlu lwe-CGM lweNtlekele yeGo-Bag¶

Pakisha ezi zinto kwingxowa egqunyiweyo, engenamanzi yokubamba kwaye uhambe igcinwe ecaleni komnyango wakho wangaphambili:

**I-Laminated Written Written Pump-to-MDI Conversion Card ** kunye nokunikezelwa kweentsuku ze-14 zawo onke amayeza omlomo.
I-Insulin eSebenza ngokuKhawulezileyo + iBasal Insulin Backup eSebenza ixesha elide egcinwe kwisingxobo esibanjwa lula efrijini, kunye ne-**manzi esebenza isipaji sokupholisa esingumphunga ** esigcina i-insulin phakathi **$15 degrees\text{C kunye }30 degrees C$ ($59 degrees\text{F to }8*day degrees F okanye umkhenkce) 'Yabona ukugcina i-insulin kunye namayeza ekhuselekile ngexesha lokuphela kombane.
30 ukuya kuma-50 iisirinji ze-insulin ezingasebenziyo ze-U-100 (0.3 mL okanye 0.5 mL ubukhulu) KUNYE 30 iinaliti zokubhala jikelele eziyi-4 mm.
5 ukuya kwi-7 iiseti zokufakela impompo ezisecaleni, iireservoirs, okanye iipods ezincamathelayo, kunye nezosuleli zesithintelo solusu kunye neteyiphu yonyango.
**2 ukuya kwi-3 i-speer sensors ye-CGM kunye nekhebula lokuhambisa **, kunye ne- **20,000 mAh ibhanki yamandla ye-USB ** kunye nekhebula lokutshaja elifunwa yimpompo yakho kunye nomamkeli (kunye neebhetri ze-lithium AA ukuba ziyasebenza).
Imitha yesiNtu yeFingerstick yeGazi yeGlucose, isixhobo sokuxhoma, iibhetri eziziingqekembe (CR2032), kunye ne-100 yemigca yovavanyo kwivial yabo evaliweyo.
Ii-Blood Beta-Ketone Test Strips or Urine Ketone Strips ukujonga i-Diabetic Ketoacidosis yokuqala nanini na xa i-glucose idlula $13.9\text{ mmol/L}$ ($250\text{ mg/dL}$) okanye ngexesha lokugula.
Iikhithi zokuHlangula zeGlucagon ezimbini ezingaphelelwanga (isitshizi sempumlo okanye isitofu esizisebenzelayo solwelo) kunye 300+ iigram zecarbohydrates ezikhawulezayo ezisebenza ngokukhawuleza (iipilisi zeglucose, iipakethi zejeli yeglucose, okanye iipakethi zobusi).
Isikhongozelo esiphathwayo seeSharps (okanye ibhotile yokuhlamba impahla enodonga olungqindilili ebhalwe "I-BIOHAZARD SHARPS").

Icandelo 2: I-Hemodialysis kunye ne-peritoneal dialysis ukulungela intlekele¶

Izigulane ezine-Stage 5 Chronic Kidney Disease (I-End-Stage Renal Disease, okanye i-ESRD) exhomekeke kwi-three-weekly **in-center hemodialysis **, ** i-hemodialysis yasekhaya *, okanye imihla ngemihla ** i-peritoneal dialysis (PD) ** ziphakathi kwabemi abaninzi abasengozini yonyango kuyo nayiphi na intlekele yendalo. Iseshoni enye ye-4 yeyure ye-hemodialysis ifuna malunga ne-120 ukuya kwi-160 iilitha (i-32 ukuya kwi-42 iilitha) zamanzi acociweyo e-ultra-pure reverse-osmosis kunye namandla ombane amanqanaba amathathu aqhubekayo. Xa iinkanyamba, iinyikima, umkhenkce ebusika, okanye izandyondyo zemvula zikhupha uxinzelelo lwamanzi lukamasipala okanye izikhululo zombane, iikliniki zokuxilonga izigulana ezingalaliswayo kummandla wonke zinokuvala ngaxeshanye iiyure ezingama-48 ukuya kwezingama-96.

Umgaqo 1: Thatha iSeshini yeDialysis yangaphambi kweNtlekele "Early Surge".¶

Nanini na isivunguvungu, i-blizzard, okanye izikhukhula ezinkulu ziqikelelwa kwiiyure ezingama-48 ukuya kwii-72 kwangaphambili, ababoneleli be-dialysis abangaphandle bavula ** "IiShedyuli zokuQala ze-Dialysis Surge"** (ukuqhuba iishifti zeeyure ezingama-24 ukucofa i-dialyze yonke isigulane ngaphambi kokuba isaqhwithi senza umhlaba). - Ungaze utsibe iseshoni yokucoca yaphambi kwesiphango ukuze upakishe okanye uphume ungachazwanga: Ukucofa i-dialyzed kanye phambi kokuba uqhwithela kukunika isithinteli semetabolism ecocekileyo yeeyure ezingama-48 ukuya kwi-72 ene-potassium ephantsi kunye nolwelo oluyiqanda elinguziro. - Ukuba ufuduka uye kwesinye isixeko, thatha i-Hemodialysis yakho eShicileleyo yokuRun Sheet: Naliphi na iziko le-dialysis "londwendwe" okanye isebe likaxakeka lesibhedlele kwindawo yakho yokufuduka lifuna kanye Ubunzima obuBomiyo obujoliswe kuko (iikhilogram/iiponti), uhlobo lofikelelo lwemithambo, iprothokholi ye-heparin anticoagulation, kunye ne-dialysate potassium yoxinaniso ({}K2}\text }3 okubhaliweyo{K}$) ukukucofa kwangoko ngaphandle kokubangela ii-arrhythmias okanye uxinzelelo lwegazi.

Umthetho 2: Vala phantsi kwi-3-Day Emergency Low-Potassium, i-Low-Fluid Renal Diet ngexesha intlekele ibetha¶

Ukuba inyikima ngequbuliso, isikhukula, okanye ubumnyama bukuthintela ukuba ufikelele kwi-dialysis, **into oyifaka emlonyeni wakho kwiiyure ezingama-72 ezizayo ichaza ukuba uyasinda na **. Ngaphandle kokuhluzwa kwezintso, izinto ezimbini zibulala izigulane eziphosiweyo ze-dialysis ngokukhawuleza: 1. ** I-Dietary Potassium (K +): ** I-Spikes igazi le-potassium ngaphezu kwe-$ 6.0 umbhalo { ukuya ku-} 7.0 umbhalo { mmol / L} $, ebangela ukunyuka komlenze ukukhubazeka kunye nokubanjwa ngokukhawuleza kwentliziyo ebulalayo (i-ventricular fibrillation okanye i-asystole). 2. Ulwelo kunye neSodium (Na+): Yonke imililitha yolwelo oluselayo ihlala ngqo ngaphakathi emithanjeni yakho yegazi, inyusa uxinzelelo lwegazi ukuya kumaqondo obunzima kwaye ikhukulise imiphunga yakho ngolwelo (acute flash pulmonary edema).

Landela Iimpendulo eziNgxamisekileyo zoLuntu lweZintso (KCER), iNational Kidney Foundation (NKF), kunye CDC 3-Day Emergency Renal Diet ngokungqongqo de ube ubuyele kumatshini wokudialysis:

Ukutya kwemihla ngemihla kunye noLwako ekujoliswe kulo (Indlela yoNgxamiseko yeentsuku ezi-3)	Izahlulo eziLinganisiweyo Ngokuchanekileyo ezivumelekileyo ngoSuku	NGOKUQHELEKILEYO Ukutya okuNgxamisekileyo (Kunokubangela i-Hyperkalemia eFatal okanye ukuKhukula kwemiphunga)
Isimbuku soMda weDaily Fluid: Ubuninzi be-$500\umbhalo{ukuya }700\umbhalo{mL}$ ($16\umbhalo{ ukuya }24\umbhalo{ fl oz}$, okanye 2 ukuya 3 iikomityi) ngeeyure ezingama-24	Yahlula kube ezine $120\text{mL}$ ($4\text{ oz}$, okanye $1/2\text{ cup}$) izahlulo imini yonke, kunye nencinci $30\text{ ukuya }60\text{mL}$ ($1\text{ ukuya }2\text{ oz}$) iipilisi zemihla ngemihla ezimiselweyo zokuginya. Khumbula: Iityhubhu zomkhenkce, igelatin, iipopsicles, igravy, kunye nesiraphu yeziqhamo ezinamanzi zibalwa njenge-100% yolwelo.	Ukuxubha amanzi asebhotileni, iziselo zezemidlalo (iziselo ze-electrolyte ziqulethe i-potassium egxininisiweyo kunye ne-sodium), i-soup broths, amanzi e-coconut, ijusi ye-orenji, ijusi ye-tomato, ubisi kunye ne-vatala.
Iyonke yoMda wePotassium yoSuku: Ngaphantsi kwe-$1,500\umbhalo{mg}$ ngeeyure ezingama-24	- Fruits (2 servings/day): $1/2\text{ cup}$ applesauce, $1/2\text{cup}$ enkonkxiweyo amapere okanye iipesika igalelwe isiraphu ngokupheleleyo, okanye $1/2\text{ cup}$ amaqunube/apayina. - Imifuno (i-1 ukuya kwi-2 servings / ngosuku): $ ½ itekisi{ indebe} $ iimbotyi eziluhlaza ezinkonkxiweyo, izaqathe, okanye ingqolowa igalelwe kwaye ihlanjululwe ngamanzi acocekileyo , okanye ikhukhamba entsha / ikhaphetshu. - Isitatshi: Isonka esimhlophe esingenatyiwa, irayisi emhlophe nje, ipasta, ii-crackers ezingenatyiwa, irayisi evutshiweyo okanye i-corn flakes cereal.	UNGAZE UYITYI: Iibhanana, iiorenji, iitapile, iitshiphusi zetapile, ibhatata, iitumato, intlama yetumato/isosi, iiavokhado, isipinatshi, iziqhamo ezomisiweyo (iirasentyisi, iidatisti, iiprayina, iiapilkosi), iindongomane, umxube wendlela, ibhotolo yamandongomane, iimbotyi, iilentile, itshokolethi, ibran/ukutya okuziinkozo okugcweleyo, i-cereal yasemkhosini.
Itotali yoMda weSodium yoSuku: Ngaphantsi kwe-$1,000\text{ ukuya }1,500\text{mg}$ ngeeyure ezingama-24	Sebenzisa ityuwa yetafile enguziro kunye nothiro endaweni yetyuwa. Ukutya okunencasa okunencasa ngepepile emnyama, umgubo wegalikhi, umgubo wetswele, iviniga, okanye ijusi yelamuni. Yitya kuphela amaqhekeza angenatyiwa, ibhotolo/imargarine engafakwanga tyuwa, kunye nenyama enkonkxiweyo enesodium ephantsi.	IINDLELA EZIFUMANEKA I-POTASSIUM CHLORIDE ETYUWA (NoSalt, Nu-Salt, Lite Salt, LoSalt): Itispuni nje enye iqulathe ngaphezulu kwe-$2,500\text{mg}$ ye-potassium esulungekileyo kwaye inokunqanda intliziyo yesigulana esiphosiweyo se-dialysis. Kwakhona kuthintele isuphu enkonkxiweyo, i-ramen noodles, inyama ephilisiwe (i-spam, i-jerky, i-bacon, i-ham), i-nuts enetyuwa, kunye netshizi.
Iiprotheyini kunye neCalorie Boosters (iUrea ephantsi / amandla aphezulu)	- Iprotheyini (umda ukuya kwi-$60\text{ ukuya }85\teksti{g}$ [$2\text{ ukuya }3\text{oz}$] inyama ephekiweyo/ngosuku): ityhuna enkonkxiweyo ephantsi enesodium ecoliweyo, inkukhu enkonkxiweyo engafakwanga tyiwa/iturkey, okanye iqanda elimhlophe elizinzile kwishelufu. - I-Calorie Boosters (Zero Potassium/Fluid): Iilekese ezinomuncu oqinileyo, iimbotyi zejeli, iigumdrops, iimarshmallows, ubusi, iswekile, kunye neoli yemifuno/ibhotolo engaxutywanga (ithintela umzimba wakho ukuba wophule izihlunu zawo, ezikhupha ipotassium yangaphakathi egazini lakho).	Iiprotheyini eziphezulu zokuqina, i-protein shakes, i-jerky, ibhotela ye-peanut, kunye nenxalenye enkulu yenyama ebomvu (iprotheyini egqithisileyo iqhekeza igazi elinetyhefu ye-urea nitrogen kunye ne-asidi ye-metabolic).

Indlela yokulawula unxano oluqatha xa uthintelwe kwi-500 mL (iikomityi ezi-2) zolwelo ngosuku

Unxano ngexesha lokucima kombane ehlotyeni kuba buhlungu ukuba utya ukutya okunetyuwa. Okokuqala, susa yonke ityuwa ekutyeni kwakho. Okwesibini, ncela kwi-*i-lemon emuncu enzima **, hlafuna i-mint gum, qhwaba isiqhamo sakho semihla ngemihla esivumelekileyo (ipesika ezifakwe kwitoti okanye iidiliya) ukuba unendawo epholileyo, okanye ** ujikeleze umlomo wamanzi abandayo emlonyeni wakho kwaye uwatshice ngaphandle ** ngaphandle kokuginya. Zilinganise kwisikali sokuhlambela rhoqo kusasa: ubunzima bakho kufuneka bunyuke nge kungekho ngaphezulu kwe $0.5\text{ ukuya }1.0\text{ kilogram}$ ($1\text{ ukuya }2\text{pounds}$) ngeyure ezingama-24 ngelixa ungekho kwi dialysis.

Imithetho ekhethekileyo yeZigulana zeDiabetic Dialysis (Ukulawula zombini iimeko kunye)¶

Phantse i-40% ukuya kwi-50% yezigulane ze-dialysis nazo zinesifo seswekile. Ngexesha lentlekele, imikhuba emibini yemigangatho ingqubana ngokuyingozi: 1. UNGAZE usebenzise iJusi yeOrenji, iiBanana, Itshokholethi, okanye Ubisi ukunyanga iswekile esegazini esezantsi (uhypoglycemia) ukuba ukwi-dialysis: A single $240\text{mL}$ ($8\text{ oz}$) iglasi yejusi yeorenji iqulethe phantse $500\text{mg}$ ye potassium kunye nekomityi epheleleyo yolwelo. Endaweni yoko, phatha i-hypoglycemia (<3.9 mmol/L okanye <70 mg/dL) ngokukodwa ngeipilisi zeglucose ecocekileyo, iityhubhu zejeli yeglucose, iilekese zeswekile eqinileyo, ubusi, okanye iswekile yasetafileni inyibilikiswe ngecephe eli-1 lamanzi, equlathe i-potassium enguziro kunye nolwelo olungenamsebenzi. 2. Ziphephe i-Hard-Candy/Sugar Calorie Boosters ezidweliswe kukutya okuqhelekileyo kwezintso okungenasifo seswekile ngaphandle kokuba unyange iswekile esegazini ephantsi okanye ugqume iicarbohydrates nge-insulin. Endaweni yoko, sebenzisa i-oyile yomnquma, ioyile yecanola, ibhotolo engatyiwanga, okanye itshizi yekhrimu engafakwanga* kwi-crackers ephantsi-sodium kunye nerayisi emhlophe ukuze ufumane iikhalori ezixineneyo ngaphandle kokutshiza i-glucose yegazi okanye i-potassium yegazi.

Icandelo 3: Ukukhusela ukufikelela kwakho kwemithambo kunye nokusekwa kwe-peritoneal dialysis ekhaya kwingxaki¶

1. IArm AV Fistula / Graft kunye neCentral Catheter Emergency Kit¶

Njengoko kuchaziwe kwinqaku lethu I-dialysis fistula yopha kunye ne-dialysis ephosiweyo isikhokelo soncedo lokuqala, sonke isigulana se-hemodialysis kufuneka sigcine ikiti yokhuseleko lokufikelela ibotshelelwe kwibhegi yaso yokuhamba: - Ubonelelo ngokuLawula ukopha: Pakisha 3 iminqwazi yebhotile ecocekileyo yeplastiki ejijekileyo, ayinyumba 10 x 10 cm (4 x 4 in) izikwere ze-gauze, kunye ne-hemostatic gauze pad. Ukuba inaliti ye-fistula igqabhuka ngexesha lokufuduka, ungaze ubhinqe itawuli yokuhlamba enkulu engalweni; cofa **umnwe omnye okanye ibhotile yebhotile yeplastiki ecocekileyo ** ngokuthe ngqo kwi-pin point for 15 ukuya kwi-20 imizuzu eqhubekayo ngelixa uphakamisa ingalo ngaphezu kwentliziyo kwaye ubiza iinkonzo eziphuthumayo. - Ukubonakala okuphezulu "HAYI BP / NO IV / I-ARM YOKUFUMANA I-DIALYSIS" I-Wristband ye-Medical Alert Wristband: Ngexesha lokuzama ukukhusela indawo yokuhlala okanye ukuhlangula, nxiba ibhendi yesilumkiso sonyango esibomvu kwingalo yakho ye-fistula ukuze abe-paramedics bangaze bafake i-cuff yoxinzelelo lwegazi okanye bafake umgca we-IV kumgca wakho wotyando. - I-Catheter yeVenous Embindini (i-Permcath) Isibambiso kunye neZinxibo ezingangenwa manzi: Ukuba ucofa isifuba okanye i-catheter yentamo, pakisha iplastiki emihlathi egudileyo ye-vascular clamp, izinxibo ezingangeni manzi ezicacileyo (Tegaderm), kunye neminqwazi engenazintsholongwane. Ungaze uvumele amanzi esikhukula okanye amanzi etephu angabiliswanga ukuba achukumise indawo yokuphuma yecatheter; ukuba ityhubhu ye-catheter iyaqhekeka okanye ikepusi iyawa, bamba okanye ukhabe ityhubhu ngokukhawuleza phakathi kwekhefu kunye nesifuba sakho kwaye ulale ngecala lakho **lasekhohlo intloko yakho iphantsi ** ukunqanda i-embolism yomoya obulalayo.

2. I-Home Pertoneal Dialysis (PD) Ngexesha lokuhamba koMbane¶

Izigulana ezisebenzisa umatshini webhayisekile ozenzekelayo (** APD / CCPD**) ngobusuku ekhaya zinokusinda kumke umbane kangangeentsuku ezininzi ukuba zilungiselela kwangaphambili: - Gcina iintsuku ezisi-7 ukuya kwezili-14 ze-Manual Twin-Bag CAPD Supplies (Y-iseti kunye needrain bags) kwindawo yokugcina: Xa umbane usilela kwaye i-automated night cycler yakho iyeka ukusebenza, tshintshela ngoko nangoko ku-ukutshintshiselana kobunzima bezandla (I-Ambulatory Peritoneal Dialysis, okanye iCAPD). xhoma ingxowa yesisombululo ngaphezu kobude begxalaba kwaye ubeke ingxowa yokuhambisa amanzi emgangathweni ukuze umxhuzulane ukhuphe kwaye ugcwalise isisu sakho ngaphandle kombane. - Indlela yokufudumeza ngokukhuselekileyo iingxowa zesisombululo sePD ngaphandle kombane okanye i-microwave: Ungaze ugalele ulwelo lwe-PD olubandayo lomkhenkce, kwaye ** ungaze ushushubeze ingxowa ye-PD kwi-microwave** okanye ucwilise izibuko zeplastiki emanzini amdaka (obangela i-peritonitis ebulalayo). Endaweni yoko, bhinqa ibhegi yangaphandle eyomileyo evaliweyo kwi-**itawuli ecocekileyo eyomileyo ecaleni kweekhemikhali ezifudumala izandla okanye iibhotile zamanzi ashushu ** (ukugcina konke ukufuma kude namazibuko), okanye ubambe ingxowa emzimbeni wakho phantsi kwengubo ide ifike kubushushu bomzimba (i-$37 degrees C / 98.6 degrees F $). - I-Antisepsis yesandla esingenamanzi: Ukuba amanzi empompo aphantsi kwesaziso samanzi abilayo okanye avaliwe, hlambulula izandla zakho imizuzwana engama-60 nge 60% ukuya kwi-80% ye-alcohol-based rub yesandla, nxiba imaski yobuso botyando, kwaye ucime iifeni phambi kokuba udibanise iseti yakho yokudluliselwa kwePD.

Iinombolo zengingqi zikaxakeka kunye neeprothokholi ze-arhente¶

Ngexesha lentlekele yengingqi, uthungelwano lwe-dialysis kunye nomanyano lwesifo seswekile zisebenzisa ii-hotlines ezinikezelweyo ezingahlawulelwayo ukuze zihambise izigulana ezigxothiweyo ukuba zivule iikliniki, i-cache ye-insulin kaxakeka, kunye neendawo zokuhlala zonyango:

EUnited States:
** Imeko kaNgxamiseko yoNyango:** Fowunela 911.
Impendulo yoNgxamiseko loLuntu lweZintso (i-KCER): Tsalela umnxeba 1-866-901-3773 ukuze ufumane iikliniki ze-dialysis ezivulelekileyo.
I-National Kidney Foundation (NKF) Umnxeba woNcedo: Fowunela 1-855-NKF-CARES (1-855-653-2273) (DaVita Emergency Hotline: 1-800-400-8331; Fresenius Disaster Line: **1-800-626-129-129).
I-Diabetes Disaster Response Coalition (DDRC) & ADA: Fowunela 1-800-DIABETES (1-800-342-2383) okanye ujonge I-Healthcare Ready (RxOpen.org) kwiikhemesti ezivulekileyo.
Canada:
IiNkonzo eziNgxamisekileyo: Fowunela 911. Qhagamshelana nenethiwekhi yakho yezintso yephondo (Kidney Foundation of Canada: 1-800-361-7494) kunye Isifo seswekile Canada (1-800-BANTING).
United Kingdom:
IiNkonzo eziNgxamisekileyo: Fowunela 999 (okanye 112), okanye NHS 111 ngemimiselo engxamisekileyo ye-insulin okanye ulungelelwaniso lweyunithi yezintso. Bhalisa kwangethuba kwiinkampani zakho eziluncedo'Irejista yeeNkonzo eziPhambili (PSR) ukulungiselela ukugcinwa kombane obalulekileyo kunye nokuhanjiswa kwamanzi.
Udibano lwaseyurophu:
Iinkonzo zikaNgxamiseko: Fowunela 112. Phatha ** I-European Renal Association (ERA) ** ikhadi lentlekele kunye ne-**Ikhadi lakho le-Inshurensi yezeMpilo yaseYurophu (EHIC) ** ecaleni kwephepha lakho le-dialysis eliprintiweyo.
Ostreliya neNew Zealand:
IiNkonzo eziNgxamisekileyo: Fowunela 000 e-Australia okanye 111 eNew Zealand. Qhagamshelana ne-Kidney Health Australia* (1800 454 363) okanye Impilo Yezintso New Zealand (0800 543 639), kwaye ubhalise njengoMthengi weNkxaso yoBomi ngombane wakho kunye nezixhobo zamanzi.
Indiya kunye neAsia-Pacific:
IiNkonzo eziNgxamisekileyo: Fowunela 112 eIndiya, 119 eJapan, 995 eSingapore, okanye 999 eMalaysia naseHong Kong. Gcina ikopi ebonakalayo yomyalelo wakho we-dialysis, iHepatitis B yakutshanje, iHepatitis C, kunye neziphumo zelebhu ye-HIV, kunye neshedyuli ye-insulin.

Imibuzo ebuzwa qho¶

Kutheni umsebenzisi wempompo ye-insulin engenakulinda nje iiyure ezili-12 ukuya kwezingama-24 ukuze umbane okanye impompo yokutshintsha ifike?¶

Ipompo ye-insulin ifaka kuphela i-insulin esebenza ngokukhawuleza, ecoca egazini ngaphakathi kwe-3 ukuya kwiiyure ze-5. Ngenxa yokuba akukho insulin esebenza ixesha elide egcinwe phantsi kwesikhumba, ukuyeka ukuhanjiswa kwempompo kubangela ukusilela okupheleleyo kwe-insulin kwiiyure ezi-2 ukuya kwezi-3. Ngaphandle kwe-insulin yangasemva, isibindi sithululela i-glucose kunye ne-acidic ketones egazini, ebangela ubomi obusongela ubomi be-Diabetic Ketoacidosis (DKA) kwiiyure ezi-4 ukuya kwezi-8. Wonke umsebenzisi wempompo kufuneka aphathe i-basal insulin esebenza ixesha elide, iisirinji ze-U-100, kunye nekhadi lokuguqula elibhaliweyo kwinguqu ngokukhawuleza xa impompo ingaphumeleli.

Ngaba ndingakwazi ukutsala i-insulin kwipeni ye-insulin elahlayo okanye kwikhatriji yepompo usebenzisa isirinji eqhelekileyo ye-U-100 ukuba ipeni okanye impompo yophuka?¶

Ewe, ukuba i-insulin engaphakathi kwipeni okanye kwikhatriji ikwiqondo le-U-100 yoxinaniso (iiyunithi ezili-100 ngemilitha nganye). Ukuba i-insulin pen jam okanye impompo igqabhukile kwaye awunazinaliti zosiba okanye iiseti zokugalela, swabhu i-septum yerabha kwincam yepeni ye-U-100 okanye ikhatriji ngotywala, faka inaliti yesirinji ye-insulin esemgangathweni kwinwebu, kwaye utsale idosi yeyunithi yakho kanye. Ungaze udwebe i-insulin egxininisiweyo (U-200, U-300, okanye U-500) kwisirinji ye-U-100 ngaphandle kwemiyalelo yokuguqula ugqirha.

Kutheni i-potassium-based substitutes yetyuwa (efana ne-NoSalt okanye i-Lite Salt) ibulala izigulana ze-dialysis ngexesha lentlekele?¶

Uninzi lwezinto ezithengiswayo "ze-low-sodium" ze-seasoning zithatha indawo ye-sodium chloride kunye ne-potassium chloride ecocekileyo. I-teaspoon yenqanaba elinye le-potassium chloride endaweni yetyuwa iqulethe i-2,500 ukuya kwi-2,800 milligrams ye-potassium, phantse iphindwe kabini yonke i-1,500-milligram yentlekele yemihla ngemihla yomda we-anuric hemodialysis. Ukusebenzisa indawo yetyuwa ye-potassium xa i-dialysis ilibazisekile kunokonyusa i-serum potassium ngaphezu kwe-6.5 mmol/L ngeeyure kwaye kubangele ukubanjwa kwentliziyo ngokukhawuleza.

Ngaba umntu onesifo seswekile kunye nokungaphumeleli kwezintso kwi-dialysis kufuneka anyange njani iswekile ephantsi yegazi (i-hypoglycemia)?¶

Ungaze usebenzise ijusi yeorenji, iibhanana, ubisi, okanye itshokolethi ukunyanga i-hypoglycemia ukuba ukwi-dialysis, kuba ijusi yeorenji kunye neebhanana zigcwele izixa eziyingozi ze-potassium kunye nolwelo. Endaweni yoko, landela "uMthetho we-15" usebenzisa i-15 grams ye-carbohydrate ecocekileyo, engena-potassium-esebenza ngokukhawuleza: hlafuna iipilisi ezi-3 ukuya kwezi-4 ze-glucose ecocekileyo, ucofe ityhubhu e-1 yejeli yeglucose, uginye icephe eli-1 lobusi okanye iswekile etafileni, okanye ufunxe iilekese zeswekile eqinileyo, uze uphinde ujonge iswekile yegazi lakho kwimizuzu eli-15.

Ngawaphi amaxwebhu afunwa ziikliniki ze-dialysis phambi kokunyanga isigulana esikhutshiweyo se-dialysis?¶

Amaziko e-dialysis angxamisekileyo afuna iPhepha lakho loNyango lweHemodialysis ("Run Sheet") elichaza ubunzima obomileyo obujoliswe kuko, imodeli ye-dialyzer, igazi kunye ne-dialysate flow rates, i-potassium kunye ne-calcium bath concentrations, i-heparin dose, uluhlu lwamayeza lwangoku, kunye ne-Hepatitis B yakutshanje, i-Hepatitis C, kunye neziphumo zelebhu ye-HIV. Ukugcina ikopi elaminethiweyo kwi go-bag yakho kuthintela ulibaziseko triage.

Izikhokelo ezinxulumeneyo¶

Imithombo kunye nezikhokelo ezisemthethweni¶

Iimpendulo eziNgxamisekileyo zoLuntu lweZintso (i-KCER) kunye namaZiko oLawulo lweZifo kunye noThintelo (CDC, eUnited States): *Ukulungiselela iimeko eziNgxamisekileyo: Isikhokelo sabantu kwi-Dialysis * (i-CMS Pub. No. 10150, i-3-Day Emergency Renal Diet kunye ne-Run Sheet Protocol).
I-National Kidney Foundation (NKF, eUnited States) kunye ne-UK Kidney Association (UKKA): *UkuCwangciswa kweeNgxamiseko: Izifo ezingapheliyo zezintso kunye ne-Hemodialysis Access Control *.
** I-Diabetes Disaster Response Coalition (DDRC), i-American Diabetes Association (ADA), kunye noMbutho we-Endocrine: ** *ISifo seSifo sokuLungiselela iSicwangciso seSigulane seNtlekele kunye noTshintsho kwi-Insulin Pump ukuya kwii-Multiple Daily Injections (MDI) *.
I-United States yoLawulo lokuTya kunye neDrugs (i-FDA): *Impompo ye-insulin kunye ne-Glucose eqhubekayo yokuHlola uKhuseleko ngexesha leNtlekele *.
Umbutho wamazwe ngamazwe we-Peritoneal Dialysis (ISPD): *Izikhokelo ze-ISPD ekuThintelweni kwe-Peritoneal Dialysis Infections kunye noTshintsho lweNtlekele *.

Pump Setting Parameter	Where to Find It on Your Pump or App	How It Is Used When Switching to Manual Syringes / Pens
1. Hourly Basal Schedule (e.g., `12:00 AM - 6:00 AM: 0.8 U/hr`, `6:00 AM - 12:00 PM: 1.1 U/hr`, etc.)	Pump Menu \(\rightarrow\) Basal Settings / Personal Profiles	Allows you to program a loaner replacement pump, or calculate a 3-to-4-hour manual rapid-acting bridge dose if no long-acting insulin is available.
2. Total Daily Basal Dose (TDBD) (Sum of all 24 hourly basal rates, e.g., `22.4 Units/day`)	Pump History \(\rightarrow\) Daily Totals \(\rightarrow\) Basal Insulin	Used by your doctor to set your once-daily Long-Acting Basal Insulin dose (glargine or degludec), typically equal to \(100\%\) (or \(80\%\text{ to }100\%\) during high physical exertion) of your pump's 24-hour basal total.
3. Insulin-to-Carbohydrate Ratio (ICR) (e.g., `1 Unit per 10 grams of carbohydrate`)	Pump Menu \(\rightarrow\) Bolus Settings / Carb Ratios	Used to calculate your manual rapid-acting mealtime bolus before eating: \(\text{Grams of Carbs Eaten} \div \text{ICR} = \text{Units of Rapid-Acting Insulin}\).
4. Insulin Sensitivity / Correction Factor (ISF) (e.g., `1 Unit lowers glucose by 2.8 mmol/L [50 mg/dL]`)	Pump Menu \(\rightarrow\) Bolus Settings / Correction Factor	Used to calculate manual correction doses for high blood sugar: \((\text{Current Glucose} - \text{Target Glucose}) \div \text{ISF} = \text{Correction Units}\).
5. Target Blood Glucose (e.g., `6.7 mmol/L [120 mg/dL]` or Disaster Safe Target `8.3 mmol/L [150 mg/dL]`)	Pump Menu \(\rightarrow\) Target Glucose	During a disaster with scarce food or heavy physical labor, diabetes disaster guidelines (such as the Diabetes Disaster Response Coalition [DDRC]) advise raising your target slightly to \(7.8\text{ to }10.0\text{ mmol/L}\) (\(140\text{ to }180\text{ mg/dL}\)) to prevent life-threatening hypoglycemia.
6. Pump Serial Number, Manufacturer 24/7 Hotline, and Current Insulin Type	Back of pump case / App About screen	Required for warranty emergency air-drop replacement and shelter medical triage.

Ukutya kwemihla ngemihla kunye noLwako ekujoliswe kulo (Indlela yoNgxamiseko yeentsuku ezi-3)	Izahlulo eziLinganisiweyo Ngokuchanekileyo ezivumelekileyo ngoSuku	NGOKUQHELEKILEYO Ukutya okuNgxamisekileyo (Kunokubangela i-Hyperkalemia eFatal okanye ukuKhukula kwemiphunga)
Isimbuku soMda weDaily Fluid: Ubuninzi be-\(500\umbhalo{ukuya }700\umbhalo{mL}\) (\(16\umbhalo{ ukuya }24\umbhalo{ fl oz}\), okanye 2 ukuya 3 iikomityi) ngeeyure ezingama-24	Yahlula kube ezine \(120\text{mL}\) (\(4\text{ oz}\), okanye \(1/2\text{ cup}\)) izahlulo imini yonke, kunye nencinci \(30\text{ ukuya }60\text{mL}\) (\(1\text{ ukuya }2\text{ oz}\)) iipilisi zemihla ngemihla ezimiselweyo zokuginya. Khumbula: Iityhubhu zomkhenkce, igelatin, iipopsicles, igravy, kunye nesiraphu yeziqhamo ezinamanzi zibalwa njenge-100% yolwelo.	Ukuxubha amanzi asebhotileni, iziselo zezemidlalo (iziselo ze-electrolyte ziqulethe i-potassium egxininisiweyo kunye ne-sodium), i-soup broths, amanzi e-coconut, ijusi ye-orenji, ijusi ye-tomato, ubisi kunye ne-vatala.
Iyonke yoMda wePotassium yoSuku: Ngaphantsi kwe-\(1,500\umbhalo{mg}\) ngeeyure ezingama-24	- Fruits (2 servings/day): \(1/2\text{ cup}\) applesauce, \(1/2\text{cup}\) enkonkxiweyo amapere okanye iipesika igalelwe isiraphu ngokupheleleyo, okanye \(1/2\text{ cup}\) amaqunube/apayina. - Imifuno (i-1 ukuya kwi-2 servings / ngosuku): $ ½ itekisi{ indebe} $ iimbotyi eziluhlaza ezinkonkxiweyo, izaqathe, okanye ingqolowa igalelwe kwaye ihlanjululwe ngamanzi acocekileyo , okanye ikhukhamba entsha / ikhaphetshu. - Isitatshi: Isonka esimhlophe esingenatyiwa, irayisi emhlophe nje, ipasta, ii-crackers ezingenatyiwa, irayisi evutshiweyo okanye i-corn flakes cereal.	UNGAZE UYITYI: Iibhanana, iiorenji, iitapile, iitshiphusi zetapile, ibhatata, iitumato, intlama yetumato/isosi, iiavokhado, isipinatshi, iziqhamo ezomisiweyo (iirasentyisi, iidatisti, iiprayina, iiapilkosi), iindongomane, umxube wendlela, ibhotolo yamandongomane, iimbotyi, iilentile, itshokolethi, ibran/ukutya okuziinkozo okugcweleyo, i-cereal yasemkhosini.
Itotali yoMda weSodium yoSuku: Ngaphantsi kwe-\(1,000\text{ ukuya }1,500\text{mg}\) ngeeyure ezingama-24	Sebenzisa ityuwa yetafile enguziro kunye nothiro endaweni yetyuwa. Ukutya okunencasa okunencasa ngepepile emnyama, umgubo wegalikhi, umgubo wetswele, iviniga, okanye ijusi yelamuni. Yitya kuphela amaqhekeza angenatyiwa, ibhotolo/imargarine engafakwanga tyuwa, kunye nenyama enkonkxiweyo enesodium ephantsi.	IINDLELA EZIFUMANEKA I-POTASSIUM CHLORIDE ETYUWA (NoSalt, Nu-Salt, Lite Salt, LoSalt): Itispuni nje enye iqulathe ngaphezulu kwe-\(2,500\text{mg}\) ye-potassium esulungekileyo kwaye inokunqanda intliziyo yesigulana esiphosiweyo se-dialysis. Kwakhona kuthintele isuphu enkonkxiweyo, i-ramen noodles, inyama ephilisiwe (i-spam, i-jerky, i-bacon, i-ham), i-nuts enetyuwa, kunye netshizi.
Iiprotheyini kunye neCalorie Boosters (iUrea ephantsi / amandla aphezulu)	- Iprotheyini (umda ukuya kwi-\(60\text{ ukuya }85\teksti{g}\) [\(2\text{ ukuya }3\text{oz}\)] inyama ephekiweyo/ngosuku): ityhuna enkonkxiweyo ephantsi enesodium ecoliweyo, inkukhu enkonkxiweyo engafakwanga tyiwa/iturkey, okanye iqanda elimhlophe elizinzile kwishelufu. - I-Calorie Boosters (Zero Potassium/Fluid): Iilekese ezinomuncu oqinileyo, iimbotyi zejeli, iigumdrops, iimarshmallows, ubusi, iswekile, kunye neoli yemifuno/ibhotolo engaxutywanga (ithintela umzimba wakho ukuba wophule izihlunu zawo, ezikhupha ipotassium yangaphakathi egazini lakho).	Iiprotheyini eziphezulu zokuqina, i-protein shakes, i-jerky, ibhotela ye-peanut, kunye nenxalenye enkulu yenyama ebomvu (iprotheyini egqithisileyo iqhekeza igazi elinetyhefu ye-urea nitrogen kunye ne-asidi ye-metabolic).