1. Tif nguon g o c d on g vat: til tuy cua bo hay Idn, co khac biet mot chut ve cau true so vdi insulin cua ngUdi. Loai insulin nay dUdc tinh che bang phildng phap sic ky dat do tinh khiet hoa rat cao. Ngay nay ngufdi ta co xu hildng it dung insulin co nguon goc til dong vat vi e ngai cac chiing benh co the lay sang ngiidi nhii benh “bo dien” ch&ng han.
2. Insulin “ ngifcfi” : dUdc san xuat til insulin dong vat qua cac phildng phap.
- Ban tong hdp til insulin Idn, ban chat cung tii nguon dong vat, hien it dUdc sii dung.
- Tai to hdp gen: la loai insulin trung tinh ddn thanh phan, dtfdc san xuat bin g ky thuat tai to hdp gen, sii dung nam men lam cd the sinh san sau do dtfdc chiet xuat dat den do tinh khiet hoa va chat ltfdng cao nhat, co cau true giong het nhtf insulin til nhien cua ngtfdi, do vay it tao khang the va thdi gian tac dung ng&n hdn. Khi co khang the khang insulin, mot phan insulin tiem vao se bi trung hoa b6t dan den viec phai tang lieu dieu tri.
* Ltfu y:
Nong do insulin theo so" ddn vi trong 1ml:
- Loai dung cho bdm tiem: 1ml co 40 ddn vi dong trong lo nho 10ml (400 ddn vi/lo).
- Loai dung cho but chich: 1ml co 100 ddn vi dong trong ong 3ml (300 ddn vi/ong).
- Loai dung cho bdm tiem nong do tii 100 - 500 ddn vi/ml hien nay chua co tai Viet Nam.
Khi mua insulin can xem ky nong do insulin va tong ltfdng insulin co trong lo.
P h an loa i insulin theo thai g ia n ta c dung 1. Insulin ta c dun g nhanh
D ac tinh: trong suot, co the dung bang tat ca moi diidng tiem: tinh mach, dtfdi da, tiem b ip va dung dtfdc trong moi tinh huong.
4___ 10 12 14 16 18 20 22 24
P s \
s
\
Khi tiem dtf6i da: insulin b it dau co tac dung sau 15- 20 phut. Co tac dung ctfc dai sau 2 - 4 gid. Het tac dung sau 6 - 8 gid.
* Ltfu y: khi dung insulin tiem dtfcii da thi insulin co tac dung nhanh hdn va ngin hdn neu nhtf vung tiem co tang hoat dong the ltfc (dui neu nhtf tap chay, canh tay neu nhtf chdi tennis va bung neu nhtf bdi thuyen...).
Ldi ich:
- La loai duy nhat dung trong cap ctfu do tac dung ha dtfdng huyet nhanh chong.
- Co the tron lan v6i insulin cham tuy theo muc dich va nhu cau dieu tri.
- Co thdi gian tac dung ng&n va manh de lam giam dtfdng huyet sau khi an.
Bat ldi:
Thdi gian tac dung ngan nen phai tiem nhieu lan trong ngay (4 mui tiem dtfdi da, thtfc te khong dung rieng insulin tac dung nhanh de dieu tri ma phai ket hdp them insulin tac dung ban cham hoac cham).
2. Insulin ta c dung ban ch a m (dich tiem due nhu suta)
De lam giam bdt so" lan tiem trong ngay, ngiidi ta da san xuat ra loai insulin co tac dung dai hdn gom 2 loai insulin la NPH (Neutral Protamine Hagedorn) va, IZS (Insulin Zinc Suspension) hay lent de sik dung trong che do dieu tri vdi 2 hay 3 mui tiem trong ngay.
L oai insulin NPH: sxi dung protamin la mot loai polypeptid co kha nang gfin insulin.
- Bat dau tac dung sau 1 gid.
- Tac dung manh nhat sau 4 - 8 gid.
- Het tac dung sau 14 - 18 gid.
- Vdi loai insulin nay thi cac diem gin ket insulin cua protamin da bao hoa nen loai insulin nay co the dung tron lan vdi insulin nhanh.
- Tuy nhien nhtfdc diem cua loai insulin nay co the gay ra loan dtfdng md ndi tiem (hiem gap).
Loai insulin IZS (insulin kem):
Thdi gian tac dung co the tii 6 - 36 gid tuy theo each thtfc san xuat.
- Uu diem cua cac loai insulin tac dung trung binh la co nhieu loai vdi thdi gian tac dung khac nhau thich ling vdi yeu cau dieu tri va stf thuan ldi cua tifng benh nhan.
- Nhtfdc diem: Cd the gay dau khi tron vdi insulin nhanh.
* Can chu y khi tron lan insulin nhanh vdi cham thi loai nhanh phai dtfdc lay vao bdm tiem trtfdc va dich tron phai dtfdc tiem ngay.
3. Insulin tron san (dich tiem due nhtf stfa)
La loai insulin tron lin gitf a 2 loai nhanh va trung binh theo ty le nhat dinh.
- Cd ty le 30% insulin nhanh va 70% insulin trung binh.
- Cd ty le 50% insulin nhanh va 50% insulin trung binh. Ngoai ra con tien hanh tron theo nhtfng ty le khac, trong do loai nhanh chiem 10-20-40%.
Dac tinh: cung luc cd 2 tac dung la nhanh do loai nhanh dam trach va keo dai do loai trung binh dam trach.
- Vdi ngtfdi an nhieu tinh bot - dtfdng thi thich hdp vdi loai tron 40-50% nhanh.
- Phan Idn benh nhan dung loai tron 30% nhanh.
- Mot vai ngtfdi co khuynh htfdng ha dtfdng huyet gitfa cac btfa an nen dung tron 10 - 20%.
tfu diem : tien dung, phu hdp hdn vdi sinh ly m&
khong doi hoi phai ttf tron lay lieu khi dung rieng ttfng loai nhanh cham.
Nhtfdc diem : vi ty le pha tron la co" dinh nen kho dieu chinh cho phu hdp vdi ttfng tinh huong cu the: &n btfa no neu tang lieu ca insulin nhanh va cham se gay ha dtfdng huyet muon. Trong khi le ra chi tang ttf 2 den 6 ddn vi loai insulin nhanh.
4. Insulin tac dung cham (dich tiem due nhtf stfa)
& ? T f ? 8 10 12 14 16 18 2 0 2 2 24
Dac tinh: la loai insulin cd ket hdp vdi kem, chia lam 2 nhom chinh
- Nhom 1: loai tac dung 24 gid.
- Nhom 2: loai tac dung 36 gid.
l/u diem :
- Chi can mot mui tiem cd tac dung trong ca 24 gid trong ngay.
- Cd the dung trong ky thuat 4 mui tiem/ngay,
3 mui nhanh vao trtfdc cac btfa an va mot mui cham vao luc di ngu (22 gid).
Nhtf tfc diem :
- Tai cho: do, dau ndi tiem.
- Ha dtfdng huyet khong ltfdng trtfdc do tac dung keo dai chong cheo vdi cac mui tiem khac.
- Thtfdng khong lam giam dtfdc dtfdng mau sau an do thdi gian hap thu vao mau cham.
5. Insulin tac d u n g sieu cham (dich tiem trong) Dac tinh: la loai insulin nhan tao co tac dung keo dai thtfc stf.
tfu diem : toe do hap thu on dinh hdn 2 loai insulin ban cham va cham, do do co tac dung lam insulin nen tot hdn, it gay ha dtfdng huyet hdn. Hien chtfa co d Viet Nam.
6. Insulin ta c d u n g ngan (dich tiem trong)
Dac tinh: la loai insulin nhan tao co tac dung chi 10-15 phut sau khi tiem. Het tac dung sau 3 gid.
l/u diem : co tac dung ha dtfdng huyet sau an tot.
Khong can phai chd 30 phut mo'i dude an nhtf doi vdi loai insulin tac dung nhanh.
Nhtf tfc diem: gia thanh dat. Chtfa san co d Viet Nam.
B an g 13: M ot so loai insulin co tren thi trtfdng
r j
Loai insulin (Thcfi gian
tac dung)
]
Xguon goc Nong do/ml
Thdi gian bat dau
co tac dung
Thcrt giau het tac 1 dung
- . 1. Loai tac
dung
nhanh "XgUdi’ /sin h 40 ddn vi/m l (lo) 30 phut 8 gib i - A ctra p id ton g hdp 100 ddn v i/m l 30 phut 6 gid
H M (bu t tiem )
"X gU d r/sin h 40 ddn vi/m l Op) 30 phut 6 gid - In su lid d R ton g hdp
C hiet xu at 40 ddn vi/m l (lo) 30 phut 7-5 gid - In su lin u m tii tuy Idn
M a xira p id 2. Loai ban cham
- In su la tard "XgU di7sinh 40 ddn vi/m l do) 1 gid 20 gid
H M ton g hdp 100 ddn v i ml
(hut tiem )
1 gid 20 gid
- M on ota rd “XgU di- sinh 40 ddn vi/m l (lo) 2 gid 18 gib H M ton g hdp 40 ddn vi/m l (lo) 1 gid 24 gid - Ir.sulidd X 'X g tfd i- sinh
ton g hdp - S em ilen te
M C
C hiet xuat :u tuy Idn
40 ddn v i ml (Ip) 1 gid 30 ph u t
16 gid
3. Loai tron san nhanh / ban cham - M ixtard HM 30. 10, 20, 40, 50 - Insulidd 30/70
NgUdi’Vsinh tong hdp
“Ngutdi7sinh tong hdp
40 ddn vi/ml (lo) 100 ddn vi/m l (but tiem ) 40 ddn vi/ml (lo)
30 phut 30 phut
30 phut
20 gid 16 gid
16 gid
4. Loai tac dung dai - Ultra Lente M C - Lent M C
- Insulidd L
- Insulinum lent Cho-S
C hiet xuat t i tuy bo Chiet xuat til tuy Idn, bo
“NgUdi’Vsinh tong hdp C hiet xuat tii tuy bo
40 ddn vi/ml (lo)
40 ddn vi/ml (Id)
40 ddn vi/ml 09)
40 ddn vi/ml (lo)
4 gid
2 gid 30 phut 4 gid
1-2 gid
24 gid
24 gid
28 gid
24 gid
5. Loai tac dung dai khong co dinh - Lentus - Levem ir
N han tao
100 ddn vi/m l 100 ddn vi/m l
2 gid 24 gid 20 gid 6. Loai tac
dung ngan - H u m alog - N ovorap id - A p id ra
N han tao 100 ddn vi/m l 5-10 phut
3 gid