Ngaba ukhe weva ngendlela entsha yokusebenzisa i-insulin kwabo banesifo seswekile? (I-Insulin Pump)

Ukuba uphila neDiabetes Mellitus, ukuthatha i-insulin amaxesha amaninzi ngemini ngamanye amaxesha kunokuba yingxaki, akunjalo? Usenokudinwa kukujova okanye ukuyithatha ngepeni. Kodwa, ubusazi, kukho iindlela ezintsha nezilula zokwenza oku ngoku. Enye yeendlela ezinjalo yipompo ye-insulin . Ngaba singathetha ngayo ngokweenkcukacha namhlanje?

Yintoni i-Insulin Pump?

Ngamafutshane, sisixhobo esincinci, esinokunxitywa sezonyango esikhupha i-insulin encinci phantsi kolusu lwakho, phantse rhoqo. Cinga ngaso njengebhokisi encinci yejusi okanye idekhi yamakhadi. Iipompo ezininzi zisebenza ngekhompyutha.

Le yindlela elungileyo yokusebenzisa i-insulin endaweni ye-multiple daily injections (MDI) usebenzisa i-syringe okanye ipeni. Oku kuluncedo kakhulu kwabo bayidingayo ngokupheleleyo i-insulin.

Ubuchwepheshe bepompo ye-insulin kwimarike buhambela phambili ngokukhawuleza. Njengazo zonke iipompo ezikhoyo eMelika ngoku, zenzelwe ukusebenza ngeteknoloji ye-CGM (Continuous Glucose Monitoring), isixhobo esihlala silinganisa amanqanaba eswekile egazini lakho. Oku kuthetha ukuba ezi pump zintsha zinokulungisa ngokuzenzekelayo ubungakanani be-insulin oyifunayo ngelo xesha, ngokusekelwe kumanqanaba eswekile egazini lakho.

Isebenza njani le (i-Insulin Pump)?

Le mpompo ye-insulin isebenza ngokulinganisa indlela ipancreas yethu ekhupha ngayo i-insulin ngokwendalo. Ihambisa i-insulin emzimbeni wakho ngeendlela ezimbini eziphambili:

1. Ukuhlangabezana neemfuno ze-Basal Insulin

Okwenzekayo kukuba umzimba wakho ufumana inani elincinci kakhulu le-insulin rhoqo imini yonke, iyure neyure. Oku sikubiza ngokuba yi -'basal insulin' . Oku kugubungela iimfuno zomzimba wakho ezisisiseko ze-insulin.

Ubusazi na ukuba ubungakanani be-insulin esisiseko esiyidingayo imizimba yethu buyahluka ngamaxesha ahlukeneyo emini? Umzekelo, abantu abaninzi bafuna i-insulin esisiseko engaphezulu kancinci kusasa kunangokuhlwa. Oku kungenxa yokuba imizimba yethu ngokwendalo ikhupha i-hormone cortisol eninzi kusasa. Le cortisol ibangela ukuba amanqanaba eswekile egazini lethu anyuke kancinci.

Kufuneka uthethe nogqirha wakho uze ufumane 'i-basal rate' ekufaneleyo, oko kukuthi, ingakanani i-insulin oyifunayo ngeyure. Ekuhambeni kwexesha, njengoko umzimba wakho utshintsha kwaye imikhwa yakho yemihla ngemihla itshintsha, kuya kufuneka utshintshe le 'basal rate'. Iipompo ezininzi ngoku ziyakwazi ukulungisa ngokuzenzekelayo le basal rate ngokusekelwe kwidatha evela kwi-(CGM) yakho. Ungayibeka 'ngesandla', oko kukuthi, ngesandla, usebenzisa i-rate wena nogqirha wakho eniyilungisileyo kunye.

2. I-insulin inikwa xa kutyiwa naxa amanqanaba eswekile egazini enyuka (i-Bolus Insulin)

Le yindlela yesibini. Xa usitya isidlo, okanye xa iswekile yakho egazini iphezulu kunomlinganiselo ocetyiswayo, unikwa isixa esifunekayo se-insulin ngaxeshanye . Oku kubizwa ngokuba yi -'bolus insulin' .

Xa ufaka ubungakanani beecarbohydrate ekutyeni okutyayo kunye nenqanaba leswekile egazini lakho ngelo xesha kwimpompo, ibala kwaye ikuxelela ubungakanani be-insulin 'ebolus' efunekayo. Kwiimeko ezininzi, ipompo ngokwayo iya kubonisa ubungakanani obufanelekileyo. Ungayijonga ukuze ubone ukuba ichanekile na, wenze utshintsho oluncinci ukuba kuyimfuneko, kwaye uqinisekise ukuba ufuna ukunika i-insulin.

Ziziphi ezinye iimpawu ezikhoyo?

Zonke iintlobo zepompo ye-insulin, zonke iintlobo, zineempawu zobugcisa ezahlukeneyo kunye nezicwangciso. Nazi imizekelo embalwa:

• Ukukwazi ukusebenza kunye netekhnoloji (i-CGM) yokunyusa, ukunciphisa, okanye ukuyeka ukuhanjiswa kwe-insulin ngokuzenzekelayo ngokusekelwe kumanqanaba eswekile egazini.
• Ukukwazi ukunyusa okanye ukunciphisa 'iBasal Rate' okwethutyana kangangexesha elithile, njengoko unqwenela (umzekelo, ngexesha lokuzilolonga).
• Kukho ii-alamu zezinto ezinje xa ibhetri iphantsi okanye xa i-insulin reservoir iphantse ingabi nanto.
• Ukuba i-CGM iqhagamshelwe kwimpompo, iya kukwazisa nokuba inqanaba leswekile egazini lakho lidlula kwinqanaba elicetyiswayo.
• Ukukwazi ukuqhagamshela kwii-apps zefowuni kunye nezinye izixhobo ezikrelekrele.

Iintlobo zeempompo ze-insulin

Kukho iintlobo ezimbini eziphambili zeempompo ze-insulin: ezo zinemibhobho kunye nezo zingenayo imibhobho.

1. Iimpompo ze-insulin ezinetyhubhu

Njengoko igama lisitsho, le pump inetyhubhu ende, ebhityileyo enamathele kuyo. Le tube yiyo ethwala i-insulin ukusuka kwipompo ukuya kwityhubhu encinci ebizwa ngokuba yi-'cannula' phantsi kolusu lwakho. Makhe sijonge ezinye zeendawo zayo:

• Umatshini wokupompa kunye netekhnoloji:Le pump yenziwe ngeplastiki nesinyithi. Inesikrini sokujonga nokukhetha useto olwahlukeneyo, idatha. Inekhatriji, okanye ithangi, elizaliswe yi-insulin. Ngokuxhomekeke kuhlobo lwayo, inokuba yibhetri enokutshintshwa okanye etshajwayo. Ubungakanani be-insulin enokufakwa kule tanki buhluka ukusuka kwipompo ukuya kwenye. Kodwa uyizalisa kuphela ngobungakanani oqhele ukubusebenzisa iintsuku ezimbini ukuya kwezintathu. Ungayibeka le pump epokothweni yakho okanye uyiqhoboshele kwimpahla, njengebhulukhwe yakho.
• Iseti yetyhubhu kunye neseti yokufakwa: Le yityhubhu ende yee-intshi ezimbalwa ethwala i-insulin ukusuka kwindawo yokugcina i-insulin epompo ukuya kwiseti yokufakwa ebekwe phantsi kolusu lwakho. Iseti yokufakwa inamathele eluswini ngeteyiphu yokuncamathelisa kwaye inetyhubhu encinci yeplastiki eguquguqukayo (i-cannula) ehamba phantsi kolusu. I-cannula ingamamilimitha ambalwa kuphela ubude. Ungayifaka ngesandla iseti yokufakwa, okanye ungasebenzisa isixhobo esincinci esiza nayo. I-cannula inenaliti ehamba eluswini ize ingene kwinaliti. Emva koko inaliti iyasuswa, kushiyeke i-cannula kuphela phantsi kolusu. Ungakwenza oku engalweni yakho engasentla, esiswini, esinqeni, empundu, okanye ethangeni.

Uninzi lwexesha, i-reservoir kunye ne-infusion set kufuneka zitshintshwe rhoqo emva kweentsuku ezimbini ukuya kwezintathu. Ukuba i-insulin iphelile, i-reservoir kufuneka itshintshwe. I-infusion set entsha, i-reservoir, kunye ne-tube kufuneka zisetyenziswe ngalo lonke ixesha. Nangona kunjalo, ipompo ingasetyenziswa iminyaka eliqela.

Nangona ezinye iimpompo zetyhubhu zingangeni manzi, abantu abaninzi bazikhupha kwiseti yokufakwa xa behlamba okanye bentywila. Zingaphinda ziqhagamshelwe kwakhona. Ezinye azinamanzi ngokupheleleyo, azinamanzi ngokupheleleyo.

2. Iimpompo ze-insulin ezingenatyhubhu / iimpompo ze-patch

Ezi pumps zikwanayo netyhubhu yeplastiki eguquguqukayo ('i-cannula') engena phantsi kwesikhumba. Nangona kunjalo, zombini i-insulin reservoir kunye ne-'cannula' zikwi-'pod' enye, eyinxalenye encinci efana ne-patch. Oku kunokubotshelelwa eluswini nge-adhesive patch. Akukho tyhubhu ibonakalayo. Emva koko ilawulwa ngaphandle kwentambo nge-'controller' ephathwayo.

I-'Pod' nganye isetyenziswa kube kanye kuphela. Njengempompo enetyhubhu, kufuneka itshintshwe rhoqo emva kweentsuku ezimbini ukuya kwezintathu. Kufuneka itshintshwe ukuba i-insulin iphelile.

Ngaphambi kokuba ufake iPod, uzalisa i-reservoir nge-insulin uze uncamathisele umcu wokuncamathelisa eluswini lwakho. Emva koko, xa ucinezela iqhosha, inaliti engaphakathi kwi-cannula kwiPod iyaphuma, ihlabe ulusu, ize ibuyele kwiPod. Yi-cannula kuphela ehlala phantsi kolusu. Ungayibeka nakwingalo yakho engasentla, esiswini, esinqeni, empundu, okanye ethangeni.

Into ekhethekileyo kukuba ezi pumps zingenamapayipi azinamanzi, ngoko ke ungazinxiba xa udada okanye ungena emanzini.

Zeziphi iintlobo zeempompo ze-insulin ezikhoyo kwimarike?

Kukho iintlobo ezahlukeneyo zeepompo ze-insulin kumazwe ahlukeneyo kwihlabathi liphela. Nazi ezinye zeentlobo ezidumileyo ezikhoyo ngoku kwimarike yaseMelika:

• Inkqubo ye-iLet® Bionic Pancreas (ipompo enetyhubhu)
• I-Medtronic MiniMed™ (iintlobo ezahlukeneyo zeempompo zeengcongolo)
• I-Omnipod® (iintlobo ezahlukeneyo zeempompo ezingenazingcongolo)
• I-Tandem® t:slim (iintlobo ezahlukeneyo zeempompo zeengcongolo)

Kukho enye ipompo engenamatyhubhu ebizwa ngokuba yi-Accu-Chek® Solo Micropump System ekhoyo e-UK, elinde imvume evela e-US (FDA - Food and Drug Administration). Ezinye zezi okanye ezinye iintlobo ezintsha zinokufumaneka naseSri Lanka. Eyona nto ingcono onokuyenza kukubuza ugqirha wakho weswekile ngale nto.

Ngubani osebenzisa le pump ye-insulin?

Nabani na onesifo seswekile ofuna ukuthatha i-insulin ngokwenziwa angasebenzisa ipompo ye-insulin. Oku kuthetha ukuba:

• Kwabo banesifo seswekile sohlobo loku-1 - oko kuthetha ukuba abantwana abancinci kunye nabantu abadala bayagula.
• Kwabanye abantu abanesifo seswekile sohlobo lwesibini.
• Ipompo ingafaneleka nakubantu abanesifo seswekile sohlobo lwe-3c okanye isifo seswekile 'seMonogenic'.

Uhlobo ngalunye lwepompo lunomda wobudala obuncinci bokusetyenziswa, oluvunyiweyo ziiarhente ezifana ne-FDA. Ezinye iipompo zivunyiwe ukuba zisetyenziswe ngabantwana abaneminyaka emi-2 ubudala. Ezinye ezininzi zivunyiwe ukuba zisetyenziswe ngabantu abaneminyaka engaphezu kwe-7 ubudala.

Ipompo ye-insulin yindlela enye yonyango lokulawula isifo seswekile - sisigqibo somntu ngamnye. Wena (okanye umntwana wakho) ninokucinga ngepompo ukuba:

• Ukuba unengxaki yokulawula amanqanaba eswekile egazini lakho nokuba sele usele utyale inaliti (MDI) izihlandlo ezininzi ngemini.
• Ukuba ufuna ukulungisa ubungakanani be-insulin, nika ngokuchanekileyo, ngendlela othanda ngayo.
• Ukuba ungumntu ohlala etshintsha, ongakwaziyo ukwenza imisebenzi yakho yemihla ngemihla okanye amaxesha okutya.
• Ukuba kufuneka i-insulin encinci, oku kusebenza rhoqo kubantwana abancinci nakwiintsana ezinesifo seswekile.
• Ukuba une-gastroparesis (oko kuthetha ukuba ukutya kuyacotha ukugaywa nokufunxwa).
• Ukuba une-'Dawn Phenomenon' (oko kukuthi, ukuba iswekile yakho egazini iyanda kusasa).
• Ukuba unethemba lokukhulelwa.

Ngubani ongafanelanga ipompo ye-insulin?

Iimpompo ze-insulin azilona khetho lufanelekileyo kuye wonke umntu – kukho izizathu ezininzi zokuba kutheni ipompo ingakulungeli wena okanye umntwana wakho, kuquka:

• Ukuba unengxaki yokusebenzisa izandla zakho neminwe yakho: Kufuneka usebenzise izandla zakho neminwe yakho ukuze uzalise i-insulin reservoir uze ucinezele amaqhosha epompo. Ukuba unengxaki yokusebenzisa izandla zakho, nokuba kungenxa yemeko efana ne-arthritis okanye i-neuropathy, ukusebenza ngepompo kunokuba ngumceli mngeni.
• Ukuba ungaboni kakuhle okanye uyimfama: Ukuba ungaboni kakuhle, ukhetho lwakho ngetekhnoloji yePump lunokuncipha. Kuya kufuneka uqwalasele izinto ezinje ngobungakanani besikrini sePump, ukucaca kombhalo, ubungakanani boonobumba namanani, kunye nesibane sangasemva.
• Ukuba unengxaki yokubamba ipompo: Umzekelo, ukuba wena okanye umntwana wakho nineengxaki zokuva, okanye i-aleji yolusu enzima, ipompo isenokungafaneleki kuba ifuna ukuba uyibambe ihlale endaweni yayo ngamaxesha onke.

Zithini iingenelo zokusebenzisa ipompo ye-insulin?

Kukho iingenelo ezininzi zokusebenzisa ipompo ye-insulin kunokusebenzisa i-multiple injections (MDI) izihlandlo ezininzi ngemini:

• Ukukwazi ukulungisa ubungakanani be-insulin enikiweyo (kwezinye iipompo) ukuze ihambelane nokutya okwahlukileyo kunye nokuzilolonga. Oku kuvumela ukuba idosi ye-insulin ibe ngokuchanekileyo.
• Ukuhanjiswa kwe-insulin kunokudityaniswa netekhnoloji ye-CGM.
• Ukukwazi 'ukukhuphela' idatha. Oku kuya kukunceda wena kunye nogqirha wakho wesifo seswekile (i-Endocrinologist) ukuba nilungelelanise ngcono isicwangciso senu sonyango.
• Ulawulo olungcono lweswekile egazini. Izifundo kubantu abadala nakubantwana zibonise ukuba abantu abasebenzisa iipompo ixesha elide banolawulo olungcono kakhulu lweswekile yegazi kunabo basebenzisa ii-MDI.
• Into enye abantu abaninzi abatshintsha kwi-MDI baye kwi-insulin pump bathi umgangatho wobomi babo uphucuke kakhulu .
• Ukuncipha kobuninzi bokufakwa kwe-insulin.

Iingcali ezininzi zesifo seswekile (ii-Endocrinologists) zikhuthaza ukusetyenziswa kwezi pumps ngenxa yezibonelelo zazo eziqinisekisiweyo.

Ngaba kukho naziphi na iingxaki kwiimpompo ze-insulin?

Kunye neenzuzo, kunokubakho iingxaki ezithile. Xa kuthelekiswa nee-injections (MDI), enye yezona ngxaki zinkulu zeempompo ze-insulin ziingxaki ezinokubakho xa i-insulin ingena emzimbeni.

Iingxaki ezinokubakho xa ufumana i-insulin:

Oku kunokubangela izizathu ezahlukeneyo:

• Ukukrwitshwa okanye ukubhajwa kweCannula: I-cannula inokukrwitshwa okanye ibambeke ngenxa yoxinzelelo oluvela kwizicubu ezingaphantsi kolusu. Oku kuyayithintela i-insulin ukuba ingangeni emzimbeni.
• Ukwenziwa kwe-Insulin Crystallization: Kwiintsuku ezimbalwa, i-insulin inokubumba ngaphakathi kwi-cannula okanye kwityhubhu. Oku kunokukuthintela ekufumaneni isixa esifanelekileyo se-insulin. Yiyo loo nto kucetyiswa ukuba kutshintshwe iiseti ezininzi ze-infusion kunye neepompo ezingenamatyhubhu rhoqo emva kweentsuku ezimbini ukuya kwezintathu.
• Ukuqhawulwa kweSeti yoMxube: Ukuba usebenzisa ipompo enetyhubhu, ityhubhu isenokuphuma ngokungazi kwiseti yoMxube. Oku kuya kubangela ukuba i-insulin iphume kwityhubhu endaweni yokuba ingene emzimbeni wakho.
• Ukudumba okanye ukuqokelelwa kwegazi (iHematoma) kwindawo yokufakwa igazi: Ukuba kukho ukudumba okukhulu kufutshane ne-cannula, okanye ukuba kukho ihlwili legazi, i-insulin ayizukufunxwa kakuhle.
• Ityhubhu ephukileyo okanye evalekileyo: Ityhubhu ekwipompo inokubhideka okanye iqhekeke (umzekelo, isilwanyana sakho singayihlafuna ityhubhu). Nangona kunjalo, i-insulin ayizukuhanjiswa emzimbeni.
• Iingxaki zeTayipi yokuncamathelisa: Iiseti zokufunxa kunye neeMpompo ezingenazityhubhu zincamatheliswe eluswini ngeglu. Ezi zinokuphuma ngengozi okanye ngaphambi kwexesha. Iglu eyongezelelweyo ingasetyenziselwa ukuthintela oku.
• Ukungasebenzi kakuhle kwepompo: Kwiimeko ezingaqhelekanga, ipompo yakho ye-insulin inokwaphuka okanye ingasebenzi kakuhle. Ibhetri nayo inokuphela.

Ngamanye amaxesha, ipompo yakho iya kubona ukuvaleka ize ikwazise ukuba utshintshe ipompo okanye iseti yokufakwa kwe-infusion. Kodwa ngamanye amaxesha, umzekelo, ukuba ityhubhu iphuma kwiseti, ipompo isenokungayiboni ingxaki. Ukuba usebenzisa i-CGM, unokubona ukuba iswekile yakho yegazi iphezulu ngokungalindelekanga, nto leyo enokubonisa ingxaki ngokuhanjiswa kwe-insulin.

Eyona nto ibalulekileyo: Ukuba uhlala ungenayo i-insulin ixesha elithile - ngesiqhelo iiyure ezimbalwa - usengozini enkulu yokuba ne -hyperglycemia kunye nemeko esongela ubomi ebizwa ngokuba yi -diabetesic ketoacidosis (DKA) .

Ngenxa yezi ngxaki zokuhanjiswa kwe-insulin, ukuba usebenzisa ipompo, kubaluleke kakhulu ukuba uhlale unesicwangciso sokugcina idatha. Ingabonakala ngolu hlobo:

• Xa uphuma endlwini, phatha i-insulin kunye nezinto ezinxulumene nepompo.
• Gcina i-insulin, iisirinji, okanye ipeni ye-insulin kufutshane ukuze utofe.
• Gcina inombolo yenkonzo yabathengi yenkampani eyenze ipompo ikufutshane ukuze ufumane uncedo ngokukhawuleza ukuba unengxaki yobuchwepheshe.

Ukuze uthintele okanye ufumanise ezi ngxaki kwangethuba, zenze umkhwa ukujonga iseti yepompo yakho kunye/okanye ye-infusion ubuncinci kube kanye ngemini. Kubaluleke kakhulu ukujonga amanqanaba eswekile egazini lakho rhoqo.

Ngaba kukho ezinye iingxaki?

Ukongeza kwiingxaki eziphambili ezikhankanywe apha ngasentla, kukho nezinye izinto onokuzifumana zingalunganga:

• Ixabiso: Iimpompo ze-insulin kunye nezixhobo zingabiza kakhulu kune-insulin therapy (MDI). Le ndleko iya kwahluka ngokuxhomekeke kwisicwangciso sakho se-inshorensi yezempilo.
• Kufuneka uhlale uqaphela umzimba wakho: Ipompo nganye sisixhobo esongezelelweyo osincamathisela emzimbeni wakho. Zininzi iindlela ezikrelekrele zokuzisebenzisa, kodwa kuthatha ixesha ukuziqhela.
• Ubungakanani bezinto ezifunekayo: Xa kuthelekiswa ne-MDI, iimpompo ze-insulin zifuna izinto ezininzi – "izinto" – kuneempompo ze-insulin. Zifuna indawo yokuzigcina ekhaya, kwaye kufuneka uphathe iibhegi ezongezelelweyo xa uhamba, ingakumbi xa uhamba ixesha elide.
• Iimpendulo ze-allergy kwi-adhesives: Abanye abantu banokuba neempendulo ze-allergy kwi-adhesives ezisetyenziswa kwiimpompo ze-insulin nakwiiseti ze-infusion.

Yintoni ekufuneka uyiqwalasele xa ukhetha ipompo ye-insulin?

Ukukhetha ipompo ye-insulin sisigqibo esikhulu. Kwaye zininzi izinto ekufuneka uzicinge. Iindaba ezimnandi zezokuba iinkampani zepompo zinolwazi oluninzi malunga noku, kwaye zinabaqeqeshi bokuphendula imibuzo yakho. Ugqirha wakho wesifo seswekile naye uluncedo olukhulu.

Nazi ezinye izinto ekufuneka uziqwalasele kwaye uzibuze xa ukhetha ipompo:

• Ngaba ufuna ipompo enemibhobho okanye ipompo engenamibhobho? Zithini iingenelo kunye neengxaki zohlobo ngalunye?
• Ingakanani ubunzima, ubungakanani, kunye nembonakalo yepompo?
• Zeziphi iimpompo ezigutyungelwe yi-inshurensi yakho yezempilo, zithini iindleko ezinxulumene nazo, kwaye zibiza malini ngonyaka?
• Injani inkonzo yabathengi evela kwinkampani eyenza ipompo?
• Ufumana njani uqeqesho?
• Le pump ihambelana njani neteknoloji yeCGM?
• Ndingatshintshela kwipompo entsha nini?
• Ingaba ayingeni manzi/ayingeni manzi?
• Ziziphi iintlobo zeenkqubo zokuhambisa i-insulin ezikhoyo?
• Luhlobo luni lwee-alamu kunye nezilumkiso ezikhoyo? Ngaba zenza izandi okanye ziyangcangcazela?
• Ngaba ungafunda ngokucacileyo izikrini zepompo?
• Zeziphi izixhobo ezikrelekrele ezinokuqhagamshelwa?
• Kulula kangakanani ukuyisebenzisa (ngokucacileyo)?
• Zeziphi iinkqubo zesoftware ezikhoyo zokukhuphela idatha onokwabelana ngayo nogqirha wakho?

Okokugqibela, izinto ekufuneka uzikhumbule

Ngoko ke, ipompo ye-insulin yindlela eguquguqukayo nelula kubantu abaninzi yokusebenzisa i-insulin. Abantu abaninzi abanesifo seswekile bafumanisa ukuba ipompo ye-insulin ilula kuneenaliti.

Into ebalulekileyo kukuba ipompo ye-insulin ayihlali ihleli. Ukuba uqala ukusebenzisa ipompo kwaye ungayithandi, ungabuyela kwiinaliti nangaliphi na ixesha.

Ukukhetha phakathi kweentlobo ezahlukeneyo zeepompo ezithengiswayo kunokuba ngumsebenzi onzima. Nangona kunjalo, khumbula ukuba ugqirha wakho wesifo seswekile uza kukunceda wenze isigqibo esifanelekileyo kuwe. Ngoko ke, thetha nogqirha wakho ngale nto ngakumbi.

Ipompo ye - insulin, isifo seswekile, i-insulin, iswekile yegazi, i-CGM, i-insulin esisiseko, i-insulin ye-bolus