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hypoglycemia unawareness

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https://www.readbyqxmd.com/read/29780096/-the-status-of-glycemic-control-and-hypoglycemia-in-elderly-patients-visiting-the-outpatient-department-specializing-in-diabetes
#1
Yui Soma, Rie Oka, Sumie Fujii, Naoko Ito, Mitsuhiro Kometani, Shigehiro Karashima, Yoshiyu Takeda, Takashi Yoneda, Akimichi Asano
AIM: The Japan Diabetes Society (JDS)/Japan Geriatrics Society (JGS) Joint Committee reported 'Glycemic Targets for Elderly Patients with Diabetes' in 2016. Based on this recommendation, we aimed to clarify 1) the achievement status of glycemic targets in the elderly and 2) the presence of hypoglycemia in real life among elderly individuals with an HbA1c below the lower limit. SUBJECTS AND METHODS: [Analysis I] In 326 elderly with diabetes ≥65 years of age visiting the outpatient department specializing in diabetes, the proportions of patients with HbA1c values below the lower limit and the use of drugs potentially associated with severe hypoglycemia (e...
2018: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
https://www.readbyqxmd.com/read/29779835/concerns-and-hopes-of-patients-with-type-1-diabetes-prior-to-islet-cell-transplantation-a-content-analysis
#2
Queena F Luu, Celine J Villareal, Cynthia Fritschi, Rebecca S Monson, Jose Oberholzer, Kirstie K Danielson
AIMS: Islet cell transplantation can functionally cure type 1 diabetes complicated by hypoglycemia unawareness (HU), but requires immunosuppression. This study identified the lived experiences and risk/benefit considerations of patients pre-transplant. METHODS: Content analysis identified themes from four open-ended questions pre-transplant in an islet transplant clinical trial. The sample included 23 (19 female) patients, with a mean age = 48.3 and diabetes duration = 29...
April 17, 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29768718/dysregulated-plasma-glucagon-levels-in-japanese-young-adult-type-1-diabetes-patients
#3
Dan Kawamori, Naoto Katakami, Mitsuyoshi Takahara, Kazuyuki Miyashita, Fumie Sakamoto, Tetsuyuki Yasuda, Taka-Aki Matsuoka, Iichiro Shimomura
Currently, the clinical dynamics of glucagon needs to be revised based on previous data obtained from conventional glucagon radioimmunoassays. In this study, we evaluated plasma glucagon levels in type 1 diabetes patients using a newly-developed sandwich enzyme-linked immunosorbent assay (ELISA), and its association with clinical parameters and markers of diabetes complications were statistically assessed. The plasma glucagon level in 77 Japanese type 1 diabetes patients was 28.1±17.7 pg/mL, and comparable to that reported previously for type 2 diabetes patients...
May 16, 2018: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/29757443/impact-of-genetic-polymorphism-in-the-%C3%AE-%C3%A2-receptor-gene-on-risk-of-severe-hypoglycemia-in-patients-with-type-1-diabetes
#4
Kim Zillo Rokamp, Niels Vidiendal Olsen, Louise Færch, Peter Lommer Kristensen, Birger Thorsteinsson, Ulrik Pedersen-Bjergaard
Context and Objective: Severe hypoglycemic events are unevenly distributed in subjects with type 1 diabetes making a genetic influence probable. The adrenergic beta-2-receptor gene (ADRB2) has several common polymorphisms of which the Arg16 allele is associated with receptor down-regulation and reduced agonist-mediated endogenous glucose production. We tested the hypothesis that the Arg16 variant is associated with severe hypoglycaemia. Method: A cohort of 311 subjects with type 1 diabetes reported severe hypoglycemic events retrospectively in a validated questionnaire...
May 10, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29728302/clinically-significant-cognitive-impairment-in-older-adults-with-type-1-diabetes
#5
Naomi S Chaytor, Celestina Barbosa-Leiker, Christopher M Ryan, Laura T Germine, Irl B Hirsch, Ruth S Weinstock
AIMS: Little is known about cognition in older adults with type 1 diabetes. The aim of this study was to identify correlates of clinically significant cognitive impairment. METHODS: Neuropsychological, diabetes-related and glycemic (HbA1c, Continuous Glucose Monitoring; CGM) data were collected from 201 older adults (≥60 years) with longstanding type 1 diabetes. RESULTS: Clinically significant cognitive impairment (≥2 cognitive tests ≥1...
April 14, 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29549574/clinical-and-cost-implications-of-insulin-degludec-in-patients-with-type-1-diabetes-and-problematic-hypoglycemia-a-quality-improvement-project
#6
Muhammad Ali Karamat, Shujah Dar, Srikanth Bellary, Abd A Tahrani
INTRODUCTION: To assess the real-life clinical benefits and cost implications of switching from another basal insulin to insulin degludec (degludec) in patients with type 1 diabetes (T1D) on basal-bolus regimens with recurrent hypoglycemia and/or hypoglycemia unawareness. METHODS: Patients with T1D who were aged ≥ 18 years, were on a basal-bolus regimen, and had switched to degludec plus bolus insulin for at least 6 months were included. Patients had to have switched to degludec as a result of recurrent hypoglycemia and/or hypoglycemia unawareness...
March 16, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29508275/eadsg-guidelines-insulin-therapy-in-diabetes
#7
Bahendeka Silver, Kaushik Ramaiya, Swai Babu Andrew, Otieno Fredrick, Sarita Bajaj, Sanjay Kalra, Bavuma M Charlotte, Karigire Claudine, Anthony Makhoba
A diagnosis of diabetes or hyperglycemia should be confirmed prior to ordering, dispensing, or administering insulin (A). Insulin is the primary treatment in all patients with type 1 diabetes mellitus (T1DM) (A). Typically, patients with T1DM will require initiation with multiple daily injections at the time of diagnosis. This is usually short-acting insulin or rapid-acting insulin analogue given 0 to 15 min before meals together with one or more daily separate injections of intermediate or long-acting insulin...
April 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29393675/overnight-glucose-control-with-dual-and-single-hormone-artificial-pancreas-in-type-1-diabetes-with-hypoglycemia-unawareness-a-randomized-controlled-trial
#8
Alexander Abitbol, Remi Rabasa-Lhoret, Virginie Messier, Laurent Legault, Mohamad Smaoui, Nathan Cohen, Ahmad Haidar
BACKGROUND: The dual-hormone (insulin and glucagon) artificial pancreas may be justifiable in some, but not all, patients. We sought to compare dual- and single-hormone artificial pancreas systems in patients with hypoglycemia unawareness and documented nocturnal hypoglycemia. METHODS: We conducted a randomized crossover trial comparing the efficacy of dual- and single-hormone artificial pancreas systems in controlling plasma glucose levels over the course of one night's sleep...
March 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29381484/hypoglycemia-unawareness-in-type-1-diabetes-suppresses-brain-responses-to-hypoglycemia
#9
Janice Jin Hwang, Lisa Parikh, Cheryl Lacadie, Dongju Seo, Wai Lam, Muhammad Hamza, Christian Schmidt, Feng Dai, Anne-Sophie Sejling, Renata Belfort-DeAguiar, R Todd Constable, Rajita Sinha, Robert Sherwin
BACKGROUND: Among nondiabetic individuals, mild glucose decrements alter brain activity in regions linked to reward, motivation, and executive control. Whether these effects differ in type 1 diabetes mellitus (T1DM) patients with and without hypoglycemia awareness remains unclear. METHODS: Forty-two individuals (13 healthy control [HC] subjects, 16 T1DM individuals with hypoglycemia awareness [T1DM-Aware], and 13 T1DM individuals with hypoglycemia unawareness [T1DM-Unaware]) underwent blood oxygen level-dependent functional MRI brain imaging during a 2-step hyperinsulinemic euglycemic (90 mg/dl)-hypoglycemic (60 mg/dl) clamp for assessment of neural responses to mild hypoglycemia...
April 2, 2018: Journal of Clinical Investigation
https://www.readbyqxmd.com/read/29348712/assessment-of-ramadan-education-and-knowledge-among-diabetic-patients
#10
Mussa Hussain Almalki, Ibtihal Hussen, Shawana A Khan, Abdulrahman Almaghamsi, Fahad Alshahrani
Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients' overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City...
2018: Clinical Medicine Insights. Endocrinology and Diabetes
https://www.readbyqxmd.com/read/29273897/impact-of-flash-glucose-monitoring-on-hypoglycaemia-in-adults-with-type-1-diabetes-managed-with-multiple-daily-injection-therapy-a-pre-specified-subgroup-analysis-of-the-impact-randomised-controlled-trial
#11
Per Oskarsson, Ramiro Antuna, Petronella Geelhoed-Duijvestijn, Jens Krӧger, Raimund Weitgasser, Jan Bolinder
AIMS/HYPOTHESIS: Evidence for the effectiveness of interstitial glucose monitoring in individuals with type 1 diabetes using multiple daily injection (MDI) therapy is limited. In this pre-specified subgroup analysis of the Novel Glucose-Sensing Technology and Hypoglycemia in Type 1 Diabetes: a Multicentre, Non-masked, Randomised Controlled Trial' (IMPACT), we assessed the impact of flash glucose technology on hypoglycaemia compared with capillary glucose monitoring. METHODS: This multicentre, prospective, non-masked, RCT enrolled adults from 23 European diabetes centres...
March 2018: Diabetologia
https://www.readbyqxmd.com/read/29210476/delayed-revascularization-of-islets-after-transplantation-by-il-6-blockade-in-pig-to-non-human-primate-islet-xenotransplantation-model
#12
Byoung-Hoon Min, Jun-Seop Shin, Jong-Min Kim, Seong-Jun Kang, Hyun-Je Kim, Il-Hee Yoon, Su-Kyoung Park, Ji-Won Choi, Min-Suk Lee, Chung-Gyu Park
BACKGROUND: Pancreatic islet transplantation is currently proven as a promising treatment for type 1 diabetes patients with labile glycemic control and severe hypoglycemia unawareness. Upon islet transplantation, revascularization is essential for proper functioning of the transplanted islets. As IL-6 is important for endothelial cell survival and systemic inflammation related to xenograft, the effect of IL-6 receptor antagonist, tocilizumab, on revascularization of the transplanted islets was examined in pig to non-human primate islet xenotransplantation model...
January 2018: Xenotransplantation
https://www.readbyqxmd.com/read/29190340/continuous-glucose-monitoring-for-hypoglycemia-avoidance-and-glucose-counterregulation-in-long-standing-type-1-diabetes
#13
Michael R Rickels, Amy J Peleckis, Cornelia Dalton-Bakes, Joseph R Naji, Nina A Ran, Huong-Lan Nguyen, Shannon O'Brien, Sanjian Chen, Insup Lee, Mark H Schutta
Context: Patients with long-standing type 1 diabetes (T1D) are at increased risk for severe hypoglycemia because of defects in glucose counterregulation and recognition of hypoglycemia symptoms, in part mediated through exposure to hypoglycemia. Objective: To determine whether implementation of real-time continuous glucose monitoring (CGM) as a strategy for hypoglycemia avoidance could improve glucose counterregulation in patients with long-standing T1D and hypoglycemia unawareness...
January 1, 2018: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/29075301/insulinoma-masquerading-as-a-loss-of-consciousness-in-a-teenage-girl-case-report-and-literature-review
#14
Meghana Gudala, Mahmuda Ahmed, Rushika Conroy, Ksenia Tonyushkina
BACKGROUND: Hypoglycemia due to a pancreatic beta cell neoplasm - insulinoma, is uncommon with only a few cases described. We report on a previously healthy 15-year-old Hispanic female with insulinoma who presented with a loss of consciousness due to hypoglycemia unawareness. CASE PRESENTATION: EM was first brought to the emergency department (ED) after she was found unresponsive at home with point of care (POC) glucose of 29 mg/dL(1.6 mmol/L) documented by emergency medical services (EMS) upon arrival...
2017: International Journal of Pediatric Endocrinology
https://www.readbyqxmd.com/read/28888148/hypoglycemia-awareness-among-insulin-treated-patients-with-diabetes-in-malaysia-a-cohort-subanalysis-of-the-hat-study
#15
MULTICENTER STUDY
Zanariah Hussein, Nor Azmi Kamaruddin, Siew Pheng Chan, Anand Jain, Shweta Uppal, Wan Mohamad Wan Bebakar
AIMS: The present Malaysian cohort analysis determined the prevalence of hypoglycemia among patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) attending primary care- or hospital-based diabetes clinics in Malaysia and their awareness of the symptoms of hypoglycemia. METHODS: The Hypoglycemia Assessment Tool (HAT) study was a non-interventional, 6-month retrospective and 4-week prospective analysis of hypoglycemic events in 24 countries, using self-assessment questionnaires and diaries among patients with T1DM/T2DM aged ≥18years, using insulin for >12months...
November 2017: Diabetes Research and Clinical Practice
https://www.readbyqxmd.com/read/28796932/factors-associated-with-greater-benefit-of-a-national-reimbursement-policy-for-blood-glucose-test-strips-in-adult-patients-with-type-1-diabetes-a-prospective-cohort-study
#16
Sang-Man Jin, Jong Ha Baek, Sunghwan Suh, Chang Hee Jung, Woo Je Lee, Cheol-Young Park, Hae Kyung Yang, Jae Hyoung Cho, Byung-Wan Lee, Jae Hyeon Kim
AIMS/INTRODUCTION: We aimed to identify factors independently associated with greater benefit of a national reimbursement policy for blood glucose test strips in adult patients with type 1 diabetes (T1DM), in terms of glycemic control and rate of severe hypoglycemia. MATERIALS AND METHODS: This was a prospective cohort study of 466 adult patients with T1DM from five tertiary referral hospitals who registered for a national reimbursement program for blood glucose strips and were then followed-up for 12 months...
August 10, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/28719066/insights-into-optimal-basal-insulin-titration-in-type-2-diabetes-results-of-a-quantitative-survey
#17
Lori Berard, Mireille Bonnemaire, Marie Mical, Steve Edelman
AIMS: Basal insulin (BI) treatment initiation and dose titration in type 2 diabetes (T2DM) are often delayed. Such "clinical inertia" results in poor glycaemic control and high risk of long-term complications. This survey aimed to determine healthcare professional (HCP) and patient attitudes to BI initiation and titration. METHODS: An online survey (July-August 2015) including HCPs and patients with T2DM in the USA, France and Germany. Patients were ≥18 years old and had been on BI for 6 to 36 months, or discontinued BI within the previous 12 months...
February 2018: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28683068/prediction-of-nocturnal-hypoglycemia-unawareness-by-fasting-glucose-levels-or-post-breakfast-glucose-fluctuations-in-patients-with-type-1-diabetes-receiving-insulin-degludec-a-pilot-study
#18
Hiroshi Takahashi, Rimei Nishimura, Yoshiko Onda, Kiyotaka Ando, Daisuke Tsujino, Kazunori Utsunomiya
OBJECTIVE: To evaluate whether nocturnal asymptomatic hypoglycemia (NAH) can be predicted by fasting glucose levels or post-breakfast glucose fluctuations in patients with type 1 diabetes (T1D) receiving insulin degludec. METHODS: Patients with T1D receiving insulin degludec underwent at-home CGM assessments. Indices for glycemic variability before and after breakfast included fasting glucose levels and the range of post-breakfast glucose elevation. For comparison, the patients were classified into those with NAH and those without...
2017: PloS One
https://www.readbyqxmd.com/read/28632818/benefits-of-islet-transplantation-as-an-alternative-to-pancreas-transplantation-retrospective-study-of-more-than-10-ten-years-of-experience-in-a-single-center
#19
Barbora Voglová, Martina Zahradnická, Peter Girman, Jan Kríž, Zuzana Berková, Tomáš Koblas, Ema Vávrová, Lenka Németová, Lucie Kosinová, David Habart, Eva Fábryová, Eva Dovolilová, Ivan Leontovyc, Tomáš Neškudla, Jan Peregrin, Jozef Kovác, Kvetoslav Lipár, Matej Kocík, Tomáš Marada, Jirí Svoboda, František Saudek
BACKGROUND: Pancreas transplantation (PTx) represents the method of choice in type 1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. In 2005, the Institute for Clinical and Experimental Medicine (IKEM) launched a program to investigate the safety potential of islet transplantation (ITx) in comparison to PTx. AIM: This study aims to compare the results of PTx and ITx regarding severe hypoglycemia elimination, metabolic control, and complication rate...
2017: Review of Diabetic Studies: RDS
https://www.readbyqxmd.com/read/28589447/cognitive-neurophysiologic-and-metabolic-sequelae-of-previous-hypoglycemic-coma-revealed-by-hyperinsulinemic-hypoglycemic-clamp-in-type-1-diabetic-patients
#20
Alberto Maran, Cristina Crepaldi, Franco Del Piccolo, Ian Macdonald, Lisa Zarantonello, Angelo Avogaro, Piero Amodio
To examine the relationship between electroencephalographic (EEG) activity and hypoglycemia unawareness, we investigated early parameters of vigilance and awareness of various symptom categories in response to hypoglycemia in intensively treated type 1 diabetic (T1DM) patients with different degrees of hypoglycemia unawareness. Hypoglycemia was induced with a hyperinsulinemic-hypoglycemic clamp in six T1DM patients with a history of hypoglycemia unawareness previous severe hypoglycemic coma (SH) and in six T1DM patients without (C) history of hypoglycemia unawareness previous severe hypoglycemic coma...
June 6, 2017: Metabolic Brain Disease
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