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Hypoglycemia

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https://www.readbyqxmd.com/read/28234964/whole-genome-expression-profiling-associates-activation-of-unfolded-protein-response-with-impaired-production-and-release-of-epinephrine-after-recurrent-hypoglycemia
#1
Juhye Lena Kim, Edmund F La Gamma, Todd Estabrook, Necla Kudrick, Bistra B Nankova
Recurrent hypoglycemia can occur as a major complication of insulin replacement therapy, limiting the long-term health benefits of intense glycemic control in type 1 and advanced type 2 diabetic patients. It impairs the normal counter-regulatory hormonal and behavioral responses to glucose deprivation, a phenomenon known as hypoglycemia associated autonomic failure (HAAF). The molecular mechanisms leading to defective counter-regulation are not completely understood. We hypothesized that both neuronal (excessive cholinergic signaling between the splanchnic nerve fibers and the adrenal medulla) and humoral factors contribute to the impaired epinephrine production and release in HAAF...
2017: PloS One
https://www.readbyqxmd.com/read/28230322/comparative-effectiveness-and-safety-of-different-basal-insulins-in-a-real-world-setting
#2
Linong Ji, Puhong Zhang, Dongshan Zhu, Juming Lu, Xiaohui Guo, Yangfeng Wu, Xian Li, Jiachao Ji, Weiping Jia, Wenying Yang, Dajin Zou, Zhiguang Zhou, Yan Gao, Satish K Garg, Changyu Pan, Jianping Weng, Sanjoy K Paul
AIMS: To compare glucose control and safety of different basal insulin (BI, including Insulin NPH, glargine and detemir) therapies in real-life clinical settings based on a large-scale registry study. METHODS: In this multi-center 6-month prospective observational study, patients with type 2 diabetes uncontrolled (HbA1c≥7%) by oral anti-diabetic drugs (OADs) and willing to initiate BI were enrolled from 209 hospitals of eight regions of China. Type and dose of BI were at the physician's discretion and patients' willingness...
February 23, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28229636/exercise-partially-reverses-the-inhibitory-effect-of-caffeine-on-liver-gluconeogenesis-in-type-1-diabetic-rats-with-hypoglycemia
#3
E H Gilglioni, C M Ghuidotti, V R Vilela, C Bataglini, J P Furlan, J A Berti, Mmd Pedrosa, Vaf Godoi
The purpose was to determine the possible effects of exercise and/or caffeine on hypoglycemia and liver gluconeogenesis in diabetic rats. These were divided into four subgroups: (a) intraperitoneal insulin only, (b) exercise bout before insulin, (c) caffeine after insulin, and (d) exercise bout before and caffeine after insulin. The marked glycemic drop 45 min after insulin (0 min = 229.00, 45 min = 75.75) was considerably reduced (p < 0.05) by caffeine or exercise (45 min: exercise = 127...
September 2016: Physiol Int
https://www.readbyqxmd.com/read/28228892/metastatic-extrapleural-malignant-solitary-fibrous-tumor-presenting-with-hypoglycemia-doege-potter-syndrome
#4
Andrew J Degnan, Kenneth K W Lee, Marta I Minervini, Amir A Borhani
We report a rare case of metastatic malignant solitary fibrous tumor (SFT) that presented with hypoglycemia because of insulin growth factor-2 production. Initial workup included computed tomography imaging that revealed a large, partially necrotic liver mass, a hypervascular pancreatic head lesion, and 2 renal lesions. Following hepatic resection, pancreatic head resection and nephrectomy, all these lesions demonstrated pathological findings that were consistent with SFT. The patient also had a history of an intracranial mass that had been previously resected and treated with gamma knife therapy at an outside institution, which was found to also be SFT...
March 2017: Radiology case reports
https://www.readbyqxmd.com/read/28228574/delays-in-door-to-needle-times-and-their-impact-on-treatment-time-and-outcomes-in-get-with-the-guidelines-stroke
#5
Noreen Kamal, Shubin Sheng, Ying Xian, Roland Matsouaka, Michael D Hill, Deepak L Bhatt, Jeffrey L Saver, Mathew J Reeves, Gregg C Fonarow, Lee H Schwamm, Eric E Smith
BACKGROUND AND PURPOSE: Despite quality improvement programs such as the American Heart Association/American Stroke Association Target Stroke initiative, a substantial portion of acute ischemic stroke patients are still treated with tissue-type plasminogen activator (alteplase) later than 60 minutes from arrival. This study aims to describe the documented reasons for delays and the associations between reasons for delays and patient outcomes. METHODS: We analyzed the characteristics of 55 296 patients who received intravenous alteplase in 1422 hospitals participating in Get With The Guidelines-Stroke from October 2012 to April 2015, excluding transferred patients and inpatient strokes...
February 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28227270/deep-learning-framework-for-detection-of-hypoglycemic-episodes-in-children-with-type-1-diabetes
#6
Phyo Phyo San, Sai Ho Ling, Hung T Nguyen, Phyo Phyo San, Sai Ho Ling, Hung T Nguyen, Sai Ho Ling, Hung T Nguyen, Phyo Phyo San
Most Type 1 diabetes mellitus (T1DM) patients have hypoglycemia problem. Low blood glucose, also known as hypoglycemia, can be a dangerous and can result in unconsciousness, seizures and even death. In recent studies, heart rate (HR) and correct QT interval (QTc) of the electrocardiogram (ECG) signal are found as the most common physiological parameters to be effected from hypoglycemic reaction. In this paper, a state-of-the-art intelligent technology namely deep belief network (DBN) is developed as an intelligent diagnostics system to recognize the onset of hypoglycemia...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28226972/design-of-a-dual-hormone-model-predictive-control-for-artificial-pancreas-with-exercise-model
#7
Navid Resalat, Joseph El Youssef, Ravi Reddy, Peter G Jacobs, Navid Resalat, Joseph El Youssef, Ravi Reddy, Peter G Jacobs, Navid Resalat, Joseph El Youssef, Peter G Jacobs, Ravi Reddy
The Artificial Pancreas (AP) is a new technology for helping people with type 1 diabetes to better control their glucose levels through automated delivery of insulin and optionally glucagon in response to sensed glucose levels. In a dual hormone AP, insulin and glucagon are delivered automatically to the body based on glucose sensor measurements using a control algorithm that calculates the amount of hormones to be infused. A dual-hormone MPC may deliver insulin continuously; however, it must avoid continuous delivery of glucagon because nausea can occur from too much glucagon...
August 2016: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
https://www.readbyqxmd.com/read/28225638/laparoscopic-resection-of-pancreatic-tumors-in-children-results-of-a-multicentric-survey
#8
Ciro Esposito, Pascal De Lagausie, Maria Escolino, Amulya Saxena, George W Holcomb, Alessandro Settimi, Francois Becmeur, David van der Zee
AIM: This study aimed to report the results of a multicentric survey about laparoscopic treatment of pancreatic tumors in children. MATERIALS AND METHODS: The data of patients operated using minimally invasive surgery (MIS) for a pancreatic tumor in 5 International centers of Pediatric Surgery in the last 5 years were retrospectively reviewed. We recorded data relating to the clinical presentation, diagnostic evaluation, surgical technique, and outcome. RESULTS: Fifteen patients (average age 2...
February 22, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28225432/use-of-dipeptidyl-peptidase-4-inhibitors-in-patients-with-type-2-diabetes-and-chronic-kidney-disease
#9
Polly A Bittle
There is a need for treatment options in patients with type 2 diabetes mellitus and kidney disease to achieve glucose targets without risk of hypoglycemia. This article describes management options for these patients using glucose-lowering therapies, in particular dipeptidyl peptidase-4 inhibitors.
February 20, 2017: Nurse Practitioner
https://www.readbyqxmd.com/read/28225315/improving-glycemic-control-safely-in-critical-care-patients-a-collaborative-systems-approach-in-nine-hospitals
#10
Gregory A Maynard, Janet Holdych, Heather Kendall, Karen Harrison, Patricia A Montgomery, Kristen Kulasa
Objective Safely improve glycemic control in the critical care units of nine hospitals. Methods Critical care adult inpatients from nine hospitals with ≥ 4 point-of-care (POC) blood glucose (BG) readings over ≥ 2 days were targeted by collaborative improvement efforts to reduce hyper- and hypo-glycemia. Balanced glucometric goals for each hospital were set targeting improvement from baseline, or goals deemed desirable from Society of Hospital Medicine (SHM) benchmarking data. Collaborative interventions included standardized insulin infusion protocols, hypoglycemia prevention bundles, audit and feedback, education, and measure-vention (coupling measurement of patients "off protocol" with concurrent interventions to correct suboptimal care)...
February 22, 2017: Endocrine Practice
https://www.readbyqxmd.com/read/28225059/decreased-levels-of-fibroblast-growth-factor-21-are-correlated-with-improved-hypoglycemia-in-patients-with-insulinoma
#11
Xu Li, Haoyong Yu, Jun Yin, Lianxi Li, Jian Zhou, Ming Li, Qing Li, Haibing Chen, Fang Liu, Yuqian Bao, Junfeng Han, Weiping Jia
Fibroblast growth factor-21 (FGF-21) improves insulin sensitivity and lipid metabolism in obese or diabetic animal models and has been proposed as a potential therapeutic agent for treating T2DM, obesity, and their related complications. However, little is known about the changes of FGF21 levels in response to endogenous hyperinsulinemic hypoglycemia. To explore its relationship with parameters of glucose metabolism in patients with insulinoma, eleven subjects with pathological insulinoma and twenty-two healthy subjects were recruited for this study...
February 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28225016/novel-liver-targeted-conjugates-of-glycogen-phosphorylase-inhibitor-psn-357-for-the-treatment-of-diabetes-design-synthesis-pharmacokinetic-and-pharmacological-evaluations
#12
Liying Zhang, Chengjun Song, Guangxin Miao, Lianzhi Zhao, Zhiwei Yan, Jing Li, Youde Wang
PSN-357, an effective glycogen phosphorylase (GP) inhibitor for the treatment for type 2 diabetics, is hampered in its clinical use by the poor selectivity between the GP isoforms in liver and in skeletal muscle. In this study, by the introduction of cholic acid, 9 novel potent and liver-targeted conjugates of PSN-357 were obtained. Among these conjugates, conjugate 6 exhibited slight GP inhibitory activity (IC50 = 31.17 μM), good cellular efficacy (IC50 = 13.39 μM) and suitable stability under various conditions...
February 22, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28224463/liraglutide-versus-lixisenatide-long-term-cost-effectiveness-of-glp-1-receptor-agonist-therapy-for-the-treatment-of-type-2-diabetes-in-spain
#13
Pedro Mezquita-Raya, Antonio Ramírez de Arellano, Nana Kragh, Gabriela Vega-Hernandez, Johannes Pöhlmann, William J Valentine, Barnaby Hunt
INTRODUCTION: Glucagon-like peptide-1 (GLP-1) receptor agonists are used successfully in the treatment of patients with type 2 diabetes as they are associated with low hypoglycemia rates, weight loss and improved glycemic control. This study compared, in the Spanish setting, the cost-effectiveness of liraglutide 1.8 mg versus lixisenatide 20 μg, both GLP-1 receptor agonists, for patients with type 2 diabetes who had not achieved glycemic control targets on metformin monotherapy. METHODS: The IMS CORE Diabetes Model was used to project clinical outcomes and costs, expressed in 2015 Euros, over patient lifetimes...
February 21, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28224092/language-and-cognitive-outcome-for-high-risk-neonates-at-the-age-of-2-3-years-experience-from-an-arab-country
#14
Tamer Abou-Elsaad, Hesham Abdel-Hady, Hemmat Baz, Doaa ElShabrawi
AIM: To investigate the effect of different neonatal risk factors on different language parameters as well as cognitive abilities among Arabic speaking Egyptian children at the age of two to three years of life and to find out which risk factor(s) had the greatest impact on language and cognitive abilities. METHODS: This retrospective cohort study was conducted on 103 children with age range of 2-3 years (median age 31 mo). They were 62 males and 41 females who were exposed to different high-risk factors in the perinatal period, with exclusion of metabolic disorders, sepsis/meningitis, congenital anomalies and chromosomal aberrations...
February 8, 2017: World Journal of Clinical Pediatrics
https://www.readbyqxmd.com/read/28223444/basal-glucose-can-be-controlled-but-the-prandial-problem-persists-it-s-the-next-target
#15
Matthew C Riddle
Both basal and postprandial elevations contribute to the hyperglycemic exposure of diabetes, but current therapies are mainly effective in controlling the basal component. Inability to control postprandial hyperglycemia limits success in maintaining overall glycemic control beyond the first 5 to 10 years after diagnosis, and it is also related to the weight gain that is common during insulin therapy. The "prandial problem"-comprising abnormalities of glucose and other metabolites, weight gain, and risk of hypoglycemia-deserves more attention...
March 2017: Diabetes Care
https://www.readbyqxmd.com/read/28223296/cardiac-effects-of-sulfonylurea-related-hypoglycemia
#16
Timothy L Middleton, Jencia Wong, Lynda Molyneaux, Belinda A Brooks, Dennis K Yue, Stephen M Twigg, Ted Wu
OBJECTIVE: To determine the effect of sulfonylurea-related hypoglycemia on cardiac repolarization and ectopy in the setting of well-controlled type 2 diabetes. RESEARCH DESIGN AND METHODS: Thirty subjects with sulfonylurea-treated type 2 diabetes underwent 48 h of concurrent continuous glucose monitoring and ambulatory electrocardiography. Ventricular repolarization (QTc) and QT dynamicity were analyzed during periods of hypoglycemia (<3.5 mmol/L for >20 min) and compared with periods of euglycemia and hyperglycemia combined...
February 21, 2017: Diabetes Care
https://www.readbyqxmd.com/read/28222404/glycemic-control-in-patients-with-insulinoma
#17
REVIEW
Agata Matej, Hanna Bujwid, Jakub Wroński
Insulinoma is the most common neuroendocrine tumor of the pancreas. Surgical management of insulinomas is considered to be the only curative method. However, effective glycemic control preoperatively and in unresectable insulinomas remains a significant issue. Hyperinsulinism, occurring as a result of the hormone-secreting tumor, leads to life-threatening hypoglycemia episodes which require urgent medical treatment. This article discusses current management of hypoglycemia in insulinoma patients, including: education and lifestyle modifications, pharmacotherapy (diazoxide, somatostatin analogs, mTOR inhibitor - everolimus), cytoreductive methods and continuous glucose monitoring systems...
October 2016: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28221823/evaluation-of-a-predictive-low-glucose-management-system-in-clinic
#18
Bruce A Buckingham, Timothy S Bailey, Mark Christiansen, Satish Garg, Stuart Weinzimer, Bruce Bode, Stacey M Anderson, Ron Brazg, Trang Ly, Francine R Kaufman
BACKGROUND: Predictions based on continuous glucose monitoring (CGM) data are the basis for automatic suspension and resumption of insulin delivery by a predictive low-glucose management feature termed "suspend before low," which is part of the Medtronic MiniMed(®) 640G combined insulin pump and CGM system. This study assessed the safety and performance characteristics of the system in an in-clinic setting at eight sites. MATERIALS AND METHODS: In-clinic standardized increases in basal insulin delivery rates were used to induce nocturnal hypoglycemia in subjects (14-75 years) with type 1 diabetes wearing the MiniMed 640G system...
February 16, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/28220460/glycemic-control-in-a-real-life-setting-in-patients-with-type-2-diabetes-treated-with-ideglira-at-a-single-swiss-center
#19
Daniela Sofra
INTRODUCTION: The aim of the present study was to describe clinical outcomes in a real-world population of Swiss patients with long-standing, poorly controlled type 2 diabetes after switching to IDegLira [a combination of insulin degludec (IDeg) and liraglutide (Lira)]. METHODS: This was a prospective, open-label, single-center observational follow-up at the Cabinet Medical de Diabétologie, Lausanne, Switzerland, of 61 patients [HbA1c 9.2% (77 mmol/mol) and 56...
February 20, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28218564/-a-brief-of-gestational-diabetes-mellitus-risk-factors-and-current-criteria-of-diagnosis
#20
Zahra Al-Aissa, Orsolya Hadarits, Klára Rosta, András Zóka, János Rigó, Gábor Firneisz, Anikó Somogyi
Diabetes is one of the most common metabolic disorders that may cause pathological pregnancy. Treating diabetes recognized during pregnancy results in lowering maternal and fetal complications. These patients present higher risk for excessive weight gain, preeclampsia, delivery with cesarean sections, high risk of developing type 2 diabetes and cardiovascular disease in the future. Fetuses of mothers with gestational diabetes are at higher risk for macrosomia and birth trauma, after delivery they present higher risk of developing neonatal hypoglycemia, hyperbilirubinemia, and respiratory distress syndrome...
February 2017: Orvosi Hetilap
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