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https://www.readbyqxmd.com/read/29344829/rapid-acting-and-regular-insulin-are-equal-for-high-fat-protein-meal-in-individuals-with-type-1-diabetes-treated-with-multiple-daily-injections
#1
Karolina Jabłońska, Piotr Molęda, Krzysztof Safranow, Lilianna Majkowska
INTRODUCTION: The fat and protein content can impact late postprandial glycemia; therefore, prolonged insulin boluses for high-fat/-protein meals are recommended for patients with type 1 diabetes on insulin pump therapy. It is not clear how to translate these findings to multiple daily injection (MDI) therapy. We hypothesized that regular insulin with a slower onset and a longer duration of action might be advantageous for such meals. METHODS: Twenty-five patients with well-controlled type 1 diabetes (mean HbA1c 6...
January 17, 2018: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/29340167/subcutaneous-glucagon-infusion-and-continuous-glucose-monitoring-enable-effective-management-of-hypoglycemia-in-a-patient-with-igf-2-producing-hemangiopericytoma
#2
Eric D Buras, Emily Weatherup, Jennifer Wyckoff
Background: Ectopic insulin-like growth factor (IGF)-2 production is a rare complication of an array of epithelial and mesenchymal tumors, and can clinically manifest as life-threatening hypoglycemia. Case presentation: A 49-year-old woman with 13-year history of metastatic hemangiopericytoma, previously treated with multiple rounds of chemotherapy and palliative radiation, presented to the emergency department after a hypoglycemic seizure. On arrival, glucose was 18 mg/dL (1...
2018: Clinical Diabetes and Endocrinology
https://www.readbyqxmd.com/read/29337383/the-national-pregnancy-in-diabetes-npid-audit-challenges-and-opportunities-for-improving-pregnancy-outcomes
#3
H R Murphy, R Bell, A Dornhorst, R Forde, N Lewis-Barned
Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22...
January 16, 2018: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29316338/efficacy-of-automatic-bolus-calculator-with-automatic-speech-recognition-in-patients-with-type-1-diabetes-a-randomized-crossover-trial
#4
Piotr Foltynski, Piotr Ladyzynski, Ewa Pankowska, Karolina Mazurczak
BACKGROUND: Patients using an insulin pump as part of their diabetes treatment need to calculate insulin bolus to compensate for a meal. Some patients do not modify their meal boluses according to the changing amount and composition of food products in a meal. The lack of correct meal boluses leads to unstable, and therefore harmful blood glucose levels. The aim of the current study was to test the system supporting bolus determination based on the voice description of a meal. METHODS: The developed bolus calculator consists of the smartphone application and three remote servers for automatic speech recognition, text analysis, and insulin dosage calculation...
January 8, 2018: Journal of Diabetes
https://www.readbyqxmd.com/read/29303370/the-effects-of-subcutaneous-insulin-infusion-versus-multiple-insulin-injections-on-glucose-variability-in-young-adults-with-type-1-diabetes-the-2-year-follow-up-of-the-observational-metro-study
#5
Maria Ida Maiorino, Giuseppe Bellastella, Ofelia Casciano, Paolo Cirillo, Vittorio Simeon, Paolo Chiodini, Michela Petrizzo, Maurizio Gicchino, Ornella Romano, Paola Caruso, Dario Giugliano, Katherine Esposito
BACKGROUND: Type 1 diabetic patients have high instability of daily glucose levels. The aim of this study was to evaluate the long-term effects of continuous subcutaneous insulin infusion (CSII) therapy, compared with multiple daily injections of insulin (MDI), on glucose variability, in young type 1 diabetic patients transitioned to the adult diabetes care. METHODS: Patients aged 18-30 years and considered eligible for insulin pump therapy were included in the study...
January 5, 2018: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29298818/fifteen-minute-consultation-insulin-pumps-for-type-1-diabetes-in-children-and-young-people
#6
Philippa Prentice, Daniela Elleri
There is increasing worldwide use of continuous subcutaneous insulin infusions in paediatric type 1 diabetes (T1D), reflecting recent research outcomes and guidance, as well as families' wishes. Children/young people may present acutely with medical or surgical problems, in addition to issues related to T1D. This review provides general paediatricians with an introduction to pump therapy, highlighting common problems, management issues and when to seek specialist advice.
January 3, 2018: Archives of Disease in Childhood. Education and Practice Edition
https://www.readbyqxmd.com/read/29295580/diabetic-ketoacidosis-severity-at-diagnosis-and-glycaemic-control-in-the-first-year-of-childhood-onset-type-1-diabetes-a-longitudinal-cohort-study
#7
Amal R Khanolkar, Rakesh Amin, David Taylor-Robinson, Russell M Viner, Justin Warner, Evelien F Gevers, Terence Stephenson
It is unclear whether diabetic ketoacidosis (DKA) severity at diagnosis affects the natural history of type 1 diabetes (T1D). We analysed associations between DKA severity at diagnosis and glycaemic control during the first year post-diagnosis. We followed 341 children with T1D, <19 years (64% non-white) attending paediatric diabetes clinics in East London. Data were extracted from routine medical registers. Subjects were categorized with normal, mild, moderate, or severe DKA. Linear mixed-effects modelling was used to assess differences in longitudinal HbA1c trajectories (glycaemic control) during 12 months post-diagnosis (1288 HbA1c data-points) based on DKA, adjusting for sex, age, ethnicity, SES (Socioeconomic Status) and treatment type...
December 25, 2017: International Journal of Environmental Research and Public Health
https://www.readbyqxmd.com/read/29288524/insulin-deficiency-with-and-without-glucagon-a-comparative-study-between-total-pancreatectomy-and-type-1-diabetes
#8
Fumimaru Niwano, Yoshihisa Hiromine, Shinsuke Noso, Naru Babaya, Hiroyuki Ito, Sara Yasutake, Ippei Matsumoto, Yoshifumi Takeyama, Yumiko Kawabata, Hiroshi Ikegami
AIMS: Patients with total pancreatectomy and type 1 diabetes are similar in absolute insulin deficiency, but different in glucagon, providing unique opportunity to study the contribution of glucagon on glucose metabolism in insulin-dependent state. To investigate the contribution of glucagon to glucose homeostasis in complete insulin deficiency in vivo. METHODS: A total of 38 subjects with a complete lack of endogenous insulin (fasting C-peptide < 0.0066 nmol/L) and whose glycemic control was optimized with an insulin pump during hospitalization were retrospectively studied...
December 30, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/29285796/weight-based-carbohydrate-treatment-of-hypoglycaemia-in-people-with-type-1-diabetes-using-insulin-pump-therapy-a-randomized-crossover-clinical-trial
#9
L McTavish, B Corley, M Weatherall, E Wiltshire, J D Krebs
AIM: To test whether weight-based treatment is more effective than usual care in people with Type 1 diabetes receiving continuous subcutaneous insulin infusion therapy with regard to both hypoglycaemia and avoiding excessive rebound hyperglycaemia. METHODS: Children and adults on continuous subcutaneous insulin infusion were enrolled into a study with a crossover design. Each episode of hypoglycaemia (defined as capillary glucose <4.0 mmol/l) was randomly assigned one of two treatment protocols using glucose tablets: either 0...
December 28, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29284290/occlusion-detection-time-in-insulin-pumps-at-two-different-basal-rates
#10
Guido Freckmann, Ulrike Kamecke, Delia Waldenmaier, Cornelia Haug, Ralph Ziegler
BACKGROUND: The detection of insulin infusion set (IIS) occlusions is an important feature of insulin pumps with regard to patient safety. However, there are no requirements for a time limit until an alarm has to be triggered after an occlusion occurred. The standard IEC 60601-2-24 is applicable for insulin pumps and describes test settings and procedures to determine occlusion detection time (ODT). METHODS: In this study, ODT of six different insulin pump models with different IIS (in total 10 different insulin pump systems) was tested for two basal rates (1...
December 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/29258910/glucose-responsive-insulin-delivery-for-type-1-diabetes-the-artificial-pancreas-story
#11
Lia Bally, Hood Thabit, Roman Hovorka
Insulin replacement therapy is integral to the management of type 1 diabetes, which is characterised by absolute insulin deficiency. Optimal glycaemic control, as assessed by glycated haemoglobin, and avoidance of hyper- and hypoglycaemic excursions have been shown to prevent diabetes-related complications. Insulin pump use has increased considerably over the past decade with beneficial effects on glycaemic control, quality of life and treatment satisfaction. The advent and progress of ambulatory glucose sensor technology has enabled continuous glucose monitoring based on real-time glucose levels to be integrated with insulin therapy...
December 16, 2017: International Journal of Pharmaceutics
https://www.readbyqxmd.com/read/29247547/psychosocial-impacts-of-hybrid-closed-loop-systems-in-the-management-of-diabetes-a-review
#12
C Farrington
There is a pressing need for new treatment regimens that enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop, or artificial pancreas, systems represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms that process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps...
December 16, 2017: Diabetic Medicine: a Journal of the British Diabetic Association
https://www.readbyqxmd.com/read/29224132/treatment-of-mild-to-moderate-hypoglycemia-in-patients-with-type-1-diabetes-treated-with-insulin-pump-therapy-are-current-recommendations-effective
#13
Véronique Gingras, Katherine Desjardins, Mohamed Raef Smaoui, Valérie Savard, Virginie Messier, Ahmad Haidar, Laurent Legault, Rémi Rabasa-Lhoret
AIMS: Mild-to-moderate hypoglycemia (blood glucose < 4.0 mmol/L) is recommended to be treated with 15 g of carbohydrates and to repeat the treatment if hypoglycemia persists after 15 min. This recommendation was established before intensive insulin therapy and based on studies using insulin with different pharmacokinetic profiles from actual insulin analogs showing that 15 g of glucose increases blood glucose by ~ 1.5 mmol/L in 15 min. We aimed to explore the effect of current recommended treatment of mild-to-moderate hypoglycemia in type 1 diabetes (T1D) participants and factors associated with treatment effectiveness...
December 9, 2017: Acta Diabetologica
https://www.readbyqxmd.com/read/29215299/complex-assessment-of-metabolic-effectiveness-of-insulin-pump-therapy-in-patients-with-type-2-diabetes-beyond-hba1c-reduction
#14
Rudolf Chlup, Sarah Runzis, Javier Castaneda, Scott W Lee, Xuan Nguyen, Ohad Cohen
BACKGROUND: This prospective single-center study recruited insulin-resistant continuous subcutaneous insulin infusion (CSII) therapy-naive patients with type 2 diabetes (T2D) using insulin analog-based multiple daily injections (MDI) therapy and metformin. METHODS: A total of 23 individuals with T2D (70% male), aged a mean ± standard deviation 57.2 ± 8.03 years, with body mass index of 36.2 ± 7.02 kg/m2, diabetes duration of 13.3 ± 4.64 years, and HbA1c of 10...
December 7, 2017: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/29212599/depressive-symptoms-at-critical-times-in-youth-with-type-1-diabetes-following-type-1-diabetes-diagnosis-and-insulin-pump-initiation
#15
Dayna E McGill, Lisa K Volkening, David M Pober, Andrew B Muir, Deborah L Young-Hyman, Lori M Laffel
PURPOSE: Depressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy. METHODS: Youth with type 1 diabetes (N = 96), ages 10-17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation...
December 4, 2017: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/29212333/-quo-vadis-diabetes-technology
#16
George Grunberger
Management of patients with diabetes mellitus who require intensive insulin therapy has changed dramatically. From urine and then whole blood glucose monitoring patients can now wear personal continuous glucose monitors; from using multiple insulin injections they can now deliver subcutaneous insulin continuously using ever-more sophisticated insulin pumps. With the current integration of continuous glucose monitoring and insulin pumps a new era is arriving when "smart" insulin pumps can automate insulin delivery to assure more stable glycemic control while minimizing episodes of hypoglycemia...
2017: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29212332/quo-vadis-diabetes-technology
#17
George Grunberger
Management of patients with diabetes mellitus who require intensive insulin therapy has changed dramatically. From urine and then whole blood glucose monitoring patients can now wear personal continuous glucose monitors; from using multiple insulin injections they can now deliver subcutaneous insulin continuously using ever-more sophisticated insulin pumps. With the current integration of continuous glucose monitoring and insulin pumps a new era is arriving when "smart" insulin pumps can automate insulin delivery to assure more stable glycemic control while minimizing episodes of hypoglycemia...
2017: Casopís Lékar̆ů C̆eských
https://www.readbyqxmd.com/read/29204367/protein-and-fat-meal-content-increase-insulin-requirement-in-children-with-type-1-diabetes-role-of-duration-of-diabetes
#18
M van der Hoogt, J C van Dyk, R C Dolman, M Pieters
Background and objective: Hyperglycaemia remains a challenge in type 1 diabetes since current regimes used to determine meal insulin requirements prove to be ineffective. This is particularly problematic for meals containing high amounts of protein and fat. We aimed to determine the post-prandial glycaemic response and total insulin need for mixed meals, using sensor-augmented insulin pumps in children with type 1 diabetes. Methods: Twenty-two children with type 1 diabetes, aged 4-17 years on insulin pump therapy completed this home-based, cross-over, randomised controlled trial...
December 2017: Journal of Clinical & Translational Endocrinology
https://www.readbyqxmd.com/read/29193795/lower-mean-blood-glucose-during-short-term-intensive-insulin-therapy-is-associated-with-long-term-glycemic-remission-in-patients-with-newly-diagnosed-type-2-diabetes-evidence-based-recommendations-for-standardization
#19
Liehua Liu, Juan Liu, Lijuan Xu, Weijian Ke, Xuesi Wan, Hai Li, Xiaoying He, Liangjiao Wang, Xiaopei Cao, Haipeng Xiao, Yanbing Li
AIMS/INTRODUCTION: Optimal glycemic targets during short-term intensive insulin therapy in patients with newly diagnosed type 2 diabetes were not standardized. This study is performed to determine the optimal glycemic targets during the therapy by analyzing the impacts of glucose levels on therapeutic outcomes. MATERIALS AND METHODS: Nighty-five subjects with newly diagnosed type 2 diabetes were enrolled. Short-term intensive insulin therapy was carried out using insulin pump to achieve and maintain glycemic targets (FBG< 6...
November 30, 2017: Journal of Diabetes Investigation
https://www.readbyqxmd.com/read/29191845/revisiting-the-relationships-between-measures-of-glycemic-control-and-hypoglycemia-in-continuous-glucose-monitoring-datasets
#20
Marga Gimenez, Amitai Jeremy Tannen, Monika Reddy, Vanessa Moscardo, Ignacio Conget, Nick Oliver
OBJECTIVE: The Diabetes Control and Complications Trial identified an inverse relationship between HbA1c and severe hypoglycemia. We investigated the relationship between hypoglycemia and HbA1c in a large type 1 diabetes cohort on multiple daily injection or insulin pump therapy using blinded continuous glucose monitoring (CGM) data. The impact of real-time CGM on these relationships and how these relationships differ with biochemical definitions of hypoglycemia have also been assessed...
November 30, 2017: Diabetes Care
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