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Terahertz Time-Domain Spectroscopy in the Assessment of Diabetic Complications
Published in Andrey V. Dunaev, Valery V. Tuchin, Biomedical Photonics for Diabetes Research, 2023
Sviatoslav I. Gusev, Ravshanjon Kh. Nazarov, Petr S. Demchenko, Tianmiao Zhang, Olga P. Cherkasova, Mikhail K. Khodzitsky
After data acquisition, the next step is finding dependencies between glucose concentrations and optical properties. To determine the dependence of blood optical properties upon glucose concentration, we selected the experimental data at 0.30, 0.35 0.40, and 0.45 THz. These frequencies were chosen due to maximal THz electric field amplitude and minimal absorption of water vapor [46]. Figure 10.6 shows the dependences of glucose concentration on the real part of the refractive index and on the real part of the permittivity. The dependence is not linear with blood glucose concentrations above 16 mmol/l. This may be due to the change in physicochemical properties of blood components with high glucose concentration [47,48]. As known, hyperglycemia caused by insulin deficiency is accompanied by a large loss of electrolytes, dehydration of tissues, and osmolality increase of blood plasma. In a week, we repeated these experiments to check the dependence of glucose level on the blood optical properties. The comparison of data of two experiments is shown in Figure 10.6. We observe the shift of the calibration curves, but the shape of the curves was similar. This shift may be caused by the variation of the concentrations of the patient blood components (cholesterol, uric acid, etc.) in another experiment.
The Initial Metabolic Medicine Hospital Consult
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Make note if the patient is diabetic and how much insulin or oral meds they required. Alternatively, a non-diabetic patient may experience glucose elevation because of stress metabolism. The amount of insulin resistance is a factor in determining if insulin must be added to the TPN or if sliding scale coverage is needed for the tube feeding. Much has been said about the quantity of insulin required in nutritional support (Gosmanov and Umpierrez 2013). In the very early days of high-dextrose TPN, insulin was a standard additive. But with lower, physiologic doses of glucose, we no longer add insulin routinely. Instead, insulin is added to control for severe hyperglycemia. We also now know that overly tight glucose control can be harmful, especially in the elderly (Quartuccio, Buta, and Kalyani 2017). Our goal is to give enough insulin to keep the blood glucose between 150 and 200.
Diabetic Retinopathy
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Charumathi Sabanayagam, Tien Yin Wong
Lifestyle interventions, including weight loss and increased physical activity, have been shown to reduce hyperglycemia and the need for medications in diabetic patients.56 Physical activity was found to have a protective effect on DR (risk reduction by 6%) in patients with diabetes and the effect was more pronounced in those with VTDR (risk reduction by 11%) in a meta-analysis.57 Improving self-care behaviors, including adherence to recommended diet, exercise, antidiabetic and antihypertensive medication, self-monitoring of blood glucose, and regular retinal screening, improve diabetes care and management.32
Advances in oxidative stress in pathogenesis of diabetic kidney disease and efficacy of TCM intervention
Published in Renal Failure, 2023
Xiaoju Ma, Jingru Ma, Tian Leng, Zhongzhu Yuan, Tingting Hu, Qiuyan Liu, Tao Shen
According to the 2021 International Diabetes Federation (IDF) Diabetes Atlas (10th edition), approximately 0.537 billion adults (20–79 years old) worldwide were affected by diabetes mellitus (DM), and the number was estimated to increase to 0.643 billion by 2030 while 0.783 billion by 2045 [1]. DM, therefore, has become a major public health issue in the world. Sustained hyperglycemia can lead to severe microvasculopathy which involves the heart, kidney, eyes, nerves, and teeth, etc. Diabetic kidney disease (DKD) is one of the common complications of DM. Clinical research demonstrated that around 20–40% of DM patients developed DKD, and in those who developed end-stage kidney disease, 80% were resulted from an interplay between hyperglycemia and hypertension. In addition, DKD was also reported as closely linked to cardiovascular disease (CVD) [2].
Prognostic implications of stress hyperglycemia ratio in patients with myocardial infarction with nonobstructive coronary arteries
Published in Annals of Medicine, 2023
Side Gao, Sizhuang Huang, Xuze Lin, Li Xu, Mengyue Yu
In clinical practice, the optimal treatment for stress hyperglycemia remains a dilemma. Some studies found that a tight glycemic control strategy in AMI failed to yield an improved outcome. It is reported that insulin-base therapy would not reduce mortality after an AMI [38,39]. A neutral or even deleterious effect of intensive glucose-lowering therapy was also confirmed in diabetic patients [40,41]. Indeed, the risk of hypoglycemia induced by insulin can result in acute glycemic variability and impose a harmful impact on prognosis. However, recent data showed that a strict glycemic control during AMI could reduce inflammatory responses and increase regenerative potential of myocardium [42,43]. The use of GLP-1 receptor agonist and SGLT-2 inhibitors can exhibit cardioprotective effects without the risk of hypoglycemia even in acute condition such as AMI [44], thus making the intensified management of glucose more beneficial. In this aspect, the index SHR can not only serve as a prognostic marker, but also a potential therapeutic target for tailored treatment. For those who had glycemia below the conventional treatment threshold of 11 mmol/L, SHR may help to discriminate a real glycemic rise and assist physicians to decide when to initiate the glucose-lowering therapy. Still, we should note that the prognostic value of SHR is moderate and far from claiming perfection. Its implications in MINOCA need further validation, and the effectiveness of SHR-targeted therapy in AMI also warrants more research.
Enhanced transdermal insulin basal release from silk fibroin (SF) hydrogels via iontophoresis
Published in Drug Delivery, 2022
Phimchanok Sakunpongpitiporn, Witthawat Naeowong, Anuvat Sirivat
In recent decades, diabetes mellitus has become one of the most common noncommunicable diseases in the world. In 2018, the International Diabetes Federation reported that the number of diabetes patients of around 425 millions (Mallawarachchi et al., 2019). It is expected to rise to 552 millions by 2030 (Shah et al., 2016). Diabetes is a condition in which blood sugar levels are too high (hyperglycemia). Blood glucose levels above 7.0 mmol/L during fasting and 11.1 mmol/L after lunch or dinner are indicative of diabetes (Mansoor et al., 2019). Diabetes mellitus can be classified into 2 types; type 1 is the failure of insulin secretion by the pancreas (T1DM): type 2 is the defective response of the body to insulin (T2DM) (Zhang et al., 2018). Insulin is a peptide hormone that can be used in the insulin deficiency treatment for both T1DM and T2DM (Shah et al., 2016). However, insulin can be degraded or metabolized in the gastrointestinal tract if taken orally. The self-injection is a common route for insulin delivery, but it introduces a pain and an infectious risk near the injection area. Therefore, the transdermal drug delivery (TDDS) is an alternative route for the controllable insulin administration (Tokumoto et al., 2006).