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Pathophysiology and Management of Type 1 Diabetes
Published in Emmanuel C. Opara, Sam Dagogo-Jack, Nutrition and Diabetes, 2019
Schafer Boeder, Steven Edelman
Another approach to imitating physiologic insulin delivery is to use an insulin pump to administer CSII. Currently available pumps infuse a rapid-acting insulin analogue to provide both basal and bolus insulin components. While not appropriate for all individuals with T1D, CSII has a number of advantages over MDI regimens. The basal insulin is given as a constant infusion at a programmed rate that can be fine-tuned to match diurnal variations in insulin sensitivity. This may be useful for patients who experience early-morning insulin resistance (the dawn phenomenon). Also, insulin delivery can be completely suspended if necessary (e.g., during exercise) to avoid or mitigate hypoglycemia.
The endocrine system
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
The dawn phenomenon refers to a rise in blood glucose that occurs in the early morning hours. It likely occurs as a result of circadian variations in growth hormone and may occur in patients with type 1 or type 2 diabetes. The dawn phenomenon may occur in conjunction with the Somogyi effect if there is overnight hypoglycemia and lead to significant hyperglycemia in the morning hours. The dose and timing of insulin injection may need to be adjusted in diabetic patients to prevent this occurrence.
Continuous Insulin Infusion Therapy and Nutrition
Published in Jeffrey I. Mechanick, Elise M. Brett, Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
Andrew Jay Drexler, Carolyn Robertson
Insulin pump therapy has been shown to result in improvement of hemoglobin A1C (A1C) levels with reduced frequency of severe hypoglycemia in individuals with type-1 diabetes mellitus (T1DM) [1], often with a reduction in total daily insulin dose [2]. There are many reasons for a particular patient to utilize CSII, including increased flexibility of lifestyle, avoidance of injections, ease of meal dosing, and the potential for improved control. The strongest indication for CSII is in the patient with a major manifestation of the “dawn phenomenon.” The dawn phenomenon is a rise in plasma glucose or insulin requirements in the early morning hours before rising in the absence of antecedent hypoglycemia [3]. For these patients, the only alternative is to awaken in the middle of the night and take an insulin injection. In one recent study, the use of insulin aspart in the pump resulted in lower glycemic exposure—as determined by a continuous glucose monitoring system (CGMS)—as compared with multiple daily injections (MDI) therapy using aspart and glargine, without increased risk of hypoglycemia [4]. This was attributed to the ability to control the dawn phenomenon with adjustment of nighttime basal rates and the flexibility in mealtime dosing.
Stepwise approach to continuous glucose monitoring interpretation for internists and family physicians
Published in Postgraduate Medicine, 2022
Emily D. Szmuilowicz, Grazia Aleppo
In contrast, CGM data provide direct information about personalized glucose trends which enable tailored therapeutic adjustments, as well as critical information regarding the timing and degree of hypoglycemia, hyperglycemia, and glucose variability in an individual. Real-time CGM data alert the user immediately to potentially dangerous impending hypo- or hyperglycemia, allowing interventions in real-time to prevent their occurrence or mitigate their severity. In addition, retrospective analysis of either blinded or real-time CGM data enables the recognition, by both people with diabetes and their providers, of important glycemic patterns critical to tailored diabetes management strategies. Common glycemic patterns easily detected by CGM use, but not apparent via HbA1c measurement or periodic capillary blood glucose measurements, include nocturnal hypoglycemia, postprandial hyperglycemia, reactive hyperglycemia following hypoglycemia, and dawn phenomenon.
Nutrition in the management of type 2 diabetes mellitus: review
Published in Archives of Physiology and Biochemistry, 2021
A complicated, randomised, double-blind, crossover study of 38 patients with or without diabetes consisted of four sub-trials (Johnston et al.2010). The study found that about two teaspoons of vinegar taken with meals decreased postprandial glucose by about 20%. Another small, randomised trial in 27 patients with T2DM showed that vinegar administration resulted in a small decrease in HbA1C (Johnston et al.2009). However, another small, randomised study in 11 people with well-controlled T2DM found that vinegar given at bedtime decreased fasting glucose level (White and Johnston 2007). It has been reported that Vinegar may delay gastric emptying, inhibit disaccharidase activity, and promote muscle glucose uptake (Johnston et al.2009). It may also alter the glycolysis and hepatic gluconeogenesis cycle, which may benefit individuals who experience the “dawn phenomenon” (an early morning increase in glucose level) (White and Johnston 2007).
Synthetic long-acting insulin analogs for the management of type 1 diabetes: an update
Published in Expert Opinion on Pharmacotherapy, 2021
Ulrik Pedersen-Bjergaard, Therese W. Fabricius, Birger Thorsteinsson
Replacement of basal insulin secretion by long-acting insulin is a complex task. All long-acting insulins are administered subcutaneously, and variability in absorption between patients and even between doses is a fundamental challenge. Insulins with 24 hours’ time of action or shorter need to be administered at the same time every day or twice daily to provide consistent treatment effect. This is a challenge for many patients with shifting working hours or an otherwise irregular lifestyle. Even insulins with 24 hours’ time of action may not always provide 24-hour coverage for all patients and will therefore need to be administered twice daily. Beyond this, many patients will require increased basal insulin dosing in the early morning hours (the dawn phenomenon) [5] which is almost impossible to account for by long-acting insulins. Furthermore, some people experience day-to-day variations in their basal insulin need due to days with physical work, exercise, or other vigorous activities, which may require daily adjustments of basal insulin. This may be difficult to accommodate when using an insulin with more than 24 hours coverage. Obviously, patients may have quite different requirements to the properties of their basal insulin, needing a personalized approach to basal insulin therapy in type 1 diabetes [6].