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Pregestational Diabetes
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
F. Weston Loehr, A. Dhanya Mackeen, Michael J. Paglia
Though satisfactory glucose control may be obtained solely with an intermediate-acting insulin rather than a short-acting insulin [57], we suggest optimizing metabolic control with one evening injection of long-acting insulin (e.g., insulin glargine), and meal-time (three daily) injections of short-acting insulin (e.g., lispro or aspart) (Figures 5.1 and 5.2). Glargine cannot be mixed in the same syringe with other insulins. Intermediate-acting insulin (e.g., neutral protamine Hagedorn [NPH]) twice daily can also be used, instead of insulin glargine. Studies have shown that short-acting insulin is as effective as regular insulin and may result in improved postprandial glucose control and less preterm deliveries [58, 59]. Insulin lispro should be given immediately before eating. As compared to two daily insulin injections, additional doses are associated with improved glycemic control [60]. A meta-analysis of cohort studies comparing insulin glargine to NPH did not reveal any significant differences in outcomes including infant birth weight, congenital anomalies, and respiratory distress [61]. A large randomized trial including 310 pregnancies compared insulin detemir with NPH and found no differences between maternal HgbA1c, the frequency of major hypoglycemic episodes [62], early fetal loss, congenital anomalies, or adverse events [63]. Insulin analogs have not been associated with an increased risk of congenital anomalies [64].
Immunosuppressants, rheumatic and gastrointestinal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Mealtime insulin requirement depends on the amount of carbohydrate consumed and on its glycaemic index. Historically, carbohydrate counting, carbohydrate exchanges and food weighing were encouraged, but are now less popular in an attempt to normalise the lifestyles of children with diabetes. Instead, children are now encouraged to eat a balanced and healthy diet. However, carbohydrate, and often fat exchange diets do remain the norm in many European and US centres. Either short-acting insulin, or a rapid-acting analogue is injected at mealtimes. The option to inject rapid-acting insulin analogues immediately before, or even shortly after meals, allows greater flexibility and freedom and can be useful in very young children in whom food refusal following insulin injection can be a source of anxiety and conflict for many parents.
Nursing care of the cardiac catheterisation patient
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Julie Parkinson, Jo-Anne M. Vidal, Eva Kline-Rogers
Insulin-treated patients on a morning list: Patients scheduled first on a morning list may be able to delay their insulin and breakfast until after their procedure, provided the procedure is short and they are capable of eating by 10:00 am.Patients scheduled for later procedures (morning list) may have a half-dose in the form of intermediate or long-acting insulin, although short-acting insulin should be avoided. Following procedures, a half dose of short-acting insulin can be administered prior to lunch.Patients should resume their usual insulin and diet in the evening.
Impact of Acutely Increased Endogenous- and Exogenous Ketone Bodies on FGF21 Levels in Humans
Published in Endocrine Research, 2021
Esben Stistrup Lauritzen, Mads Vandsted Svart, Thomas Voss, Niels Møller, Mette Bjerre
The study (clinicaltrials.gov ID number NCT02157155) was a placebo-controlled, non-blinded, randomized crossover study including nine male participants with T1D, previously described in detail.21 The participants underwent two study days: 1) hyperglycemic hyperketotic conditions (KET) obtained by insulin deprivation (15% of basal requirement from admission) and intravenous lipopolysaccharide (LPS) (Escherichia coli endotoxin (10,000 USP Endotoxin), bolus injection of 1 ng/kg of body weight and 2) euglycemic control conditions (CTR) obtained by variable intravenous insulin administration (Actrapid, Novo Nordisk, Copenhagen, Denmark) to keep plasma glucose levels between 5 and 7 mmol/l. Long- and intermediate-acting insulin treatments were paused and only short-acting insulin was used from the day before the study day and until the end of the study. The participants were admitted to the research facility at 22.00 h the day before each study day, and fasted until the end of the study day. At t = 0 min (07:00 h) LPS or placebo was administered intravenously. Arterialized blood was sampled at t = 0, 120, and 240 min for FGF21 analysis. Blood glucose was measured every half hour and ketone bodies were measured hourly throughout the study day.21,24
Real-world outcomes of treatment with insulin glargine 300 U/mL versus standard-of-care in people with uncontrolled type 2 diabetes mellitus
Published in Current Medical Research and Opinion, 2020
Nick Freemantle, Didac Mauricio, Andrea Giaccari, Timothy Bailey, Ronan Roussel, Denise Franco, Baptiste Berthou, Valerie Pilorget, Jukka Westerbacka, Zsolt Bosnyak, Mireille Bonnemaire, Anna M. G. Cali, My-Liên Nguyên-Pascal, Alfred Penfornis, Manuel Perez-Maraver, Jochen Seufert, Sean D. Sullivan, John Wilding, Carol Wysham, Melanie Davies
REACH was conducted between November 2015 and October 2017 and REGAIN between December 2015 and October 2017. Baseline characteristics for the overall study populations of REACH (N = 703) and REGAIN (N = 609) are presented in Table 1. The REGAIN population had longer mean duration of diabetes, a lower proportion who were receiving SUs or DPP-4 inhibitors at baseline and a higher proportion receiving SGLT2 inhibitors at baseline compared with the REACH population. Patient disposition throughout both studies is shown in Supplementary Figure 2. Among patients who did not complete the 12-month randomized period in REACH (n = 30) and REGAIN (n = 28), there were 4 (Gla-300, n = 2; SoC basal insulin, n = 2) and 5 (Gla-300, n = 3; SoC basal insulin, n = 2) deaths, respectively. The number of patients taking concomitant short-acting insulin, mainly for intensification, during the 12-month randomized periods were as follows: REACH, 21 patients (6.0%) in the Gla-300 group and 31 patients (8.8%) in the SoC group; REGAIN, 16 patients (5.2%) in the Gla-300 group and 14 patients (4.6%) in the SoC group. The most commonly used SoC basal insulin over 12 months was Gla-100 in both REACH (74%) and REGAIN (67%).
Clinical characteristics and patient treatment satisfaction with Humalog U-200 in patients with type 2 diabetes mellitus: an observational study
Published in Journal of Drug Assessment, 2020
Jil Mamza, Uchena Anyanwagu, Mohammed Alkharaiji, Iskandar Idris
Table S1 (see Supplementary Appendix 3) summarizes the baseline values of secondary care patient and clinical characteristics for nine patients whose medical care records were collected. All the patients were Caucasian with a mean age of approximately 60 ± 11) years, and comprised of predominantly men (89%, n = 8). The average HbA1c at baseline was 8.6% ± 1.3% and their average BMI was 39.7 ± 5.3) kg/m2 at baseline. Over half of the patients (56%) had a known diabetes complication at baseline and 22% had hypoglycemia unawareness. Specific complications recorded at baseline include CHD (22%), retinopathy (44%), nephropathy (56%) and neuropathy (44%). Thirty-three percent of patients received a intermediate and long-acting insulin, whereas 22% received a short-acting insulin therapy as their first insulin regimen. The remaining patients received biphasic insulin previously. Forty-four percent administered U-200 insulin three times daily on commencement. There was one patient recorded to have had U-200 insulin once a day and another one patient recorded to have had U-200 up to four times a day. Overall, the average daily dose of U-200 insulin was approximately 154.3 ± 104.1.