P1796FACTORS PREDICTING SUBCUTANEOUS INSULIN REQUIREMENT AFTER KIDNEY TRANSPLANT

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Beena Bansal ◽  
Shyam Bansal
Keyword(s):  
Kidney Transplant ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Insulin Requirement ◽  
P Value ◽  
Subcutaneous Insulin ◽  
Duration Of Diabetes ◽  
Transplant Patients ◽  
Intravenous Insulin ◽  
Insulin Infusion Rate

Abstract Background and Aims Diabetes is the most common cause for end stage renal disease leading to kidney transplant. Post transplant glycemic management has significant impact on long term outcomes, but is challenging, especially while transitioning patients from intravenous to subcutaneous insulin dose. This study was therefore planned to assess factors which influence subcutaneous insulin dose after kidney transplant. Method Data was prospectively collected from 98 consecutive kidney transplant patients with type 2 diabetes at a tertiary care hospital in India, with regards to age, gender, height, weight, duration of diabetes, pre transplant insulin dose, pre transplant use of oral antidiabetics. First two days after transplant patients are nil by mouth and are on insulin infusion (column based method). On third day, patients are transitioned to multiple subcutaneous insulin. We assessed and recorded the subcutaneous insulin dose requirement by 4th and 5th day. Results Mean (SD) for patients’ age was 52.28 (6.32) years, height 167.83 (5.64) cm, weight 70.55 (14.32) kg, body mass index 25.39 (4.72) kg/m2 and duration of diabetes 13.3 (7.02) years. All 98 transplant recipients were male. Mean insulin requirement before transplant was 15.37 (20.24) units/day. Mean post transplant intravenous insulin infusion rate for 4 hours before transitioning to subcutaneous insulin was 2.07 (0.987) units/hour. Mean subcutaneous insulin requirement after transplant was 73.18 (25.45) units/day or 1.12 (0.61) units/kgbw. Mean basal insulin dose was 25.32 (10.91) units. Mean bolus dose before breakfast was 10.75 (4.37) units, before lunch was 20.12 (7.4)) units, before evening snack was 6.65 (3.43) units and before dinner was 10.75 (4.11) units. In terms of proportion of total daily dose (TDD), mean basal insulin was 0.34 (0.08) of TDD, bolus dose before breakfast was 0.15 (0.03) of TDD, before lunch was 0.28 (0.05) of TDD, before evening snack was 0.09 (0.04) of TDD and before dinner was 0.15 (0.04) of TDD. Subcutaneous insulin dose after transplant correlated with insulin dose of the recipient before transplant (Pearson’s coefficient 0.43; p value 0.003) and weight of the patient (Pearson’s coefficient 0.32; p value 0.001). It did not correlate with age of the recipient, duration of diabetes, intravenous insulin infusion rate or tac level. On multivariate linear regression analysis to assess the factors predicting subcutaneous insulin dose after transplant, only pre-transplant insulin dose was significant (p value 0.046). Age of the recipient, duration of diabetes, weight of the patient, intravenous insulin infusion rate or preoperative use of oral anti diabetic were not significant Conclusion In kidney transplant patients with type 2 diabetes, only pre transplant insulin dose predicted the subcutaneous insulin dose post transplant.

Metabolic response of normal man and insulin-infused diabetics to postprandial exercise

1982 ◽  
Vol 242 (5) ◽  
pp. E309-E316 ◽  
Author(s):  
J. D. Nelson ◽  
P. Poussier ◽  
E. B. Marliss ◽  
A. M. Albisser ◽  
B. Zinman
Keyword(s):  
Insulin Infusion ◽  
Closed Loop ◽  
Endocrine Pancreas ◽  
Metabolic Response ◽  
Insulin Requirement ◽  
Open Loop ◽  
Artificial Endocrine Pancreas ◽  
Intravenous Insulin ◽  
Fasting Glycemia ◽  
Identical Manner

Physical exercise is often performed during absorption of meals. We have characterized the metabolic response to 45 min of moderate exercise (approximately 55% of estimated maximal oxygen uptake) beginning 30 min after breakfast in seven healthy controls. Nine insulin-dependent diabetes were studied in an identical manner, with glycemia controlled by a closed-loop "artificial endocrine pancreas" controlled by a closed-loop "artificial endocrine pancreas" (AEP). Responses were compared to those during breakfast without exercise. In the controls, onset of exercise rapidly reversed the rise in both glycemia and insulin (IRI) that occurred with breakfast alone, both returning to fasting levels (glycemia, 80 +/- 3 mg/dl; IRI, 0.38 +/- 0.10 ng/ml). After exercise, small and transient increments occurred (glycemia, 33 +/- 6 mg/dl; IRI, 0.81 +/- 0.15 ng/ml). In the diabetics, prior overnight intravenous insulin normalized fasting glycemia (98 +/- 4 mg/dl), and its postbreakfast excursion was identical to that of controls, as were those of most measured substrates. Similarly, with exercise, glycemia returned rapidly to fasting levels, accompanied by an appropriate decrease in insulin infusion rates. "Free" IRI levels mirrored changes in infusion rates by the AEP, with a decrease in insulin requirement of 30% during exercise as compared to breakfast alone (P less than 0.05). Thus, in both diabetics treated with the AEP and in normals, the responses to postprandial exercise required rapid modulation of insulin delivery. To demonstrate the effect of postprandial exercise on preprogrammed open-loop insulin replacement, four diabetic subjects were studied during breakfast with and without exercise while receiving a fixed open-loop insulin infusion pattern (6.1 +/- 0.7 U over 140 +/- 8 min). The glycemic response to breakfast alone was entirely normalized. However, symptomatic hypoglycemia occurred in all subjects when exercise was initiated 30 min after breakfast. The diabetic responses to closed-loop insulin infusion provide important data in defining the appropriate preprogrammed open-loop insulin infusion pattern for postprandial exercise.

scholarly journals Accuracy of Capillary and Arterial Whole Blood Glucose Measurements Using a Glucose Meter in Patients under General Anesthesia in the Operating Room

2017 ◽  
Vol 127 (3) ◽  
pp. 466-474 ◽  
Author(s):  
Brad S. Karon ◽  
Leslie J. Donato ◽  
Chelsie M. Larsen ◽  
Lindsay K. Siebenaler ◽  
Amy E. Wells ◽  
...  
Keyword(s):  
Blood Glucose ◽  
General Anesthesia ◽  
Operating Room ◽  
Whole Blood ◽  
Insulin Infusion ◽  
Subcutaneous Insulin ◽  
Intravenous Insulin ◽  
Diabetes Status ◽  
Glucose Meter ◽  
Arterial Glucose

Abstract Background The aim of this study was to evaluate the use of a glucose meter with surgical patients under general anesthesia in the operating room. Methods Glucose measurements were performed intraoperatively on 368 paired capillary and arterial whole blood samples using a Nova StatStrip (Nova Biomedical, USA) glucose meter and compared with 368 reference arterial whole blood glucose measurements by blood gas analyzer in 196 patients. Primary outcomes were median bias (meter minus reference), percentage of glucose meter samples meeting accuracy criteria for subcutaneous insulin dosing as defined by Parkes error grid analysis for type 1 diabetes mellitus, and accuracy criteria for intravenous insulin infusion as defined by Clinical and Laboratory Standards Institute guidelines. Time under anesthesia, patient position, diabetes status, and other variables were studied to determine whether any affected glucose meter bias. Results Median bias (interquartile range) was −4 mg/dl (−9 to 0 mg/dl), which did not differ from median arterial meter bias of −5 mg/dl (−9 to −1 mg/dl; P = 0.32). All of the capillary and arterial glucose meter values met acceptability criteria for subcutaneous insulin dosing, whereas only 89% (327 of 368) of capillary and 93% (344 of 368) arterial glucose meter values met accuracy criteria for intravenous insulin infusion. Time, patient position, and diabetes status were not associated with meter bias. Conclusions Capillary and arterial blood glucose measured using the glucose meter are acceptable for intraoperative subcutaneous insulin dosing. Whole blood glucose on the meter did not meet accuracy guidelines established specifically for more intensive (e.g., intravenous insulin) glycemic control in the acute care environment.

Management of Diabetes Resistant to Subcutaneous Insulin with Intravenous Insulin via an Implanted Infusion Pump

1988 ◽  
Vol 33 (2) ◽  
pp. 239-243 ◽  
Author(s):  
K.R. Paterson ◽  
I.W. Campbell ◽  
S.M. MacRury ◽  
D.G. Gilmour ◽  
A.C. MacCuish
Keyword(s):  
Treatment Option ◽  
Insulin Infusion ◽  
Rare Complication ◽  
Infusion Pump ◽  
Insulin Injection ◽  
Management Problem ◽  
Subcutaneous Insulin ◽  
Intravenous Insulin ◽  
Infusion Devices ◽  
Insulin Dependent

Diabetes resistant to conventional subcutaneous insulin injection is a rare complication of insulin-dependent diabetes which poses a major management problem. We report three cases treated for a total of over seven patient years with fully implanted insulin infusion devices. Technical difficulties with the devices and their operation have been substantial but the patients are much improved and hospitalisation has been dramatically reduced. We suggest that implanted insulin pumps are a real treatment option for patients with this unusual syndrome.

Evaluation of Quality of Life among Kidney Transplant Patients- A Cross Sectional Study

2021 ◽  
Vol 15 (11) ◽  
pp. 3087-3089
Author(s):  
Rashida Jabeen ◽  
Kousar Perveen ◽  
Muhammad Afzal ◽  
Sadia Khan
Keyword(s):  
Quality Of Life ◽  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Transplant Patients ◽  
Kidney Transplant Patients

Kidney transplantation is the famous and most important choice of treatment of renal replacement therapies (RRTs) because of its positive impact on morbidity, survival and cost. The health related quality of life is becoming important outcome. Quality of life is usually impaired in patients who have renal transplant because of renal transplant patients have anxiety, lack of social, physical and emotional support and diminished ability to take care of themselves. The basic purpose of renal transplantation is to achieve maximum quality of life with minimum side effects. Methods: A cross sectional study was conducted at Rukhsana Akhtar Bahria International Orchard Hospital Lahore after approval from institution board of university of Lahore. 36 patients were enrolled in study by using purposive sampling technique. After taking informed consent all Kidney transplant patients aged between 18 years to 60 years, visited the post-transplantation OPD and continuously in follow-up sessions were included in study. A validated and standard WHO questionnaire of “Kidney Disease and Quality of Life (KDQOL-36™)” was used for data collection. Data was entered and analyzed in SPSS version.21.Chi-square test was applied to find out significant association between qualitative variables. P -Value < 0.05will be considered as statistically significant. Results: Majority of patients were from 40-49 years 10(27.0%). Females were more as compared to men (20(55.6) vs 16(44.4%)). 10(27.8) patients can read and write and 8(22.2%) have done matriculation. More patients live in Urban area as compared to rural area(19(52.8%) vs 17(47.2%)).8(22.2%) patients have less than 1 year of post kidney transplantation time and 19(52.8%) have 1 to 3 years. All the seven domains of KDQOL show poor QOL. General Health, Physical function and physical and emotional function shows average QOL and Emotional, social, daily activities and overall KDQOL shows poor QOL. There was insignificant association with age, gender, education; residential area and Post kidney transplantation length of time (years)(p-value > 0.05). Conclusions: After renal transplantation HRQOL becomes very important factor. After kidney transplantation HRQOL depends on many factors. It was concluded from current study that the HRQOL was not as good as it should be. Over the period of transplantation time patient’s quality of life remain same. The society, government, family, and medical staff need to support patients so they can also improve their QOL. Key word: Renal Diseases, Kidney transplant, Quality of life, KDQOL-36

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