scholarly journals Physiological Characteristics of Type 1 Diabetes Patients during High Mountain Trekking

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Bartłomiej Matejko ◽  
Andrzej Gawrecki ◽  
Marta Wróbel ◽  
Jerzy Hohendorff ◽  
Teresa Benbenek-Klupa ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Dose ◽  
Time Frame ◽  
Physiological Characteristics ◽  
High Mountain ◽  
Good Glycemic Control ◽  
Glucose Levels ◽  
Daily Insulin Dose ◽  
Significant Difference

In this study, the aim was to provide observational data from an ascent to the summit of Mount Damavand (5670 meters above sea level (m.a.s.l), Iran) by a group of people with type 1 diabetes (T1DM), with a focus on their physiological characteristics. After a 3-day expedition, 18 T1DM patients, all treated with personal insulin pumps, successfully climbed Mount Damavand. Information was collected on their physiological and dietary behaviors, as well as medical parameters, such as carbohydrate consumption, glucose patterns, insulin dosing, and the number of hypo- and hyperglycemic episodes during this time frame. The participants consumed significantly less carbohydrates on day 3 compared to day 1 (16.4 vs. 23.1 carbohydrate units; p=0.037). Despite this, a gradual rise in the mean daily glucose concentration as measured with a glucometer was observed. Interestingly, the patients did not fully respond to higher insulin delivery as there was no significant difference in mean daily insulin dose during the expedition. There were more hyperglycemic episodes (≥180 mg/dL) per patient on day 3 vs. day 1 (p<0.05) and more severe hyperglycemic episodes (>250 mg/dL) per patient on days 2 (p<0.05) and 3 (p<0.05) vs. day 1. In summary, high mountain trekking is feasible for T1DM patients with good glycemic control and no chronic complications. However, some changes in dietary preferences and an observable rise in glucose levels may occur. This requires an adequate therapeutic response.

Additional Insulin for Coping with Fat- and Protein-Rich Meals in Adolescents with Type 1 Diabetes: The Protein Unit

2020 ◽  
Author(s):  
Roland Schweizer ◽  
Susann Herrlich ◽  
Martina Lösch-Binder ◽  
Michaela Glökler ◽  
Magdalena Heimgärtner ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
G Protein ◽  
Insulin Dose ◽  
Dietary Fats ◽  
Target Range ◽  
Pump Therapy ◽  
Glucose Levels ◽  
Protein Rich ◽  
Carbohydrate Unit

Abstract Objective Dietary proteins raise blood glucose levels; dietary fats delay this rise. We sought to assess the insulin amount required to normalize glucose levels after a fat- and protein-rich meal (FPRM). Methods Sixteen adolescents (5 female) with type 1 diabetes (median age: 18.2 years; range: 15.2–24.0; duration: 7.1 years; 2.3–14.3; HbA1c: 7.2%; 6.2–8.3%) were included. FPRM (carbohydrates 57 g; protein 92 g; fat 39 g; fibers 7 g; calories 975 Kcal) was served in the evening, with 20 or 40% extra insulin compared to a standard meal (SM) (carbohydrates 70 g; protein 28 g; fat 19 g; fibers 10 g; calories 579 Kcal) or carbohydrates only. Insulin was administered for patients on intensified insulin therapy or as a 4-hour-delayed bolus for those on pump therapy. The 12-hour post-meal glucose levels were compared between FPRM and SM, with the extra insulin amount calculated based on 100 g proteins as a multiple of the carbohydrate unit. Results Glucose levels (median, mg/dL) 12-hour post-meal with 20% extra insulin vs. 40% vs. insulin dose for SM were 116 vs. 113 vs. 91. Glucose-AUC over 12-hour post-meal with 20% extra insulin vs. 40% vs. insulin dose for SM was 1603 mg/dL/12 h vs. 1527 vs. 1400 (no significance). Glucose levels in the target range with 20% extra insulin vs. 40% were 60% vs. 69% (p=0.1). Glucose levels <60 mg/dL did not increase with 40% extra insulin. This corresponds to the 2.15-fold carbohydrate unit for 100 g protein. Conclusions We recommend administering the same insulin dose given for 1 carbohydrate unit (10 g carbs) to cover 50 g protein.

scholarly journals SAT-662 Effects of SGLT Inhibitors or GLP1 Analogues on Glucose Homeostasis and Body Weight in Patients with Type 1 Diabetes: A Network Meta-Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Soo Lim ◽  
Kim Yoon Ji
Keyword(s):  
Type 1 Diabetes ◽  
Body Weight ◽  
Meta Analysis ◽  
Insulin Dose ◽  
Mixed Treatment Comparison ◽  
Treatment Comparison ◽  
Daily Insulin ◽  
Daily Insulin Dose ◽  
Comparison Results

Abstract Objective: Despite intensive insulin treatment in patients with type 1 diabetes (T1D), many of them do not reach the glycemic target goal. We performed a network meta-analysis to evaluate the efficacy and safety of additional therapy to insulin in patients with T1D. Methods: We searched CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded from January 1970 until September 2019 to identify randomized controlled trials (RCTs) in T1D patients treated with insulin and metformin, sodium-glucose cotransporter (SGLT) inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1 RAs). We performed direct and indirect network meta-analysis using Bayesian models and generated rankings of the different hypoglycemia agents by generating mixed treatment comparison. Results: With 23 RCTs (n = 5,151), we performed the network meta-analysis using eight groups; 1) insulin alone, 2) insulin and metformin, 3) insulin and canagliflozin, 4) insulin and dapagliflozin, 5) insulin and empagliflozin, 6) insulin and sotagliflozin, 7) insulin and liraglutide, and 8) insulin and exenatide. Compared with insulin alone, HbA1c was significantly lower in the group treated with insulin and sotagliflozin (mean difference: -0.43%; 95% credible intervals: -0.62 to -0.23). Total daily insulin dose was significantly lower in the insulin and sotagliflozin group by 6.3 U/day than in insulin alone group. Compared with insulin alone, body weight was significantly decreased in the group treated with canagliflozin by 4.5kg, sotagliflozin by 2.8kg, and exenatide by 5.1 kg, respectively. Severe hypoglycemic episodes did not differ between the groups. Conclusions: In patients with T1D, sotagliflozin add-on to insulin decreased HbA1c levels, daily insulin dose, and body weight without hypoglycemia compared to insulin monotherapy. Combined treatment of canagliflozin or exenatide with insulin was effective in weight loss compared with insulin alone in these patients.

scholarly journals Metallothionein expression in slow- vs. fast-twitch muscle fibers following 4 weeks of streptozotocin-induced type 1 diabetes

FACETS ◽  
2018 ◽  
Vol 3 (1) ◽  
pp. 315-325 ◽  
Author(s):  
Pamela Mondragon ◽  
Andreas Bergdahl
Keyword(s):  
Oxidative Stress ◽  
Type 1 Diabetes ◽  
Molecular Mechanisms ◽  
Protein Carbonyl ◽  
Glucose Levels ◽  
Significant Difference ◽  
Streptozotocin Induced Diabetes ◽  
Carbonyl Formation ◽  
Fast Twitch

Type 1 diabetes (T1DM) is known to cause an increase in reactive oxygen species (ROS) and elevated intracellular glucose levels. We investigated the metallothionein I and II (MT I+II) antioxidants expression in soleus (mainly slow-twitch) and plantaris (predominantly fast-twitch) skeletal muscle using a rodent model of streptozotocin-induced diabetes. The presence of oxidative stress was confirmed by the detection of increased levels of protein carbonyl formation in the diabetic tissues. DAB (3,3′-diaminobenzidine) immunostaining and Western blotting analyses demonstrated that MT I+II expression was significantly upregulated in the diabetic soleus and plantaris muscle tissues compared with their respective controls. Moreover, no significant difference was detected between the plantaris and soleus controls or between the plantaris and soleus diabetic tissues. These findings suggest that there is an increase in MT protein expression in the soleus and plantaris muscles associated with the induction of T1DM. A better understanding of the molecular mechanisms that allow MT to prevent the oxidative stress associated with diabetes could lead to a novel therapeutic strategy for this chronic disease and its associated complications.

scholarly journals Comparing two treatment approaches for patients with type 1 diabetes during aerobic exercise: a randomised, crossover study

2020 ◽  
Author(s):  
Varun Vartak ◽  
Lynne Chepulis ◽  
Matt Driller ◽  
Ryan Paul
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Aerobic Exercise ◽  
Blood Lactate ◽  
Perceived Exertion ◽  
Trial Registration ◽  
Glucose Levels ◽  
Significant Difference ◽  
Mild Hypoglycaemia

Abstract In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age: 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate/kg of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-minute treadmill-walk at 7.24 km.h-1 and a six-minute walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, blood ketone and blood lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL⋅kg−1⋅min−1) were also calculated for the 6MWT. Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluating in other groups, including women, children and those with sub-optimal glycaemic control. Trial registration: ACTRN12619001397101p. Registered 09 September 2019, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378264

scholarly journals Specific features of pregnancy in patients with type 1 diabetes in the prepubertal period. Results of a 15-year long clinical observation

2009 ◽  
Vol 12 (4) ◽  
pp. 28-31
Author(s):  
Lyubov' Leonidovna Bolotskaya ◽  
Natalya Vladimirovna Efremova ◽  
Yury Ivanovich Suntsov
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Complications ◽  
Insulin Dose ◽  
Research Centre ◽  
Nocturnal Hypoglycemia ◽  
Significant Difference ◽  
Before And After ◽  
Pregnancy And Delivery ◽  
The Difference

Aim. To evaluate effect of different factors on pregnancy course in patients with type 1 diabetes mellitus developing in the prepubertal period. Materials and methods. The study based at Endocrinological Research Centre included 77 women with prepubertal diabetes 18 of whom developedpregnancy that ended in delivery. Results. As per 2009, the age of the patients is 26,6?4,6 years. They became pregnant at 23,2?3,3 years and had had diabetes since the age of9,6?4,8 years. Their HbA1c level before and after pregnancy was 8,6?1,4 and 6,8?1,6% respectively, the difference being insignificant (p=0,3).Significant difference was documented between these HbA1c levels and that during pregnancy (p=0,0004 and 0.003 respectively). Nine (56,2%) patientsused ultrashort-acting insulin analogs and the remaining 7 (43,7%) recombinant human insulins. The mean insulin dose was 43,7?11 U/din the 1st trimester, 51,8?13,7 U/d in the 2bd trimester, and 45,3?10,8 U/d after delivery. 16 (88%) of the patients reported frequent hypoglycemia,five (27,8%) of them had episodes of severe daytime and nocturnal hypoglycemia. 11 (61%) developed microvascular diabetic complications beforepregnancy, with 9 (50%) having DR and 4 (22,2%) DN (microalbuminuria). The delivery occurred on weeks 36-37 in 7 (38,9%) women. Naturaland cesarean section deliveries took place in one and 17 (94,4%) patients respectively. Conclusion. Long-term follow-up of patients wit DM1 in accordance with algorithms of specialized medical aid to DM1 patients in Russia at a multidisciplinaryendocrinological centre decreases the risk of pregnancy and delivery complications and that of microvascular diabetic complications

scholarly journals Comparing Two Treatment Approaches for Patients with Type 1 Diabetes During Aerobic Exercise: a Randomised, Crossover Study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Varun Vartak ◽  
Lynne Chepulis ◽  
Matthew Driller ◽  
Ryan G. Paul
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Aerobic Exercise ◽  
Perceived Exertion ◽  
Trial Registration ◽  
Clinical Trial Registry ◽  
Glucose Levels ◽  
Significant Difference ◽  
Mild Hypoglycaemia

Abstract Background In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age, 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate per kilogramme of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-min treadmill walk at 7.24 km h−1 and a 6-min walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, ketone and lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL kg−1 min−1) were also calculated for the 6MWT. Results Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Conclusion Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluation in other groups, including women, children and those with suboptimal glycaemic control. Trial Registration Australian New Zealand Clinical Trial Registry, ACTRN12619001397101p. Registered 09 September 2019.

scholarly journals A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D)

2020 ◽  
pp. 193229682090619
Author(s):  
Siân Rilstone ◽  
Monika Reddy ◽  
Nick Oliver
Keyword(s):  
Type 1 Diabetes ◽  
Pilot Study ◽  
Insulin Infusion ◽  
Insulin Dose ◽  
Total Daily Dose ◽  
Subcutaneous Insulin ◽  
Basal Rate ◽  
Absolute Change ◽  
Significant Difference

Background: Initiation of continuous subcutaneous insulin therapy (CSII) in type 1 diabetes requires conversion of a basal insulin dose into a continuous infusion regimen. There are limited data to guide the optimal insulin profile to rapidly achieve target glucose and minimize healthcare professional input. The aim of this pilot study was to compare circadian and flat insulin infusion rates in CSII naïve adults with type 1 diabetes. Methods: Adults with type 1 diabetes commencing CSII were recruited. Participants were randomized to circadian or flat basal profile calculated from the total daily dose. Basal rate testing was undertaken on days 7, 14 and 28 and basal rates were adjusted. The primary outcome was the between-group difference in absolute change in insulin basal rate over 24 hours following three rounds of basal testing. Secondary outcomes included the number of basal rate changes and the time blocks. Results: Seventeen participants (mean age 33.3 (SD 8.6) years) were recruited. There was no significant difference in absolute change in insulin basal rates between groups ( P = .85). The circadian group experienced significant variation in the number of changes made with the most changes in the morning and evening ( P = .005). The circadian group received a greater reduction in total insulin (−14.1 (interquartile range (IQR) −22.5-12.95) units) than the flat group (−7.48 (IQR −11.90-1.23) units) ( P = .021). Conclusion: The initial insulin profile does not impact on the magnitude of basal rate changes during optimization. The circadian profile requires changes at specific time points. Further development of the circadian profile may be the optimal strategy.

scholarly journals Insulin pump therapy of type 1 diabetes mellitus in children and adolescents in the Moscow region

2009 ◽  
Vol 12 (3) ◽  
pp. 60-63
Author(s):  
Elena Efimovna Petryaykina ◽  
Olga Viktorovna Dukhareva ◽  
Irina Georgievna Rybkina ◽  
Ekaterina Alexandrovna Pronina ◽  
Tatiana Dmitrievna Mikhaylova ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Children And Adolescents ◽  
Insulin Pump ◽  
Insulin Dose ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Daily Insulin Dose

Aim. To assess dynamics of glycated hemoglobin levels and insulin doses per kg bw in children and adolescents with poorly controlled type 1 diabetes mellitus using insulin pumps. Materials and methods. Retrospective analysis of HbA1c levels and insulin doses per kg bw in children aged 2-17 years with DM1 (mean duration 5.3?3.1) before and 18 months after onset of insulin pump therapy (Medtronic Minimed 712 and 722) with a short-acting insulin analog Novopramid (Novo Nordisk) or Humalog (Ely Lilly) given to 55 (52,4%) and 50 (47,6%) of the patients respectively. НbА1с level and mean daily insulin dose per kg bw were determined when a patient visited the doctors office every 3 months. Results. Insulin pump therapy in patients with initially poorly controlled DM1 resulted in a decrease of HbA1c from 9.8?0.8 to 7,8?0,5% within 18 months after its beginning (p

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