Intraperitoneal Insulin Reduces Plasma Leptin Concentration in Diabetic Patients on CAPD

2000 ◽  
Vol 20 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Pasi I. Nevalainen ◽  
Jorma T. Lahtela ◽  
Jukka Mustonen ◽  
Amos Pasternack
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
University Hospital ◽  
Glucose Disposal ◽  
Diabetic Patients ◽  
Type I ◽  
Intraperitoneal Insulin ◽  
End Stage ◽  
Plasma Leptin ◽  
Glucose Disposal Rate

Objective To determine the effects of subcutaneous (SC) and intraperitoneal (IP) insulin on serum leptin concentration in type I diabetic patients with end-stage renal failure treated with continuous ambulatory peritoneal dialysis (CAPD). Design Prospective, open, before–after study. Setting Tertiary-care university hospital. Participants Twelve type I diabetic patients with stabilized CAPD, age 43.9 ± 2.8 years, and duration of diabetes 30.4 ± 3.5 years. Intervention After stabilized CAPD therapy, all patients were treated first with SC insulin for a median of 3 months, and thereafter with IP insulin for another 3 months. Main Outcome Measures Plasma leptin, insulin sensitivity with euglycemic clamp, and glycemic and uremic status after both treatment periods. Results During SC insulin therapy, plasma leptin concentration was significantly higher than during IP insulin (19.8 ± 5.9 ng/mL and 12.8 ± 6.2 ng/mL, respectively; p < 0.001). Leptin concentration was higher in CAPD patients and was related to body mass index in both genders. No correlation was detected between plasma leptin and fasting insulin, glycemic control, glucose disposal rate, or serum lipids. Conclusion Plasma leptin concentration is lower during IP insulin therapy compared to SC insulin. Insulin has probably a direct effect on both peritoneal leptin clearance and adipose tissue leptin production. The significance of leptin in regulating appetite and anorexia in uremia remains unclear.

High Peritoneal Permeability Predisposes to Hepatic Steatosis in Diabetic Continuous Ambulatory Peritoneal Dialysis Patients Receiving Intraperitoneal Insulin

2000 ◽  
Vol 20 (6) ◽  
pp. 637-642 ◽  
Author(s):  
Pasi I. Nevalainen ◽  
Timo Kallio ◽  
Jorma T. Lahtela ◽  
Jukka Mustonen ◽  
Amos I. Pasternack
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Insulin Dose ◽  
Tertiary Care ◽  
University Hospital ◽  
Diabetic Patients ◽  
Fat Accumulation ◽  
Hepatic Fat ◽  
Intraperitoneal Insulin

Objective To evaluate hepatic fat accumulation in diabetic patients taking intraperitoneal or subcutaneous insulin treatment during continuous ambulatory peritoneal dialysis (CAPD). Design Cross-sectional study. Setting Tertiary-care university hospital. Patients We studied 16 patients with diabetic end-stage renal disease currently treated with CAPD. Median age was 42 years (range: 34 – 70 years), duration of diabetes was 27.5 years (range: 17 – 39 years), and duration of CAPD was 16.5 months (range: 2 – 59 months). Outcome Measures Ultrasound measures of liver steatotic area and thickness, peritoneal equilibration test (PET), weekly Kt/V urea, protein catabolic rate (PCR), hemoglobin A1c (HbA1c), lipoproteins, alanine aminotransferase, alkaline phosphatase, insulin dose, and dialysate glucose load. Results Focal hepatic fat accumulation was found. The location of steatosis was subcapsular; a negligible amount was periportal. Hepatic subcapsular steatosis was present in 7 of 8 patients taking insulin intraperitoneally and in 0 of 8 patients taking insulin subcutaneously. The maximal thickness of subcapsular steatosis correlated directly with peritoneal transport rate (2-hour dialysate-to-plasma creatinine ratio in PET, r = 0.80, p < 0.05) and inversely with PCR ( r = –0.82, p < 0.05). The area of the lesions correlated directly with body weight ( r = 0.80, p < 0.05) and inversely with weekly Kt/V urea ( r = –0.90, p < 0.01). Conclusions Intraperitoneal insulin, together with glucose-based peritoneal dialysate, induces hepatic subcapsular steatosis. The amount of hepatic subcapsular steatosis increases when peritoneal transfer rate and body weight are high.

Multicentre Trial of a Programmable Implantable Insulin Pump in Type I Diabetes

1995 ◽  
Vol 18 (6) ◽  
pp. 322-325 ◽  
Author(s):  
◽  
M. Pinget ◽  
N. Jeandidier ◽  
F. Ortega ◽  
D. Wix ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Insulin Infusion ◽  
Multicentre Trial ◽  
Insulin Pump ◽  
Type I Diabetes ◽  
Diabetic Patients ◽  
Type I ◽  
Catheter Obstruction ◽  
Potential Alternative ◽  
Intraperitoneal Insulin

Programmable implantable pumps permitting variable-rate intraperitoneal insulin infusion are currently investigated as a potential alternative to subcutaneous insulin therapy. An improved version of the Siemens implantable system has been evaluated in 6 European centres on 31 type I diabetic patients treated for 10–30 months. Contrary to other pump models there were no proven pump malfunctions and only one no-flow reduction unrelated to catheter obstruction. The latter resulted in 12 surgical catheter replacements. There were 2.0 incidents of programmer malfunctions per patient-year easily managed by reconfiguration or replacement. Insulin remained clear and active in the pump reservoir and glycaemic control remained in the near-normoglycaemic range. Thus, insulin therapy with the Siemens implantable pump is feasible and effective up to 2.5 years.

Localization of Rate-Limiting Defect for Glucose Disposal in Skeletal Muscle of Insulin-Resistant Type I Diabetic Patients

Diabetes ◽  
1990 ◽  
Vol 39 (2) ◽  
pp. 157-167 ◽  
Author(s):  
H. Yki-Jarvinen ◽  
K. Sahlin ◽  
J. M. Ren ◽  
V. A. Koivisto
Keyword(s):  
Skeletal Muscle ◽  
Glucose Disposal ◽  
Diabetic Patients ◽  
Type I ◽  
Insulin Resistant ◽  
Rate Limiting

scholarly journals Frequency of Hepatitis C infection in diabetes mellitus

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
Masroor A Qazi ◽  
Fayyaz M ◽  
Hyuddin Ch G Muhyuddin ◽  
Aftab Jamil ◽  
Malik A H ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Hepatitis C ◽  
Insulin Therapy ◽  
Blood Donors ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Type I ◽  
Diabetic Mellitus ◽  
Hepatitis C Infection ◽  
Poor Control

Place and duration of study: The study was conducted at diabetic clinic B.V. Hospital/Q.A.M.C Bahawalpur from December 1st, 2004 to March 15th, 2005. Background: Diabetes mellitus and hepatitis C infections are common and emerging problems of the society. Either diabetes mellitus is common in chronic hepatitis C patients as reported initially by Ellison and co-workers or hepatitis C infection is more frequent in diabetes mellitus. We want to study the frequency of hepatitis c infection in diabetes mellitus. Objectives: To study the frequency of hepatitis C infection in diabetic patients and to note any risk factors of diabetic patients predisposing to hepatitis C infection. Designs: A cross-sectionalObservational-descriptive analytic study. Subjects and Methods: A total of 250 consecutive diabetic patients of either sex were compared with 6574 blood donors for hepatitis c infection .They were evaluated for hepatitis C infection by using Enzyme Linked Immunosorbant Assay (ELISA-3) which is an anti-HCV anti body test. On basis of this test, the patients were divided into two groups, anti-HCV +ve and anti-HCV -ye. Different variables of these patients were studied and compared in these two groups Variables studied were as follows:- Age, Sex, BMI, Mode of therapy area of their residence(rural or urban) Duration of diabetes mellitus, Blood pressure, Nephropathy and Control of diabetes mellitus. Results: Among a total of 250 patients, 120 (48%) were male and 130 (52%) were female. Two hundred and forty-four (97.6%) patients were of type-II DM and 06 (2.4%) patients were of type-I DM. 22 (8.8%) patients were on insulin therapy while 228 (91.2%) were on oral hypoglycemic agents. Anti-HCV test was positive in 69 (27.6%) diabetic patients as compared to blood donors 41 (0.62%). In anti-HCV positive group, longer duration of diabetic mellitus (15yrs 15.94%), poor control of diabetic mellitus(87%), insulin therapy(17.39%) hypertension(91.3%) and nephropathy(94.2%) were the significant vari ables while BMI, age, sex and whether they were belonging to either rural or urban area were not significant in both the groups. Conclusion: Hepatitis C infection is common in diabetic patients as compared to control group (27.6% vs 0.62%). Out of diabetic patients HCV infection is more common with longer duration of diabetic mellitus, poor control of diabetic mellitus, hypertension, nephropathy and insulin therapy.

scholarly journals Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals

2018 ◽  
Vol 35 (1) ◽  
Author(s):  
Iqra Arshad ◽  
Sara Mohsin ◽  
Sana Iftikhar ◽  
Tahseen Kazmi ◽  
Luqman F. Nagi
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Early Initiation ◽  
P Value ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Creative Commons ◽  
Oral Medications ◽  
Tertiary Care Hospitals

Background and Objective: Initiation of Insulin therapy during earlier stages has proved to significantly improve health outcomes among diabetics in comparison to oral medications. Not only patients but physicians are also often resistant to early initiation of insulin therapy. The objective was to assess misconceptions and barriers to early initiation of insulin therapy among diabetic patients coming to a diabetic clinic. Methods: This cross sectional study was conducted on 300 patients selected by convenience sampling arriving in Diabetes Outdoor Clinics of Mayo and Services Hospitals, Lahore during August 2017 to May 2018. The data was entered and analyzed by using SPSS version 17. Results: Out of 300 patients included in study, 39% (n= 117) were males and 61% (n=183) were females. The mean age of the participants at presentation was 48.46±13.15 years with a range of 13 to 80 years. Study participants considered it embarrassing to inject insulin in public place (p-value 0.01). The fear associated with lifelong commitment to insulin therapy once it is started, was also found statistically significant (p-value 0.001)particularly in subjects who have long duration of DM (>5 years). Conclusion: Perceptions of diabetic patients about insulin therapy are still barriers to early initiation of therapy and tend to prevail in Pakistan and around the globe. How to cite this:Arshad I, Mohsin S, Iftikhar S, Kazmi T, Nagi LF. Barriers to the early initiation of Insulin therapy among diabetic patients coming to diabetic clinics of tertiary care hospitals. Pak J Med Sci. 2019;35(1):---------. doi: https://doi.org/10.12669/pjms.35.1.237 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Lipoprotein composition in the insulin-deficient non-acidotic phase of type I diabetic patients and early evolution after the start of insulin therapy

1993 ◽  
Vol 223 (1-2) ◽  
pp. 113-120 ◽  
Author(s):  
Jordi L. Reverter ◽  
Mariano Senti ◽  
Juan Rubiés-Prat ◽  
Anna Lucas ◽  
Isabel Salinas ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Early Evolution ◽  
Diabetic Patients ◽  
Type I ◽  
Lipoprotein Composition

Simultaneous pancreas-kidney transplant compared with kidney transplant in Type I diabetic patients with end-stage renal disease

2001 ◽  
Vol 33 (7-8) ◽  
pp. 3494-3495 ◽  
Author(s):  
R. Pérez ◽  
M.D. Navarro ◽  
D. del Castillo ◽  
R. Santamarı́a ◽  
J. Padillo ◽  
...  
Keyword(s):  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Diabetic Patients ◽  
Type I ◽  
Simultaneous Pancreas Kidney ◽  
Stage Renal Disease ◽  
End Stage

scholarly journals Facilitators and Barriers to Self-Monitoring of Blood Glucose (SMBG) in Diabetic Patients

2020 ◽  
pp. 119-127
Author(s):  
Asif Hakim Brohi ◽  
Arsalan Hakim ◽  
Shafi Muhammad Wassan ◽  
Abdul Majeed Soomro ◽  
Wasim Sarwar Bhatti ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Family Medicine ◽  
Health Care Providers ◽  
Tertiary Care ◽  
University Hospital ◽  
Diabetic Patients ◽  
Care Providers ◽  
Hospital Data ◽  
Self Monitoring ◽  
Facilitators And Barriers

Objective: To determine factors that facilitate and are barriers to self-monitoring of blood glucose in type 2 diabetic patients visiting family medicine clinics at a tertiary care teaching hospital Karachi Pakistan. Methods: Approximately 255 patients were consecutively recruited from the clinics during April 2018 to May 2019 at Family Medicine outpatient clinics at the Aga Khan University Hospital. Data on socio-demographic status, facilitators and barriers to SMBG were extracted through a questionnaire, after obtaining an informed written consent. Data was entered and analyzed in SPSS version 19. Results: Among study participants 47.5% were above 50 years and 51.4% were males. About 30.2% of the participants were practicing SMBG at least once a month and 26% were practicing it daily. Fear of complications was the biggest facilitator (80.1%) and being expensive (51.4%) was barrier for SMBG. Over half of the SMBG practicing participants (59.7%) were diagnosed with diabetes for more than 05 years (p: 0.63). Conclusion: Assessment of blood glucose is a critical component of diabetes treatment and management. It can motivate patients to become active participants in their own care. Health care providers should communicate and educate the patients about the advantages of SMBG.

scholarly journals Study of awareness of insulin usage in diabetics attending NRI Medical College and General Hospital

2017 ◽  
Vol 7 (1) ◽  
pp. 59
Author(s):  
Jagadeesh A. ◽  
Ravi Shankar K. ◽  
Krishnakanth K.
Keyword(s):  
Insulin Therapy ◽  
Tertiary Care ◽  
Disease Process ◽  
Type Ii Diabetes Mellitus ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Diabetes Treatment ◽  
Cross Sectional ◽  
High Blood Glucose ◽  
Family History Of Diabetes

Background: India had 69.2 million diabetic patients. Insulin is an important part of diabetes treatment, but one-third of patients fail to take their insulin as prescribed, and many adults intentionally skip their doses. Since, diabetes treatment continues for lifetime, there is a need to assess the knowledge and understanding of patients in relation to their disease process and its management.Methods: A cross sectional, observational, knowledge and attitude survey were carried on patients with type II diabetes mellitus who are taking insulin therapy and attended medicine diabetes OPD in tertiary care Hospital during the period of April 2017 to Dec 2017. 200 diabetic patients’ ≥18 years of age who were willing to respond to the study questionnaire were interviewed.Results: Total of 200 study participants were interviewed using structured questionnaires, almost 75 (37.5%) of the respondents were age group of 41 - 50 years. 109 (54.5 %) male, 67 (33.5%)Hindus, 121 (60.5 %) married,79 (39.5%) were primary school, 120 (73.8%) were family history of diabetes, duration of treatment1-3 years 72 (31.5 %), 160 (63%) of the study subjects know about diabetes is high blood glucose, 119(59.5%)of subjects know complications of diabetes, 165(82.5%) were know about insulin used for diabetes, 115 (57.5%) of patients know other substitute for insulin, 94 (47%) of the study subjects have knowledge of complications of insulin therapy, 85 (42.5) were know different types of insulin preparations, 141 (70.5%) were know insulin is mandatory in some patients,159 (79.5%) were understood the route of administration of insulin.Conclusions: The finding of present study showed that, diabetes patients had average knowledge and less favourable attitude among diabetic patients toward insulin therapy.

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