scholarly journals Model-Based Tool for Personalized Adjustment of Basal Insulin Supply in Patients With Intensified Conventional Insulin Therapy

2019 ◽  
Vol 13 (5) ◽  
pp. 928-934
Author(s):  
Lutz Vogt ◽  
Andreas Thomas ◽  
Gert Fritzsche ◽  
Peter Heinke ◽  
Klaus-Dieter Kohnert ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Insulin Dosage ◽  
Treatment Team ◽  
Pump Therapy ◽  
Modeling Tool ◽  
Conventional Insulin Therapy ◽  
Model Based

Background: The decisive factor in successful intensive insulin therapy is the ability to deliver need-based-adjusted nutrition-independent insulin dosages at the closest possible approximation to the physiological insulin level. Because this basal insulin requirement is strongly influenced by the patient’s lifestyle, its subtlety is of great importance. This challenge is very different between patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. Furthermore, it is more difficult to finetune a basal insulin dosage with intensified conventional insulin therapy (ICT), due to delayed insulin delivery, compared to insulin pump therapy, which provides continuous delivery of small doses of exclusively short-acting insulin. In all cases, the goal is to achieve an optimal basal delivery rate. Method: We hypothesized that this goal could be achieved with a modeling tool that determined the optimal basal insulin supply based on the patient’s anamnestic data and monitored glucose values. This type of modeling tool has been used in health insurance programs in Germany to improve insulin control in patients that receive ICT. Results: Our retrospective data analysis showed that this modeling tool provided a significant improvement in metabolic control, significant reductions in HbA1c and Q scores, and improved time-in-range values, with reduced daily insulin levels. Conclusion: The model-based basal rate test could provide additional data of the actual effect of the basal insulin adjustment in intensified insulin treated diabetes to the physician or treatment team.

scholarly journals Use of Automated Bolus Calculators for Diabetes Management

2010 ◽  
Vol 9 (2) ◽  
pp. 92 ◽  
Author(s):  
Frank L Schwartz ◽  
Cynthia R Marling ◽  
◽  
Keyword(s):  
Insulin Therapy ◽  
Glucose Control ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Smart Phone ◽  
Glycated Haemoglobin ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Numeracy Skills ◽  
Patients With Diabetes

Fewer than 30 % of patients with diabetes who are on insulin therapy achieve target glycated haemoglobin (HbA1c) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycaemia and assisting those with low numeracy skills.

scholarly journals Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery?

2021 ◽  
Vol 10 (15) ◽  
pp. 3399
Author(s):  
Elena Z. Golukhova ◽  
Ljubov S. Lifanova ◽  
Yaroslava V. Pugovkina ◽  
Marina V. Grigoryan ◽  
Naida I. Bulaeva
Keyword(s):  
Insulin Therapy ◽  
Postoperative Period ◽  
Glucose Control ◽  
Insulin Pump ◽  
Early Postoperative Period ◽  
Insulin Pump Therapy ◽  
Diabetic Patients ◽  
Pump Therapy ◽  
Hs Crp ◽  
Bolus Insulin

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (р < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

724-P: Timing of Basal Insulin Reduction to Prevent Hypoglycemia during Exercise in Adults and Adolescents with Type 1 Diabetes Using Insulin Pump Therapy: Preliminary Results

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 724-P
Author(s):  
SEMAH TAGOUGUI ◽  
NADINE TALEB ◽  
ELSA HEYMAN ◽  
VIRGINIE MESSIER ◽  
CORINNE SUPPERE ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Basal Insulin ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Preliminary Results

scholarly journals Prediction of Individual Basal Rate Profiles From Patient Characteristics in Type 1 Diabetes on Insulin Pump Therapy

2020 ◽  
pp. 193229682097269
Author(s):  
Michael A. Nauck ◽  
Melanie Kahle-Stephan ◽  
Anna M. Lindmeyer ◽  
Sina Wenzel ◽  
Juris J. Meier
Keyword(s):  
Type 1 Diabetes ◽  
Basal Insulin ◽  
Clinical Characteristics ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Adult Type ◽  
Basal Rate ◽  
The Individual

Background: Basal rate profiles in patients with type 1 diabetes on insulin pump therapy are subject to enormous inter-individual heterogeneity. Tools to predict basal rates based on clinical characteristics may facilitate insulin pump therapy. Methods: Data from 339 consecutive in-patients with adult type 1 diabetes on insulin pump therapy were collected. Basal rate tests were performed over 24 hours. A mathematical algorithm to predict individual basal rate profiles was generated by relating the individual insulin demand to selected clinical characteristics in an exploratory cohort of 170 patients. The predicted insulin pump profiles were validated in a confirmatory cohort of 169 patients. Findings: Basal rates (0.27 ± 0.01 IU.d−1.kg−1) showed circadian variations with peaks corresponding to the “dawn” and “dusk” phenomena. Age, gender, duration of pump treatment, body-mass-index, HbA1c, and triacylglycerol concentrations largely predicted the individual basal insulin demand per day (IU/d; exploratory vs prospective cohorts: r2 = 0.518, P < .0001). Model-predicted and actual basal insulin rates were not different (exploratory cohort: Δ 0.1 (95% CI −0.9; 1.0 U/d; P = .95; prospective cohort: Δ −0.5 (95% CI −1.5; 0.6 IU/d; P = .46). Similarly, precise predictions were possible for each hour of the day. Actual and predicted “dawn” index correlated significantly in the exploratory but not in the confirmatory cohort. Interpretation: Clinical characteristics predict 52% of the variation in individual basal rate profiles, including their diurnal fluctuations. The multivariate regression model can be used to initiate or optimize insulin pump treatment in patients with type 1 diabetes.

Professional and flash on the monitoring of blood glucose levels of insulin pump therapy and without it

2021 ◽  
Author(s):  
Alexander Dreval
Keyword(s):  
Insulin Therapy ◽  
Insulin Pump ◽  
Self Control ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Glucose Levels ◽  
Patients With Diabetes ◽  
Control Of Diabetes ◽  
Medical University ◽  
And Control

A new method of self-control of diabetes based on the results of continuous monitoring of glycemia (HMG) is especially relevant in patients who are on pump insulin therapy, especially since the start of pump insulin therapy is carried out with the mandatory installation of the HMG system [1,3]. Due to the novelty of these two methods (treatment of diabetes and control of glycemia) for a wide clinical practice, there is an urgent need to publish concise practical guides on this topic for doctors, both for self-study of these methods, and for advanced training courses. Based on the above and our experience of teaching at the Department of Endocrinology of the Federal Medical University of MONICA, this guide has been prepared, which will be useful, first of all, for endocrinologists, therapists working with patients with diabetes, as well as for senior students of medical institutes who are interested in new directions in practical medicine.

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