scholarly journals SAT-663 The Impact of Anxiety on the Successful Management of a Type I Diabetic Patient

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Nikhila Janakiram
Keyword(s):  
Insulin Pump ◽  
Caloric Intake ◽  
Oral Intake ◽  
Diabetes Patient ◽  
Panic Attacks ◽  
Diabetic Patients ◽  
Type I ◽  
Increased Risk ◽  
Life Threatening ◽  
The Impact

Abstract Background: Patients with both type 1 diabetes mellitus (T1DM) and generalized anxiety disorder (GAD) are known to be at increased risk for hypoglycemic events, long-term hyperglycemia, weight gain and vascular disease. However, little research has been conducted regarding management of anxiety in patients with T1DM. Clinical case: A 27 year old female with T1DM (controlled on an insulin pump), GAD, PTSD, and history of benzodiazepine abuse presented to the emergency department after experiencing multiple panic attacks the day of admission. Recently, patient had multiple bouts of emesis in addition to decreased oral intake. On admission, blood sugar was 54, which increased to 164 after administration of 1 amp of dextrose-50. Patient was obtunded and unable to provide much history. Overnight, insulin was not given due to patient’s poor oral intake. The following morning, patient had one cup of juice for breakfast. Accu-check shortly after revealed a blood glucose level over 500 and patient developed diabetic ketoacidosis (DKA) and was admitted to the ICU on our hospital DKA protocol. Once anion gap closed, patient was transferred out of the ICU for continued management of her diabetes. Patient went on to have multiple panic attacks for the duration of her hospitalization which were controlled with scheduled diazepam, valproic acid, lorazepam and quetiapine. Psychiatry was consulted and found that a major contributing factor to her developing recurrent DKA was her struggle with anxiety surrounding the responsibilities of managing her diabetes and its associated complications including gastroparesis and neuropathy. Further conversation revealed that her psychiatrist had passed away a few months prior to admission and that she had not established care with a new psychiatrist yet. Discussion: Given the life changing nature of T1DM, it is not uncommon for these patients to have difficulty coping with the daily challenges required to optimally treat their condition. It can be frustrating when the slightest shift in caloric intake or exogenous insulin leads to life-threatening situations such as DKA. The above case sheds light on the profound medical consequences and setbacks that poorly controlled anxiety can have on diabetic patients. Therefore, recognizing the impact of anxiety on our patients with diabetes is critical in preventing further complications, especially microvascular, macrovascular and potentially other life-threatening events.

scholarly journals Early Morning Food Intake as a Risk Factor for Metabolic Dysregulation

Nutrients ◽  
2020 ◽  
Vol 12 (3) ◽  
pp. 756
Author(s):  
Ellen R. Stothard ◽  
Hannah K. Ritchie ◽  
Brian R. Birks ◽  
Robert H. Eckel ◽  
Janine Higgins ◽  
...  
Keyword(s):  
Food Intake ◽  
Caloric Intake ◽  
The United States ◽  
Early Morning ◽  
Shift Workers ◽  
Wake Time ◽  
Metabolic Dysregulation ◽  
Obesity And Diabetes ◽  
Increased Risk ◽  
The Impact

Increased risk of obesity and diabetes in shift workers may be related to food intake at adverse circadian times. Early morning shiftwork represents the largest proportion of shift workers in the United States, yet little is known about the impact of food intake in the early morning on metabolism. Eighteen participants (9 female) completed a counterbalanced 16 day design with two conditions separated by ~1 week: 8 h sleep opportunity at habitual time and simulated early morning shiftwork with 6.5 h sleep opportunity starting ~1 h earlier than habitual time. After wake time, resting energy expenditure (REE) was measured and blood was sampled for melatonin and fasting glucose and insulin. Following breakfast, post-prandial blood samples were collected every 40 min for 2 h and the thermic effect of food (TEF) was assessed for 3.25 h. Total sleep time was decreased by ~85 min (p < 0.0001), melatonin levels were higher (p < 0.0001) and post-prandial glucose levels were higher (p < 0.05) after one day of simulated early morning shiftwork compared with habitual wake time. REE was lower after simulated early morning shiftwork; however, TEF after breakfast was similar to habitual wake time. Insufficient sleep and caloric intake during a circadian phase of high melatonin levels may contribute to metabolic dysregulation in early morning shift workers.

Identification of Type I Diabetic Patients at Increased Risk for Hypoglycemia during Intensive Therapy

1983 ◽  
Vol 308 (9) ◽  
pp. 485-491 ◽  
Author(s):  
Neil H. White ◽  
Donald A. Skor ◽  
Philip E. Cryer ◽  
Lucy A. Levandoski ◽  
Dennis M. Bier ◽  
...  
Keyword(s):  
Intensive Therapy ◽  
Diabetic Patients ◽  
Type I ◽  
Increased Risk

Long term morbidity and mortality among survivors of infant neuroblastoma: A report from the Childhood Cancer Survivor Study (CCSS).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 10051-10051
Author(s):  
Danielle Novetsky Friedman ◽  
Pamela J Goodman ◽  
Wendy Leisenring ◽  
Lisa Diller ◽  
Susan Lerner Cohn ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Malignant Neoplasms ◽  
Cumulative Mortality ◽  
Late Mortality ◽  
Increased Risk ◽  
Life Threatening ◽  
Standardized Mortality Ratios ◽  
Grade 3 ◽  
The Impact

10051 Background: Infants with neuroblastoma typically have low-risk disease with excellent survival. Therapy has been de-intensified over time to minimize late effects, however the impact on survivors’ risk of late mortality, subsequent malignant neoplasms (SMN), and chronic health conditions (CHC) is unclear. Methods: We evaluated late mortality, SMNs and CHCs (graded according to CTCAE v4.03), overall and by diagnosis era, among 990 5-year neuroblastoma survivors diagnosed at < 1 year of age between 1970-1999. Cumulative mortality, standardized mortality ratios (SMR), and standardized incidence ratios (SIR) of SMNs were estimated using the National Death Index and SEER rates, respectively. Cox proportional hazards estimated hazard ratios (HR) and 95% confidence intervals (CI) for CHC, compared to 5,051 CCSS siblings. Results: Among survivors (48% female; median attained age: 24 years, range 6-46), there was increased treatment with surgery alone across the 1970s, 1980s and 1990s (21.5%, 35.3%, 41.1%, respectively), but decreased treatment with combination surgery + radiation (22.5%, 5.3%, 0.3%, respectively) and surgery + radiation + chemotherapy (28.7%, 14.7%, 9.3%, respectively). The 20-year cumulative mortality was 2.3% (95% CI, 1.4-3.8), primarily due to SMNs (SMRSMN= 10.0, 95% CI, 4.5-22.3). The 20-year cumulative incidence of SMN was 1.2% (95% CI, 0.3-3.2), 2.5% (95% CI, 1.3-4.4), and zero for those diagnosed in the 1970s, 1980s, and 1990s, respectively. SIR was highest for renal SMNs (SIR 12.5, 95% CI, 1.7-89.4). Compared to siblings, survivors were at increased risk for grade 1-5 CHC (HR 2.1, 95% CI, 1.9-2.3) with similar HR across eras (HR1970s= 1.9, 95% CI, 1.6-2.2; HR1980s= 2.2, 95% CI, 1.9-2.6; HR1990s= 2.0, 95% CI, 1.7-2.4). The HR of severe, disabling, life-threatening and fatal CHC (grades 3-5) decreased in more recent eras (HR1970s= 4.7, 95% CI, 3.4-6.6; HR1980s= 4.4, 95% CI, 3.2-6.2; HR1990s= 2.9, 95% CI, 2.0-4.3). Conclusions: Survivors of infant neuroblastoma remain at increased risk for late mortality, SMN, and CHCs many years after diagnosis. However, the risk of grade 3-5 CHCs has declined in more recent eras, likely reflecting de-intensification of therapy.

scholarly journals Exocrine Pancreatic Insufficiency in Diabetic Patients: Prevalence, Mechanisms, and Treatment

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Matteo Piciucchi ◽  
Gabriele Capurso ◽  
Livia Archibugi ◽  
Martina Maria Delle Fave ◽  
Marina Capasso ◽  
...  
Keyword(s):  
Islet Cells ◽  
Pancreatic Insufficiency ◽  
Endocrine System ◽  
Exocrine Pancreatic Insufficiency ◽  
Exocrine Function ◽  
Diabetic Patients ◽  
Type I ◽  
Exocrine Insufficiency ◽  
Pancreatic Exocrine ◽  
The Impact

Pancreas is a doubled-entity organ, with both an exocrine and an endocrine component, reciprocally interacting in a composed system whose function is relevant for digestion, absorption, and homeostasis of nutrients. Thus, it is not surprising that disorders of the exocrine pancreas also affect the endocrine system and vice versa. It is well-known that patients with chronic pancreatitis develop a peculiar form of diabetes (type III), caused by destruction and fibrotic injury of islet cells. However, less is known on the influence of diabetes on pancreatic exocrine function. Pancreatic exocrine insufficiency (PEI) has been reported to be common in diabetics, with a prevalence widely ranging, in different studies, in both type I (25–74%) and type II (28–54%) diabetes. A long disease duration, high insulin requirement, and poor glycemic control seem to be risk factors for PEI occurrence. The impact of pancreatic exocrine replacement therapy on glycemic, insulin, and incretins profiles has not been fully elucidated. The present paper is aimed at reviewing published studies investigating the prevalence of PEI in diabetic patients and factors associated with its occurrence.

scholarly journals Changes in gene expression induced by Micro-Immunotherapy

2021 ◽  
Vol 11 (40) ◽  
pp. 154-155
Author(s):  
Capieaux Etienne ◽  
Donat De Groote ◽  
Pierre Dorfman ◽  
Maurice Jeaner
Keyword(s):  
Gene Expression ◽  
Growth Factor ◽  
Dna Microarray ◽  
Interleukin 1 ◽  
Interleukin 2 ◽  
Diabetic Patients ◽  
Mrna Levels ◽  
Microarray Technology ◽  
Increased Risk ◽  
The Impact

Background: Metabolic syndrome (MS) is a metabolic disorder associated with obesity, type-II diabetes, and “low grade inflammation”, with the concomitant increased risk of cardiovascular events. As a chronic inflammatory process, MS results in a dysregulation of the cytokine profile. 2L®INFLAM, a Micro-immunotherapy (MI) medication formulated with highly diluted cytokines, is currently prescribed in Belgium for inflammatory diseases and potentially may be helpful for MS patients. Aims: To investigate the impact of 2L®INFLAM on selected gene expression markers (mRNA) in patients suffering from MS, in addition to biological and clinical parameters. Methodology: Four well characterized MS adult patients with stabilized body-weight were advised to take one capsule of 2L®INFLAM per day (by sublingual-oral route) for 6 months (composition in table 1). Concomitantly to biological and clinical examination, genes expression status was assessed by a DNA microarray technology (Oxygen™) comprising 200 genes involved mainly in oxidative stress and inflammation. Whole blood collection was performed before and after treatment (3-6 months) and mRNA levels measured. Gene expression was classified in 3 series (normally expressed, up or down-regulated) and genes related to diabetes predisposition were scored by using a proprietary Diascore (Probiox). Results: Before MI medication, a significant percentage of dysregulated genes (median: 16.3%) as well as a positive Diascore (median: 1.6) were noticed. Impressive correction of dysregulated genes (reaching 90% for one patient) was observed after 3 months of treatment (median: 2.3%) in addition to an improvement of Diascore in 3 MS patients out of 4 (median: 0.5). During the same period, both clinical and biological parameters remained unchanged. Conclusions: MS patients showing a high level of gene dysregulation efficiently normalized after 3 months of 2L®INFLAM (64%-90%), suggesting a biological regulatory effect of MI and a potential benefit of this medication for diabetic patients. Up and down-deregulated gene profiles were specific for each patient and not related to cytokine components of the formula. These preliminary data support the “domino effect” of MI sequential formula to restore in depth the immune homeostasis. DNA microarray technology may represent a promising tool for new provings as well as for biochemical comprehension of the “in vivo” effectiveness of highly diluted immune messengers. Table 1: 2L®INFLAM composition Compounds Dilutions Interleukin-1 (IL-1): 17 CH* Interleukin-1 Ra (IL-1 Ra): 3 CH Interleukin-2 (IL-2): 9 CH Interleukin-4 (IL-4): 7 CH Interleukin-6 (IL-6): 9 CH Interleukin-8 (IL-8): 9 CH Interleukin-10 (IL-10): 4 CH Interleukin-13 (IL-13): 9 CH Ciliary Neuro Trophic Factor (CNTF): 17 CH Leukemia Inhibitory Factor (LIF): 17 CH Oncostatine M (OSM): 9 CH Platelet Derived Growth Factor (PDGF): 5 CH Prostaglandine E2 (PgE2): 200 K** Rantes (Rantes): 17 CH Transforming Growth Factor beta(TGFβ): 5 CH Tumor Necrosis Factor α (TNFα): 17 CH SNA INFLAMa-01 18 C SNA INFLAMb-01 18 CH * CH: Centesimal Hahnemannian (1/100) ** K: Centesimal Korsakovian (1/100)

scholarly journals Haptoglobin Hp1 Variant Does Not Associate with Small Vessel Disease

2019 ◽  
Vol 10 (1) ◽  
pp. 18
Author(s):  
Juha Lempiäinen ◽  
Petra Ijäs ◽  
Teemu J. Niiranen ◽  
Markku Kaste ◽  
Pekka J. Karhunen ◽  
...  
Keyword(s):  
Stroke Patient ◽  
Small Vessel Disease ◽  
Cerebral Small Vessel Disease ◽  
Small Vessel ◽  
Diabetic Patients ◽  
Type I ◽  
Patient Cohort ◽  
Vessel Disease ◽  
Number Of Patients ◽  
Increased Risk

Haptoglobin (Hp) is a plasma protein that binds free hemoglobin and protects tissues from oxidative damage. An Hp2 allele has been associated with an increased risk of cardiovascular complications. On the other hand, recent studies have suggested that Hp1 allele increases risk to develop severe cerebral small vessel disease. We aimed to replicate this finding in a first-ever stroke patient cohort. Hp was genotyped by PCR and gel electrophoresis in the Helsinki Stroke Aging Memory Study in patients with DNA and magnetic resonance imaging (MRI) available (SAM; n = 316). Lacunar infarcts and white matter lesions (WML) classified by Fazekas grading from brain MRI were associated with Hp genotypes. As population controls, we used participants of Cardiovascular diseases—a sub study of Health 2000 Survey (n = 1417). In the SAM cohort, 63.0% of Hp1-1 carriers (n = 46), 52.5% of Hp1-2 carriers (n = 141) and 51.2% of Hp2-2 carriers (n = 129) had severe WML (p = 0.372). There was no difference in severe WMLs between Hp1-1 vs. Hp1-2 and Hp2-2 carriers (p = 0.201). In addition, 68.9% of Hp1-1 carriers (n = 45), 58.5% of Hp1-2 carriers (n = 135), and 61.8% of Hp2-2 carriers (n = 126) had one or more lacunar lesions (p = 0.472). There was no difference in the number of patients with at least one lacunar infarct between Hp1-1 vs. Hp1-2 and Hp2-2 groups (p = 0.322). Neither was there any difference when diabetic patients (type I and II) were examined separately. Hp1 allele is not associated with an increased risk for cerebral small vessel disease in a well-characterized Finnish stroke patient cohort.

scholarly journals The impact of aspirin on Klebsiella pneumoniae liver abscess in diabetic patients

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chien-Hsiang Tai ◽  
Chien-Ning Hsu ◽  
Shih-Cheng Yang ◽  
Cheng-Kun Wu ◽  
Chih-Ming Liang ◽  
...  
Keyword(s):  
Propensity Score ◽  
Klebsiella Pneumoniae ◽  
Liver Abscess ◽  
Lower Risk ◽  
Pyogenic Liver Abscess ◽  
Rank Test ◽  
Diabetic Patients ◽  
H2 Blockers ◽  
Increased Risk ◽  
The Impact

AbstractIn this study, we aimed to investigate the impact of aspirin on the risk of pyogenic liver abscess caused by Klebsiella pneumoniae (KP-PLA) and invasive KP-PLA syndrome (IKPS) in diabetic patients. Diabetic patients who were propensity-score matched were retrospectively included from hospital-based database. Kaplan–Meier approach with a log-rank test was used to compare the cumulative incidences of KP-PLA including IKPS between aspirin users and non-users. Totally, 63,500 patients were analyzed after propensity-score matching (1:1). Compared with that of non-users, the incidence of KP-PLA was significantly reduced in aspirin users (0.31% vs. 0.50%, p < 0.01), but not for that of IKPS (0.02% vs. 0.03%, p = 0.29). Patients taking aspirin for ≥ 90 days had a significantly lower risk for KP-PLA (hazard ratio, 0.67; 95%CI, 0.50–0.90). Females, taking clopidogrel or metformin for ≥ 90 days, and taking H2-blockers or proton pump inhibitors (PPIs) for ≥ 5 days were also associated with a lower risk of KP-PLA. However, cholangitis and a glycated hemoglobin ≥ 8.5% were associated with an increased risk of KP-PLA.

scholarly journals GLP-1 Receptor Agonists and Diabetic Kidney Disease: A Call of Attention to Nephrologists

2020 ◽  
Vol 9 (4) ◽  
pp. 947 ◽  
Author(s):  
José Luis Górriz ◽  
María José Soler ◽  
Juan F. Navarro-González ◽  
Clara García-Carro ◽  
María Jesús Puchades ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Glycemic Control ◽  
Diabetic Kidney Disease ◽  
Renin Angiotensin System ◽  
Diabetic Patients ◽  
Diabetic Kidney ◽  
Receptor Agonists ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
The Impact

Type 2 diabetes mellitus (T2DM) represents the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESKD), and diabetic kidney disease (DKD) is a major cause of morbidity and mortality in diabetes. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, driving the need for renal replacement therapies (RRT) worldwide, and its incidence is increasing. Until recently, prevention of DKD progression was based around strict blood pressure (BP) control, using renin–angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a new class of anti-hyperglycemic drugs shown to improve cardiovascular and renal events in DKD. In this regard, GLP-1RA offer the potential for adequate glycemic control in multiple stages of DKD without an increased risk of hypoglycemia, preventing the onset of macroalbuminuria and slowing the decline of glomerular filtration rate (GFR) in diabetic patients, also bringing additional benefit in weight reduction, cardiovascular and other kidney outcomes. Results from ongoing trials are pending to assess the impact of GLP-1RA treatments on primary kidney endpoints in DKD.

Association of metabolic syndrome with poorer prostate cancer and overall survival in men receiving androgen deprivation therapy (ADT) for biochemical relapse.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4555-4555
Author(s):  
Sarah Maria Rudman ◽  
Kathryn P. Gray ◽  
Julie Kasperzyk ◽  
Edward Giovannucci ◽  
Michael Pitt ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Metabolic Syndrome ◽  
Overall Survival ◽  
African American ◽  
Type I ◽  
Biochemical Relapse ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

4555 Background: The metabolic syndrome (MS) has been implicated in the development of prostate cancer (PC). In our previous study of a Veterans’ Administration (VA) cohort, MS was associated with a shorter duration of PC control with ADT. We report the impact of MS on overall survival (OS) and PC specific death for a cohort of patients with biochemical relapse. Methods: 273 pts (64 VA pts and 209 pts from Health Professionals Follow up Study) treated with ADT for biochemical recurrence post radiation or prostatectomy for PC were included. The modified Adult Treatment Panel III criteria for MS was used to identify patients with MS status prior to the commencement of ADT. Cox models tested for association of MS status with OS or time to PC specific death. With 42% overall death rate, 31% MS prevalence, there was 90% power to detect HR= 1.81 (type I error rate =0.05). Results: 31% pts (84/273) had MS and 15% pts (40/273) died of PC. Median follow-up was 9.5 years. The median OS with and without MS was 7.4 and 11.2 years respectively. Patients with hypertension, being African American, having diabetes and age were associated with increased risk of death from any causes, while hypertension and being African American were also associated with increased risk of PC specific death. A multivariate Cox regression model adjusted for age at diagnosis, race, definitive local therapy (RT vs. RP), PSA at diagnosis and Gleason score revealed MS was associated with a significantly increased risk of death from any cause and PC specific death (Table). Conclusions: In men receiving ADT for biochemically recurrent androgen dependent PC, the presence of MS at the commencement of ADT is associated with an increased risk of death from any cause as well as prostate cancer specifically. [Table: see text]

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.

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