scholarly journals Specific use of CSII during enteral nocturnal nutrition in a child with type 1 diabetes, Hashimoto's thyroiditis, and Down syndrome

2013 ◽  
Vol 57 (5) ◽  
pp. 388-392 ◽  
Author(s):  
Barbara Piccini ◽  
Sonia Toni ◽  
Lorenzo Lenzi ◽  
Federica Barni ◽  
Monica Guasti ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Enteral Feeding ◽  
Case Reports ◽  
Scientific Evidence ◽  
Nutrition Therapy ◽  
Artificial Nutrition ◽  
Diabetic Patients ◽  
Glucose Levels

The management of insulin therapy in diabetic patients who have comorbidities that involve nutritional aspects, is a major challenge for diabetes care teams. In diabetic patients with compromised nutritional status, artificial nutrition, both enteral or parenteral, may help in the treatment of chronic and acute diseases, leading to better and faster recover of the health status but, if not adequately associated with insulin therapy, it may negatively affect blood glucose levels and lead to poorer metabolic control. In particular, evidence-based recommendations for the treatment of diabetic patients during enteral nutrition therapy are not currently available and, therefore, medical practices are often based on case reports, rather than outcomes of research. We report our experience with a diabetic patient receiving nocturnal enteral feeding due to comorbidities and malnutrition, who was followed up at our centre and precociously treated with continuous subcutaneous insulin infusion after the onset of type 1 diabetes. There is great need for adequately powered randomized controlled trials to provide scientific evidence for the insulin treatment of diabetic patients undergoing enteral feeding.

Diabetic euglycemic ketoacidosis in newly diagnosed type 1 diabetes mellitus during Ramadan fasting

2015 ◽  
Vol 28 (3-4) ◽  
Author(s):  
Veysel Nijat Baş ◽  
Salih Uytun ◽  
Yasemin Altuner Torun
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Glycogen Storage ◽  
Diabetic Patients ◽  
Newly Diagnosed ◽  
Ramadan Fasting ◽  
Glucose Levels ◽  
Glycogen Storage Diseases

AbstractReal euglycemic diabetic ketoacidosis [DKA; blood glucose <200 mg/dL (11.1 mmol/L)] is rare, and long-lasting starvation conditions due to intervening diseases in type 1 diabetes mellitus patients may also cause it. Euglycemic DKA is also reported in insulin-dependent diabetics with depression, alcoholics, glycogen storage diseases, and chronic liver disease apart from pregnant cases. This case report is presented to emphasize the importance of evaluation of acid-base state, urine glucose, and ketone values at the application in all newly diagnosed type 1 diabetic patients with normal glucose levels by defining euglycemic DKA that resulted from long-lasting starvation during Ramadan fasting in a newly diagnosed 14-year-old male patient.

scholarly journals The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3558
Author(s):  
Dieter Furthner ◽  
Andreas Lukas ◽  
Anna Maria Schneider ◽  
Katharina Mörwald ◽  
Katharina Maruszczak ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Dietary Fat ◽  
Health Care Professionals ◽  
Scientific Evidence ◽  
Observation Time ◽  
Bolus Insulin ◽  
The Impact

Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.

scholarly journals Prediction and prevention of hypoglycaemic events in type-1 diabetic patients using machine learning

2019 ◽  
Vol 26 (1) ◽  
pp. 703-718 ◽  
Author(s):  
Josep Vehí ◽  
Iván Contreras ◽  
Silvia Oviedo ◽  
Lyvia Biagi ◽  
Arthur Bertachi
Keyword(s):  
Machine Learning ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Diabetes Management ◽  
Machine Learning Algorithms ◽  
Support Vector ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Prediction And Prevention

Tight blood glucose control reduces the risk of microvascular and macrovascular complications in patients with type 1 diabetes. However, this is very difficult due to the large intra-individual variability and other factors that affect glycaemic control. The main limiting factor to achieve strict control of glucose levels in patients on intensive insulin therapy is the risk of severe hypoglycaemia. Therefore, hypoglycaemia is the main safety problem in the treatment of type 1 diabetes, negatively affecting the quality of life of patients suffering from this disease. Decision support tools based on machine learning methods have become a viable way to enhance patient safety by anticipating adverse glycaemic events. This study proposes the application of four machine learning algorithms to tackle the problem of safety in diabetes management: (1) grammatical evolution for the mid-term continuous prediction of blood glucose levels, (2) support vector machines to predict hypoglycaemic events during postprandial periods, (3) artificial neural networks to predict hypoglycaemic episodes overnight, and (4) data mining to profile diabetes management scenarios. The proposal consists of the combination of prediction and classification capabilities of the implemented approaches. The resulting system significantly reduces the number of episodes of hypoglycaemia, improving safety and providing patients with greater confidence in decision-making.

scholarly journals Assessment the effects of insulin on adiponectin, nitric oxide, myeloperoxidase and lipid profile in type 1 diabetic patients

Pharmacia ◽  
2021 ◽  
Vol 68 (2) ◽  
pp. 313-319
Author(s):  
Jehan A. Mohammad ◽  
Zainab H. Fathi ◽  
Thikra Ali Allwash
Keyword(s):  
Oxidative Stress ◽  
Nitric Oxide ◽  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Lipid Profile ◽  
Serum Levels ◽  
Serum Glucose ◽  
Diabetic Patients ◽  
Type 1 Diabetic Patients

Type 1 diabetes (T1DM) is well recognized risk factor cardiovascular disease (CVD). Insulin therapy is recommended for all patients with type 1 diabetes. Previous findings showed that diabetes impairs endothelial function and increased glucose level reduces nitric oxide (NO) output and increases myeloperoxidase (MPO) activity. However, adiponectin (APN) decreases serum glucose levels. The current study evaluated effects of insulin therapy on circulating levels of oxidative stress and CVD biomarkers like NO, APN, MPO, AIP and lipid profile in type 1 diabetic patients. Fifty patients with T1DM and 18 healthy people were enrolled in this study. The recruited people with T1DM were classified into two groups: 22 newly diagnosed (untreated) type 1 diabetic patients and 28 insulin treated patients. In all groups, circulating NO, APN, MPO, AIP and lipids levels were measured. Compared to control, untreated diabetes revealed a significant increase in the serum levels of APN, MPO, TG, VLDL, TC, LDL and AIP, with a marked reduction in NO and HDL levels. However, insulin therapy significantly lowered MPO, TC and LDL, with no significant changes in the other biochemical parameters. As expected, oxidative stress and CVD-associated markers were significantly increased in untreated diabetes. Insulin therapy exhibited a relatively positive effect on oxidative stress and CVD biomarkers. Accordingly, insulin plus antioxidant supplementation required to normalize these parameters.

scholarly journals Adult-Onset Type 1 Diabetes and Pregnancy: Three Case Reports

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Barbara Bonsembiante ◽  
Maria Grazia Dalfrà ◽  
Michela Masin ◽  
Alessandra Gallo ◽  
Annunziata Lapolla
Keyword(s):  
Type 1 Diabetes ◽  
High Titer ◽  
Case Reports ◽  
Acute Onset ◽  
Diabetic Patients ◽  
Adult Onset ◽  
Onset Type ◽  
Overt Diabetes ◽  
Patients At Risk

From 5% to 10% of diabetic patients have type 1 diabetes. Here we describe three cases of adult-onset type 1 diabetes in pregnancy treated at our clinic between 2009 and 2012. Two patients came for specialist examination during pregnancy, the third after pregnancy. These women had no prior overt diabetes and shared certain characteristics, that is, no family diabetes history, age over 35, normal prepregnancy BMI, need for insulin therapy as of the early weeks of pregnancy, and high-titer anti-GAD antibody positivity. The patients had persistent diabetes after delivery, suggesting that they developed adult-onset type 1 diabetes during pregnancy. About 10% of GDM patients become pancreatic autoantibody positive and the risk of developing overt diabetes is higher when two or more autoantibodies are present (particularly GAD and ICA). GAD-Ab shows the highest sensitivity for type 1 diabetes prediction. We need to bear in mind that older patients might conceivably develop an adult-onset type 1 diabetes during or after pregnancy. So we suggest that women with GDM showing the described clinical features shall be preferably tested for autoimmunity. Pregnant patients at risk of type 1 diabetes should be identified to avoid the maternal and fetal complications and the acute onset of diabetes afterwards.

Euglycemic Ketoacidosis Diagnosis and Treatment Protocol in Type 1 Diabetes Patient

2019 ◽  
Vol 26 (3) ◽  
pp. 323-326
Author(s):  
Adriana Dumitru ◽  
Mihaela Posea
Keyword(s):  
Type 1 Diabetes ◽  
Case Report ◽  
Insulin Therapy ◽  
Treatment Protocol ◽  
Diabetes Patient ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Sodium Glucose Cotransporter ◽  
New Treatment

Abstract Introduction. The introduction of sodium glucose cotransporter 2 inhibitors in the management of diabetes was an innovation in the treatment of this disease, considering the protective cardiovascular effect not only the ability of decreasing the plasma glucose. In Europe, this class of medication is approved for the treatment of type 2 diabetes and some of them (dapagliflozin and sotagliflozin) are also approved for use in certain patients with type 1 diabetes mellitus. These patients must have inadequate control of their blood glucose levels despite optimal insulin therapy. One of the adverse effects is diabetic ketoacidosis. Case report. This case report presents a diabetic patient whose treatment was changed from insulin therapy to oral therapy. Within 10 days after the initiation of the new treatment her condition gradually worsened and she arrived at the emergency room with nausea, vomiting and altered general condition. She was admitted for euglycemic ketoacidosis and treated according to the protocol. Conclusions. This case reveals the importance of continuing the insulin therapy when adding a sodium glucose cotransporter 2 inhibitor in type 1 diabetes patients.

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