The Insulin Regimen That Works

2018 ◽  
Vol 11 (2) ◽  
pp. 165-168
Author(s):  
Svitlana Crawley ◽  
Susan Chaney
Keyword(s):  
Blood Glucose ◽  
Insulin Therapy ◽  
Nurse Practitioners ◽  
Basal Insulin ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Insulin Regimen ◽  
Acting Insulin ◽  
Antihyperglycemic Therapy

Background: Type 2 diabetes mellitus requires monitoring patients’ glycemic control. Treatment must be escalated if glucose levels remain above the recommended goal in patients who are adherent to their current treatment. If glycosylated hemoglobin (HbA1c) levels remain unmet with maximum doses as recommended by the American Diabetes Association (ADA) after adding basal insulin, but fasting blood glucose is at goal, one to three injections daily of rapid-acting insulin are typically added to the treatment plan to be injected prior to meals while continuing all other antihyperglycemic medications. Objective: To describe an effective method of intensifying insulin therapy based on patients’ needs and abilities to self-manage their medications. Methods: We retrospectively reviewed the case of a patient who was referred to the Endocrinology Specialty Clinic for diabetes management. Results: Diabetes control was improved after intensifying insulin therapy by adding once-daily rapid-acting insulin injections. Conclusions: Intensifying insulin therapy by adding one dose of rapid-acting insulin prior to meals can improve HbA1c to < 7% in patients on maximum doses of basal insulin whose fasting blood glucose is at goal but whose HbA1c is above goal. Implications for Nursing: Nurse practitioners must use current care guidelines supported by evidence-based literature to improve patients’ outcomes. This case study supports ADA recommendations on early intensification of antihyperglycemic therapy in diabetic patients to decrease the risk of complications by achieving and maintaining HbA1c goals early.

scholarly journals Utilizing Technology-Enabled Intervention to Improve Blood Glucose Self-Management Outcome in Type 2 Diabetic Patients Initiated on Insulin Therapy: A Retrospective Real-World Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Jian Lin ◽  
Xia Li ◽  
Shan Jiang ◽  
Xiao Ma ◽  
Yuxin Yang ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Insulin Therapy ◽  
Fasting Blood Glucose ◽  
Blood Glucose Control ◽  
Diabetic Patients ◽  
Premixed Insulin ◽  
Type 2 Diabetic Patients ◽  
Self Monitoring

Background. The aim of this study was to assess the benefits of a mobile-enabled app through Lilly Connected Care Program (LCCP) in achieving blood glucose control and adhering to self-monitoring of blood glucose in patients with type 2 diabetes mellitus (T2DM). Methods. This retrospective study included T2DM patients who were initiated on insulin therapy (mostly premixed insulin) after failure to respond to oral antidiabetic drugs. Patients were provided with glucometers enabled with synchronous data transmission to healthcare providers and family members. The primary objective was to assess the benefits of LCCP based on changes in fasting blood glucose (FBG) and postprandial glucose (PPG) levels from baseline to 12 weeks. Paired t-test was used to assess the change in blood glucose (BG) from baseline to week 12. Results. In total, 14,085 T2DM patients were recruited. Compared with baseline, significant reductions in FBG and PPG were evident at week 12 (FBG: -0.39 mmol/L; PPG: −0.79 mmol/L; both P < 0.001 ). Furthermore, at week 12, the proportion of patients attaining a target glucose level of FBG <7.0 mmol/L and PPG <10.0 mmol/L was 25.37% and 59.68%, respectively, with a statistically significant increase compared with that at baseline (6.74% and 45.59%, respectively, both P < 0.001 ). The frequent monitoring of patients could gain a higher target achievement of FBG (28.1% vs 24.2%) and PPG (64.4% vs 55.1%) than the occasional monitoring patients. Additionally, the incidence of hypoglycemia gradually decreased and was significantly lower than the baseline level. Conclusions. In T2DM patients with poor glycemic control, the application of mobile enabled intervention (LCCP) along with insulin significantly reduced the hypoglycemia while improving glycemic control during period of naïve initiating insulin therapy. Additionally, the high frequency of BG self-monitoring was associated with better glycemic control.

scholarly journals Intravenous insulin therapy in diabetes mellitus with hyperglycemic crisis and intercurrent illness

2020 ◽  
Vol 30 (6) ◽  
Author(s):  
Budi Suprapti ◽  
Fairuza Syarfina ◽  
Chrismawan Ardianto ◽  
Cahyo Wibisono
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Common Factor ◽  
Diabetic Patients ◽  
Insulin Regimen ◽  
Inclusion Criteria ◽  
Type 2 Diabetic Patients ◽  
Intravenous Insulin ◽  
Intercurrent Illness

AbstractBackgroundHyperglycemic crisis is one of the complications of diabetes mellitus, which is common in hospitalized diabetic patient with intercurrent illness, requiring immediate action to control blood glucose. As an effort to attain rapid, gradually and more definite blood glucose, insulin is given intravenously. This study aimed to explore the patterns of blood glucose in hyperglycemic crisis and intercurrent illness, precipitating conditions, insulin regimen and blood glucose (BG) level results.MethodsIt was a cross-sectional study conducted on type 2 diabetic patients. The inclusion criteria were as follows: hospitalized in the general/internal medicine ward with or without any complication or comorbidity receiving intravenous insulin therapy; have pre- and post-BG data after insulin intervention.ResultsIn 3 months of the study period, 22 patients fulfilled the inclusion criteria with 28 cases of intravenous insulin therapy, and 1 patient could get more than one intervention. The major condition toward a hyperglycemic crisis condition was infection. The patient’s BG before interventions was 243 mg/dL to more than 600 mg/dL. The dosage of insulin varied from 4 to 10 units per hour, intravenously with a frequency of 1–4 times. The dosage consideration was not only based on BG levels but also on the patient’s condition. The reduction in BG level varied greatly between 0.2 and 28.1 mg/dL per unit of insulin. The BG level of three patients did not decrease. On the other hand, one patient experienced mild hypoglycemia.ConclusionsInfection conditions were the most common factor for the hyperglycemia crisis. Moreover, intravenous insulin dosing was done individually, and there was a large variation in the results of the decrease in BG levels.

scholarly journals Polyherbal antidiabetic drug: An approach to cure diabetes

2020 ◽  
Vol 11 (2) ◽  
pp. 2679-2683
Author(s):  
Ranjit Sidram Ambad ◽  
Gaikwad S B ◽  
Anshula G ◽  
Nandkishor Bankar
Keyword(s):  
Blood Glucose ◽  
Blood Sugar ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Complete Recovery ◽  
Health Concern ◽  
Diabetic Patients ◽  
Medical College ◽  
The World ◽  
Animal House

In recent years, diabetes has become a major health concern. India is referred to as the diabetes capital of the world. There are plenty of chemical agents available to monitor and treat diabetic patients, but up to this date, no complete recovery from diabetes has been recorded. Many herbal plants with hypoglycemic properties are known from around the world as an alternative to these synthetic agents; which is a natural remedy to keep the blood sugar under control by consuming vegetables & herbs in our diet. Such medicinal plants & their herbal preparation with proven antidiabetic and related beneficial effects were used in the treatment of diabetes in rats. The effect of polyherbal drug Anti-hyperglycemic activity is studied in rats against alloxaninduced diabetes. This polyherbal drug consists of 16 antidiabetic plants. Disorders in diabetes-induced glucose metabolism have been shown to be regulated. The present study was conducted in the Dept. of Pharmacology and Dept. of Biochemistry at Central Animal House Facility of the SBH Govt Medical College, Dhule, in collaboration with Datta Meghe Medical College, (Datta Meghe Institute of Medical Sciences Sawangi, Meghe) Nagpur, Maharashtra, India. After the treatment, fasting blood glucose, plasma insulin and glycosylated hemoglobin (HbA1c) were determined in normal and experimental rats. Polyherbal mixture was seen to be an effective and safe method for management of diabetes which reduces blood sugar levels & shows positive effect in altering blood glucose levels. The herbal formulation could be lowering the insulin resistance, thereby normalizing the uptake of glucose by cells.

scholarly journals Frequency of the anti-glutamic acid decarboxylase immunological marker in patients with diabetes duration longer than three years in southern Brazil

2011 ◽  
Vol 129 (3) ◽  
pp. 130-133 ◽  
Author(s):  
Marina Carolina Moreira ◽  
Gustavo Müller Lara ◽  
Rafael Linden ◽  
Luciane Rosa Feksa ◽  
Rejane Giacomelli Tavares ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glutamic Acid ◽  
Glutamic Acid Decarboxylase ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Control Group ◽  
Acid Decarboxylase ◽  
Diabetic Patients ◽  
Southern Brazil ◽  
The Mean

CONTEXT AND OBJECTIVE: The anti-GAD (glutamic acid decarboxylase) antibody is considered to be an important marker for type 1 diabetes mellitus (DM1), with frequency that varies depending on the population studied and the duration of the disease. Therefore, the aim of this study was to determine the frequency of this autoantibody in a group of patients in southern Brazil with DM1 that had been diagnosed more than three years previously. DESIGN AND SETTING: Analytical cross-sectional study with a control group conducted at the Biomedicine Laboratory of Universidade Feevale. METHODS: This study was conducted between June 2007 and December 2008, and 109 individuals were enrolled during this period. Fifty-eight were DM1 patients and 51 were individuals free from DM1 and without any history of diabetes, who constituted the control group. RESULTS: In the DM1 group, the mean age was 27 ± 1.7 years and 50% were men. The mean fasting blood glucose in the DM1 group was 208 ± 15 mg/dl and mean HbA1c (glycosylated hemoglobin) was 8.7 ± 0.25%. In the control group, the mean fasting blood glucose and HbA1c were 82 mg/dl and 5.0% respectively. Thirty-seven individuals with DM1 (63.8%) were positive for anti-GAD, and this proportion was significantly larger than in the control group. CONCLUSIONS: These results show the high prevalence of anti-GAD in the population of diabetic patients in southern Brazil, thus indicating that the antibody was still present a long time after the disease had been diagnosed.

scholarly journals The Correlation between Serum Uric Acid and Renal Function in Elderly Chinese Diabetes with Normoalbuminuria

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Qiaojing Qin ◽  
Yingjun Qian ◽  
Guanghua Zhu ◽  
Weifeng Fan ◽  
Jianying Niu ◽  
...  
Keyword(s):  
Renal Function ◽  
Uric Acid ◽  
Blood Glucose ◽  
Serum Uric Acid ◽  
Pearson Correlation ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Diabetic Patients ◽  
Urine Ph ◽  
Elderly Chinese

Objective. The elder diabetic patients increases rapidly in China and often accompany with hyperuricemia. Recently evidences show that renal function has been impaired in part of diabetic patients with normoalbuminuria. Therefore, we investigated the relationship between serum uric acid (SUA) and renal function in Chinese elder diabetes with normoalbuminuria. Methods. The physical examination data from 1052 cases of diabetic residents with normoalbuminuria aged 70 years and over in the Jiangchuan community of Minhang District, Shanghai, from October 2011 to September 2014 was analyzed retrospectively. Each received height, body weight, waist circumference (WC), waist-to-hip ratio (WHR), blood pressure (BP), and collected samples of fasting blood and morning urine to detect blood routine, blood glucose, glycosylated hemoglobin (HbA1c), blood lipids, serum creatinine, urinary albumin, urine creatinine, and urine PH value. Correlation between SUA and renal function, an index of which is estimated using estimated glomerular filtration rate (eGFR), was analyzed. Results. The prevalence of hyperuricemia was 21.10%. Levels of WC and triglyceride (TG) increased and the levels of HbA1c, high density lipoprotein-cholesterol (HDL-C), eGFR, and urine PH decreased while the levels of SUA increased. Moreover, negative correlation of eGFR with age, WC, leukocyte, and SUA (Pearson r=0.415) was observed via Pearson correlation analysis. It indicates the strong association between SUA and eGFR. Furthermore, eGFR independently associated with SUA, age, leukocyte, hemoglobin (Hb), and fasting blood glucose (FBG) was confirmed by multiple linear stepwise regression analysis. Conclusion. SUA may play an important role in the decrease of eGFR in elderly Chinese diabetic patients with normoalbuminuria.

scholarly journals Medication Adherence to Oral Hypoglycemic Agents Among Type II Diabetic Patients and Their Clinical Outcomes with Special Reference to Fasting Blood Glucose and Glycosylated Hemoglobin Levels

2015 ◽  
Vol 11 (3) ◽  
pp. 226-232 ◽  
Author(s):  
SS Shrestha ◽  
R Shakya ◽  
BM Karmacharya ◽  
P Thapa
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Special Reference ◽  
Clinical Outcomes ◽  
Glycosylated Hemoglobin ◽  
Fasting Blood Glucose ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Age Group ◽  
Oral Hypoglycemic Agents

Background Oral hypoglycemic agents (OHAs) are the major treatment for people with type 2 diabetes mellitus (DM2). However, non-adherence to OHAs remains as one of the main reasons for poor glycemic control. Objectives To assess the adherence pattern to OHAs and clinical outcomes with special reference to fasting blood glucose (FBG) level and glycosylated hemoglobin (HbA1c) levels. Methods Informed consent was obtained from patients fulfilling the criteria and from the patient party in case of incapacitated patients. Information was obtained by interviewing them and filled in the appropriate questionnaire. All the medical information of the patients was obtained from the medical case records and laboratory reports. Results OHAs had been discontinued by 25% of patients. Overall 38% had ever discontinued and/ or often missed OHAs. Intentional discontinuation of OHAs attributed for 72% of the patients, followed by forgetfulness (42.9%), carelessness (30.6%), and hypoglycemia, (24%). There were 50.50% patients who had uncontrolled FBG (>130 mg/dl) level and 39% had uncontrolled HbA1c (≥ 7%) level. Taking reference age group 51-60 years, control of FBG level was found to be statistically associated with the decreasing age group (p = 0.006, OR = 4.8) as well as increasing age group (p = 0.008, OR = 4.034). There was significant association between controlled HbA1c level and patients’ knowledge about the precautions to be taken while using OHAs (p = 0.044, OR = 4). However, there was no significant association between glycemic control and OHAs adherence. Conclusion Majority of the patients who had missed OHAs attributed it to forgetfulness. Hypoglycemia may also be one of the contributing factors for poor adherence to OHAs. However no association was found between adherence and various other factors like age groups, treatment complexity, health literacy and social or family support. DOI: http://dx.doi.org/10.3126/kumj.v11i3.12508 Kathmandu Univ Med J 2013; 43(3):226-232

scholarly journals Addition of a single short-acting insulin bolus to basal insulin-supported oral therapy: a systematic review of data on the basal-plus regimen

2019 ◽  
Vol 7 (1) ◽  
pp. e000679 ◽  
Author(s):  
Jochen Seufert ◽  
Anja Borck ◽  
Peter Bramlage
Keyword(s):  
Basal Insulin ◽  
Fixed Ratio ◽  
Severe Hypoglycemia ◽  
Insulin Regimen ◽  
Premixed Insulin ◽  
Minimal Impact ◽  
Short Acting ◽  
Acting Insulin ◽  
Short Acting Insulin ◽  
Basal Bolus

We summarize here clinical and trial data on a once-daily administration of a single bolus to the meal with the largest expected postprandial glucose excursion (basal-plus), and comment on its clinical utility in the treatment of type 2 diabetes. A PubMed search of data published until September 2018 was taken into consideration and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eighteen reports representing 15 studies were identified (age: 18–80 years; 50–890 patients; follow-up: 8 days to 60 weeks). Data suggest basal-plus is efficacious for improving glycemic control, with a low incidence of (severe) hypoglycemia and minor increases in bodyweight. The timing of short-acting insulin administration and use of different monitoring/titration approaches appear to have minimal impact. When compared with premixed insulin, basal-plus results in largely comparable outcomes. Compared with basal-bolus, it may result in non-inferior glycemic improvements with less weight gain, less hypoglycemia and fewer daily injections. A basal insulin/glucagon-like peptide-1 receptor agonist fixed ratio combination may offer several advantages over the basal-plus regimen, at the cost of gastrointestinal side effects. We conclude that the stepwise introduction of short-acting insulin via the basal-plus strategy represents a viable alternative to a full basal-bolus regimen and may help to overcome barriers associated with multiple injections and anticipated complexity of the insulin regimen.

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