scholarly journals Suggested Insulin Regimen for Pregnant Women with Diabetes Who Wish To Fast in Ramadan

2018 ◽  
Vol 17 (2) ◽  
Author(s):  
Ahmad Shuib Yahaya ◽  
Adibah Ibrahim ◽  
Mohd Shukri Othman ◽  
Mohd Pazudin Ismail
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Pregnant Women ◽  
Insulin Requirement ◽  
Hypoglycaemic Episode ◽  
Total Daily Dose ◽  
Insulin Regimen ◽  
Ramadan Fasting ◽  
Safety And Efficacy ◽  
Acting Insulin

Introduction: Pregnant women are among those who are exempted from Ramadan fasting. Despite that, many pregnant women had chosen to fast despite understanding the risk of complications especially hypoglycaemia. In Hospital USM (HUSM), an insulin regime for pregnant women who wish to fast was designed based on expert opinion of obstetricians, but its safety and efficacy are yet to be determined. Objective: To determine the safety and efficacy of the formulated insulin regime using subcutaneous Actrapid® and Insulatard® amongst pregnant women with diabetes who fast in Ramadan. Methodology: Pregnant patients with diabetes on insulin who wish to fast during Ramadan were invited to participate in the study. The total daily dose of insulin requirement prior to Ramadan was divided 3 parts; 2/3 for iftar (sunset meal) and 1/3 for sahur (pre-dawn meal). For each timing, 2/3 of the calculated dose was given as short-acting insulin Actrapid® and remaining 1/3 as intermediate-acting insulin Insulatard®. Three patients were monitored in the ward while fasting for two days. Blood glucose checked eight times a day. Following that, eight patients were followed up during Ramadan fasting with this regime. Weekly blood sugar profile (BSP) was taken and glycaemic control evaluated. Results: All patients were able to fast without any hypoglycaemic episode, both during in-patient study and during out-patient Ramadan fasting. Mean daily blood glucose per day for in-patient monitoring was 7.3 mmol/l with the lowest being 4.56 mmol/l in the afternoon. During Ramadan fasting, average glucose level was higher (6.79 mmol/l) compared to prior to Ramadan value (5.67 mmol/l) (p> 0.05). However, improvement of glycaemic control was observed towards end of Ramadan. Conclusion: Pregnant women with diabetes treated with insulin can fast safely during Ramadan using the suggested insulin regime with improvement of glycaemic control observed at the end of Ramadan.

scholarly journals Topical problems of diabetes treatment during pregnancy

2009 ◽  
Vol 12 (4) ◽  
pp. 32-36
Author(s):  
Irina Yur'evna Demidova ◽  
Natalya Yur'evna Arbatskaya ◽  
Elena Petrovna Mel'nikova
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Insulin Therapy ◽  
Pregnant Women ◽  
Intensive Insulin Therapy ◽  
Insulin Requirement ◽  
Subcutaneous Insulin ◽  
Diabetes Treatment ◽  
Self Monitoring ◽  
Stable Control

The main causes behind decompensation of diabetes mellitus (DM) in pregnant women are consid-ered, such as metabolic and hormonal disturbancesinfluencing insulin requirement in different periods of pregnancy and variability of glycemia related to pharmacokinetic and pharmacodynamicproperties of insu-lin preparations. Recommended target levels of glycemia in pregnant women with DM are cited. The fre-quencyof self-monitoring blood glucose and principles of intensive insulin therapy are discussed. Advan-tages of continuous subcutaneous insulin infusionand its role in the maintenance of stable control of car-bohydrate metabolism during pregnancy are discussed.

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 Successful transition from insulin to sulfonylurea, on second attempt, in a 24-year-old female with neonatal diabetes secondary to KCNJ11 gene mutation

2021 ◽  
Vol 14 (4) ◽  
pp. e239973
Author(s):  
Sulaiman Hajji ◽  
Khaled Aljenaee ◽  
Aoife Garrahy ◽  
Maria Byrne
Keyword(s):  
Blood Glucose ◽  
Glycaemic Control ◽  
Gene Mutation ◽  
Neonatal Diabetes ◽  
Later Life ◽  
Total Daily Dose ◽  
High Dose ◽  
Old Irish ◽  
Kcnj11 Gene ◽  
Blood Glucose Homeostasis

Neonatal diabetes (NDM) is defined as diabetes that occurs in the first 6 months of life, the majority of cases are due to sporadic mutations. ATP-sensitive potassium channels located in the beta cells of the pancreas play a major role in insulin secretion and blood glucose homeostasis. Mutations that alter the function of these channels may lead to NDM. We report a case of a 26-year-old Irish woman who was diagnosed with NDM at the age of 4 weeks and treated as type 1 diabetes mellitus, with multiple daily injections of insulin with suboptimal glycaemic control and frequent episodes of hypoglycaemic. She underwent genetic testing for NDM and was diagnosed with a KCNJ11 gene mutation. She was transitioned to high dose glibenclamide at the age of 16 years, but the trial failed due to poor glycaemic control and patient preference, and she was restarted on insulin. At 24 years of age, she was successfully transitioned from insulin (total daily dose 50 units) to high dose sulfonylurea (SU) (glibenclamide 15 mg twice daily). This resulted in optimal control of blood glucose (HbA1C fell from 63 to 44 mmol/mol), lower rates of hypoglycaemic and better quality of life. This case demonstrates that a second trial of SU in later life may be successful.

VIRTUAL TRIAL AND MONTE CARLO ANALYSIS OF MODEL-BASED GLYCAEMIC CONTROL PROTOCOL WITH REDUCED NURSING EFFORT

2015 ◽  
Vol 77 (7) ◽  
Author(s):  
Athirah Razak ◽  
Normy N. Razak ◽  
Nurhamim Ahamad ◽  
Fatanah Suhaimi ◽  
Ummu Jamaluddin
Keyword(s):  
Monte Carlo ◽  
Intensive Care ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Insulin Glargine ◽  
Monte Carlo Analysis ◽  
Tight Glycaemic Control ◽  
Control Protocol ◽  
Acting Insulin ◽  
Long Acting

Tight glycaemic management has been shown to be beneficial to the outcomes of patients receiving intensive care. However, tight glycaemic control (TGC) protocol within intensive care (ICU) comes with a high clinical demand, namely high nursing effort. Thus, there is a need for a protocol that is safe, effective, robust, yet does not require a high nursing effort. A less intensive protocol is designed to use a combination of subcutaneous long-acting insulin (glargine) with IV insulin bolus and only requires blood glucose (BG) measurements every 4 hours while maintaining measurement within 4.0-6.1 mmol/L. 

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.

scholarly journals Prevalence of anxiety and depression symptoms in pregnant women with type 2 diabetes and the impact on glycaemic control

2020 ◽  
Author(s):  
Björg Ásbjörnsdóttir ◽  
Marianne Vestgaard ◽  
Nicoline C. Do ◽  
Lene Ringholm ◽  
Lise L.T. Andersen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Pregnant Women ◽  
Anxiety And Depression ◽  
Depression Symptoms ◽  
The Impact

Elevated Circulating Levels of Motilin are Associated with Diabetes in Individuals after Acute Pancreatitis

2019 ◽  
Vol 128 (01) ◽  
pp. 43-51 ◽  
Author(s):  
Fuchsia D. Gold-Smith ◽  
Ruma G. Singh ◽  
Maxim S. Petrov
Keyword(s):  
Acute Pancreatitis ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Confidence Interval ◽  
Gastrointestinal Motility ◽  
Fasting Blood Glucose ◽  
Glycated Haemoglobin ◽  
Symptom Index ◽  
Plasma Motilin ◽  
Cardinal Symptom

Abstract Aim The study aimed to investigate the associations between glycaemic control after acute pancreatitis and gastrointestinal motility, using plasma motilin concentration and gastroparesis cardinal symptom index score as proxies. Methods This cross-sectional study recruited a total of 93 individuals after acute pancreatitis. Gastroparesis cardinal index scores, demographic and anthropometric factors, as well as pancreatitis-related factors were analysed. Fasting venous blood was collected to measure motilin, glycated haemoglobin, and fasting blood glucose. Linear regression analyses were conducted to investigate the associations between glycaemic control and gastrointestinal motility in unadjusted and adjusted models. Results Motilin was significantly higher in individuals with diabetes across all adjusted models, with the highest ß-coefficient (95% confidence interval) of 588.89 (138.50, 1039.28); P=0.010. Fasting blood glucose was significantly associated with motilin across all models, with the highest ß-coefficient (95% confidence interval) of 156.30 (55.49, 257.10); P=0.002. Glycated haemoglobin was significantly associated with motilin in one adjusted model with ß-coefficient (95% confidence interval) of 18.78 (1.53, 36.02); P=0.033. Gastroparesis cardinal symptom index was not significantly associated with any measure of glycaemic control. Conclusions Diabetes in individuals after acute pancreatitis appears to be characterised by elevated plasma motilin but not gastroparesis cardinal symptom index. The role of motilin in this setting warrants further investigations.

scholarly journals Glycaemic control by monoamine oxidase inhibition in a patient with type 1 diabetes

2016 ◽  
Vol 14 (2) ◽  
pp. 163-165 ◽  
Author(s):  
Hamlin Emory ◽  
Neptune Mizrahi
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Monoamine Oxidase ◽  
Monoamine Oxidase Inhibitor ◽  
Combined Treatment ◽  
Insulin Regimen ◽  
Imaging Data ◽  
Monoamine Oxidase Inhibition ◽  
Oxidase Inhibition

We present clinical, electroencephalographic and low-resolution electromagnetic tomography data that support combined treatment with insulin and a monoamine oxidase inhibitor in a patient with type 1 diabetes. We suggest that brain imaging data can identify a subgroup of patients who are likely to benefit from an insulin regimen and monoamine oxidase inhibition to improve glycaemic control, cardiovascular function, normalize the circadian rhythm and restore perception of glycaemic awareness.

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