exogenous insulin
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Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 135
Author(s):  
Ioannis Kakoulidis ◽  
Costas Thomopoulos ◽  
Ioannis Ilias ◽  
Stefanos Stergiotis ◽  
Stefanos Togias ◽  
...  

Gestational diabetes mellitus (GDM) is associated with hypertensive disorders in pregnancy. Alpha-methyl-DOPA (αMD) is a commonly used medication for hypertension in pregnant women. This medication may be associated with alteration in insulin resistance and glucose homeostasis. The aim of the present study was to investigate in 152 pregnant women whether the demands of exogenous insulin in glucocorticoid-treated women during pregnancy are different between those with GDM and hypertension treated with αMD and those without hypertension. In the group of women with GDM under insulin treatment, who received αMD for hypertension, the increase in insulin needs was relatively lower by at least 30% of the pre-admission insulin dose compared to all of the remaining women not receiving αMD in the same group (9 women vs. 50 women, p = 0.035). Our work raises the hypothesis that αMD can favorably modulate insulin sensitivity in the third trimester of pregnancy in previously insulin-treated women with gestational diabetes who receive glucocorticoids.


Author(s):  
Maegan L. Watson-Skaggs ◽  
Tracy L. Gieger ◽  
Hiroto Yoshikawa ◽  
Michael W. Nolan

Abstract OBJECTIVE To describe clinical outcomes in cats with insulin resistance and acromegaly treated with stereotactic radiosurgery (SRS). ANIMALS 14 client-owned cats. PROCEDURES Medical records of cats with insulin resistance and acromegaly treated with SRS (17 Gy) between August 2013 and November 2019 at a single institution were reviewed. Kaplan-Meier analysis was used to evaluate overall survival time. RESULTS Acute adverse effects of SRS included somnolence (n = 2) and alopecia (1). Delayed adverse effects of SRS included unspecified neurologic complications (n = 1; 481 days), seizures (1; 1,541 days), and hypothyroidism (1; 64 days). Exogenous insulin requirements decreased in 10 of the 14 cats, with a median time to lowest insulin dose of 399 days (range, 42 to 879 days). Complete diabetic remission was achieved in 3 cats. The median overall survival time was 741 days (95% CI, 353 to 1,129 days). Six cats were still alive at the end of the study period, with a median follow-up time of 725 days. In 7 of the 8 cats that had died, death was presumptively attributed to acromegaly owing to continued insulin resistance, organ failure, or altered neurologic status. CLINICAL RELEVANCE The SRS protocol was well tolerated and associated with survival times similar to those reported previously. Most cats had decreased exogenous insulin requirements after SRS. Latency to an endocrine response was highly variable, emphasizing the need for careful ongoing diabetic monitoring of acromegalic cats after pituitary gland irradiation.


2021 ◽  
Vol 68 (3) ◽  
pp. 180-187
Author(s):  
Philip M. Yen ◽  
Andrew S. Young

The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. This review provides a concise overview of the pathophysiology of T1DM, introduces foundational aspects of common insulin pump systems, and discusses several general recommendations regarding the perioperative management of insulin pumps during dental surgeries.


Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 943
Author(s):  
Diana Šimonienė ◽  
Džilda Veličkienė

Background and objectives: Although the role of insulin in the periphery is well understood, not as much is known about its multifactorial role in the brain. The aim of this study is to determine whether exogenous insulin, evaluated by daily insulin requirement, has an impact on mild cognitive impairment (MCI), and whether this relationship is mediated by insulin doses and other risk factors. Materials and methods: A sample of 100 participants with type 2 diabetes aged 40 and over was divided into case and control groups, according to their insulin requirement. Patients with an insulin requirement >1 IU/kg/day were assessed as the case group whereas those with an insulin dose <1 IU/kg were used as the control group. All participants underwent cognitive testing using MoCA questionnaire scoring and blood analysis to determine lipid and uric acid levels in plasma. Subjects were categorized as having normal cognitive function or MCI. Results: Results showed that the prevalence of MCI in Lithuanian elderly diabetic patients was high in the groups with a normal insulin requirement or high insulin requirement at 84.8% and 72%, respectively (p = 0.14). Age (p = 0.001) and insulin dose (p < 0.0001) were related to the MCI. Using ROC curve analysis, the highest rate risk of MCI occurred when the insulin dose was lower than 144 IU/d. Conclusions: In summary, the results of this study provided evidence that increased exogenous insulin supply improves cognitive function. Higher insulin dose (>144 IU/d) demonstrated a positive effect on cognitive function, especially in individuals with poorly controlled diabetes (HbA1c ≥ 9%). Finally, the prevalence of MCI in the T2DM population was found to be very high. Future research is needed to determine whether high exogenous insulin doses have a protective effect on MCI.


Author(s):  
Elinor C Mannon ◽  
Christina L Sartain ◽  
Trevin C Wilkes ◽  
Jingping Sun ◽  
Aaron J Polichnowski ◽  
...  

Impairments in insulin sensitivity can occur in patients with chronic kidney disease (CKD). Correction of metabolic acidosis has been associated with improved insulin sensitivity in CKD, suggesting metabolic acidosis may directly promote insulin resistance. Despite this, the effect of acid or alkali loading on insulin sensitivity in a rodent model of CKD (remnant kidney) has not been directly investigated. Such studies could better define the relationship between blood pH and insulin sensitivity. We hypothesized that in remnant kidney rats, acid or alkali loading would promote loss of pH homeostasis and consequently decrease insulin sensitivity. To test this hypothesis, we determined the impact of alkali (2 weeks) or acid (5-7 days) loading on plasma electrolytes, acid-base balance, and insulin sensitivity in either sham control, 2/3 or 5/6 nephrectomy rats. Rats with 5/6 nephrectomy had the greatest response to insulin followed by animals with 2/3 nephrectomy and sham control rats. We found that treatment with a 0.1M sodium bicarbonate solution in drinking water had no effect on insulin sensitivity. Acid loading with 0.1M ammonium chloride resulted in significant reductions in pH and plasma bicarbonate. However, acidosis did not significantly impair insulin sensitivity. Similar effects were observed in Zucker obese rats with 5/6 nephrectomy. The effect of renal mass reduction on insulin sensitivity could not be explained by reduced insulin clearance or increased plasma insulin levels. We found that renal mass reduction alone increases sensitivity to exogenous insulin in rats, and that this is not acutely reversed by development of acidosis.


2021 ◽  
Vol 6 (8) ◽  

Diabetes is a disease currently affecting over 30 million Americans and is a leading cause of amputation, blindness, and chronic kidney disease. Treatment of diabetes with medications and lifestyle modifications alone have not eliminated these complications, because in part they lack the ability to restore the periodic cycles and rest periods of insulin that exist in healthy physiology. Insulin is excreted in a cyclical and oscillatory pattern by the pancreas, that is critical to maintain adequate insulin sensitivity at the insulin receptor level. Administration of exogenous insulin bio identically matching this physiologic profile is more effective at controlling blood glucose level and reducing complications of diabetes than standard drug therapy and lifestyle modifications alone. This matching of physiological insulin helps reduce inflammatory cascades responsible for a number of diabetic complications. In this article, we will review how insulin is secreted and functions physiologically and highlight a dynamic insulin delivery modality that mimics normal secretion profiles. This biomimicry reduces insulin exposure, which appears to reduce the progression to or worsening of insulin resistance. We will review how administration of insulin in this manner has been associated with reduction of diabetic complications.


2021 ◽  
Vol 11 (1) ◽  
pp. 229-239
Author(s):  
ASV Prasad

The occurrence of both hyperglycaemia and hypoglycaemia, individually and in combination is reported in the literature, occurring in various insulin resistance (IR) syndromes, both to endogenous insulin, like Hirata disease, otherwise called the Insulin Autoimmune syndrome (IAS), type A, I R, Type B, IR etc. and to exogenous administered insulin, like, exogenous insulin antibody syndrome, (EIAS), non- classical auto immune syndrome to exogenous insulin, etc. Glycaemic disturbances without IR and in non-diabetics, like idiopathic and symptomatic reactive hypoglycaemias are also described in the literature. This author, recently reported for the first time, a biphasic post - vaccinal syndrome, following vaccination for Covid 19 (Covishield), causing glycemic disturbances in an elderly diabetes mellitus type 2 (DM2) patient on insulin who had moderate IR. Insulin resistance to exogenous insulin observed in the patient, is considered crucial for the occurrence of the observed clinical syndrome as, an increase or decrease of IR, and could explain the observed glycaemic disturbances. The IR to exogenous insulin, and the vaccine to Covid 19, both have immunological basis. The immunological aspects of both IR and the Covid 19 vaccine are briefly reviewed to explore any possible interaction between the two, that could explain the observed clinical syndrome, referred to above. Also, the various underlying mechanisms for the glycaemic disturbances, in the above-mentioned IR syndromes and non-IR or r syndromes are explored as to shed some light on the mechanism of the glycaemic disturbances in the syndrome reported. A hypothesis is suggested, taking into consideration, the aforesaid observations. Apart from IR to exogenous insulin, other unidentified factors that might be causing the clinical syndrome reported, and which might account for its paucity of reporting, need to be investigated by future research.


Author(s):  
Hiroyasu Sakai ◽  
Maho Asami ◽  
Hiroaki Naito ◽  
Satoko Kitora ◽  
Yuta Suzuki ◽  
...  

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