Intermediate-acting biosynthetic human (NPH) insulin was administered by disposable insulin syringe into the right upper thigh of nine insulin-dependent diabetic youths. Seven days later, the same amount and type of NPH insulin was given in the same anatomic site with a Medi-Jector II, which delivers insulin as a jet stream. Blood was collected before insulin injection and at hourly intervals subsequently for the measurement of glucose and insulin. The total serum insulin measured before the first morning dose with the needle and syringe and the Medi-Jector II was 41.2 +/- 10.7 microU/ml and 46.2 +/- 10.7 microU/ml, respectively. During the next 9 h, the areas under the respective total insulin curves were not different, but the area under the free-insulin curve after jet injection was greater than the free-insulin area after needle injection (P less than .01). The ratio of free/total serum insulin was 0.31 +/- 0.02 after needle injection and 0.40 +/- 0.03 after jet injection (P less than .0025). The peak of total insulin concentration occurred 4.2 h after jet injection of NPH: 1 h earlier than the peak after needle injection. The plasma glucose at time zero was 197 +/- 15 mg/dl before needle injection and 242 +/- 19 mg/dl before jet injection. Although the diet consumed by each subject on the 2nd study day was identical to that of the 1st day, the mean glucose increase was greater after needle-injected insulin than after jet-spray injection. This indicates that the greater amount of free insulin observed after jet-injected insulin had a direct effect in lowering the plasma glucose. Jet injection may reduce insulin requirements by increasing the availability of free insulin.
Previous research has shown that children and adolescents on different CP trajectories are exposed to a higher risk of being not in education employment or training (NEET) in young adulthood/adulthood. However, there has not been much research on factors that may mediate the association between CP trajectories and NEET status at age 20. In the present study, we investigated the role of school experience at age 14 years in mediating the association between CP trajectory group defined from age 4 to 13, namely Early-Onset Persistent (EOP), Adolescent-Onset (AO) and Childhood-Limited (CL), and Low (L) and NEET status at age 20. Using G-computation, we estimated the natural direct and indirect effects of CP trajectory group on NEET using data from ALSPAC. We found that school experience mediates the relationship between EOP trajectory and NEET status at age 20. The impact of attrition on these results was also investigated via imputation of missing values under the assumption of missing at random. These findings highlight the role of schools in potentially minimising the risk of becoming NEET in high-risk youth.Aims Empower our young people and encourage self-management and advocacy -that remains the overarching principle at our diabetes clinic. A key component of this is to understand the expectations of young people and answer questions they seek answers to. By using their checklist and not our own, we may cover fewer items but are more likely to have a purposeful and eventually fruitful conversation. Our aim was to identify each patient' individual goals and tailor discussions accordingly. Methods We distributed questionnaires, in the form of a 'mind bubble', to young people over 12 years attending paediatric diabetes clinics in our hospital over a two-month period. A 'mind bubble' is a simplified visual questionnaire designed to be user-friendly and engage with young people. Young people were asked 'What would you like to discuss today at your diabetes clinic?' and their responses were then addressed at that attendance. Results We received 32 completed 'mind bubbles'. The most common response was for advice on hyperglycemia and hypoglycaemia management (44%). 7 responses (22%) were regarding practical advice on holidays and exercise, 6 responses (19%) for specific questions regarding insulin pumps and infusion sets, and 3 (9%) regarding the use of associated computer programmes. 3 responses (9%) asked for education on ketones. Feedback from these were very positive specially from parents who felt their young person was empowered to articulate exactly what they wanted from us. Conclusions The 'mind bubble' provides a practical way for young people to inform the diabetes team of their expectations for each clinic visit. The wide variety of responses highlights the challenges of engaging with young people with complex, life long conditions, and the need for patient centred care to enable our young people grow in confidence.
AimsTo evaluate current practice with regards screening for coeliac disease (CD) in children and young people with type 1 diabetes (T1D) within our Trust and to compare it with the other 6 hospitals within in the region. This also includes ongoing surveillance practice for CD at subsequent follow-ups until the young person is transitioned into adult services.To compare our practice with national and international guidelines.1,2,3,4,5 To undertake cost analysis for various screening strategies.MethodsA complete list of all known T1D children and young persons within our Trust in 2017 was obtained. The upper age limit was restricted to 18 years. A pre-designed proforma was used to record demographic information including sex, current age, age at diagnosis and current coeliac status. We also recorded how often and what method was used to undertake coeliac surveillance. This was compared with national and international recommendations for CD in high-risk groups.Simultaneously we sent out a questionnaire to all other children and young people’s services in the region regarding their screening and surveillance practices for CD in T1D children and young people. The results obtained were compared with our practice.We undertook economic evaluation for various screening strategiesResultsPrevalence of CD in T1D children and young persons within our trust is 7.6%All hospitals within the region used coeliac serology rather than HLA specific alleles for initial screening for CDThere is regional variation regarding the frequency of on-going surveillance for CD reflecting a national and international lack of consensus.HLA allele testing at diagnosis is significantly more expensive even though it reduces eventual number of surveillance serology testing.ConclusionAll hospitals within the region are compliant with guidelines regarding screening for CD in T1D in children and young people at diagnosisAlthough none of the hospitals used HLA specific alleles as suggested by joint Coeliac UK and BSPGHAN,3 we felt this was not cost effective and would only reduce a small number of repeat testingWe propose a unified region wide ongoing surveillance of once every 3 to 4 years.References. NICE guideline [NG20]September 2015. Coeliac disease: recognition, assessment and management.. NICE guideline [NG18] August 2015 [Last updated: November 2016]. Diabetes (type 1 and type 2) in children and young people: diagnosis and management.. Joint BSPGHANand Coeliac UK guidelines for the diagnosis and management ofcoeliac disease in children.. European Society for Paediatric Gastroenterology, Hepatology, and Nutrition Guidelines for the Diagnosis of Coeliac Disease.. NASPGHAN Diagnosisand Treatment of Celiac Disease in Children.
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