A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital

Kedia, Rohit; Desouza, Cyrus; Smith, Lynette M.; Shivaswamy, Vijay

doi:10.1016/j.jdiacomp.2017.02.008

Cited by 4 publications

(1 citation statement)

References 22 publications

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“…To achieve this goal, total daily insulin doses exceeding 100 I.U. can be utilized ( 87 ). These are doses that would normally be toxic in the absence of an underlying insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Resistance as a Possible Cause of Autoimmune Diseases: A Hypothesis Confirmed by a Therapeutic High-Dose Vitamin D Protocol

et al. 2021

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Vitamin D3 (cholecalciferol) is a secosteroid and prohormone which is metabolized in various tissues to the biologically most active vitamin D hormone 1,25(OH)2D3 (calcitriol). 1,25(OH)2D3 has multiple pleiotropic effects, particularly within the immune system, and is increasingly utilized not only within prophylaxis, but also within therapy of various diseases. In this context, the latest research has revealed clinical benefits of high dose vitamin D3 therapy in autoimmune diseases. The necessity of high doses of vitamin D3 for treatment success can be explained by the concept of an acquired form of vitamin D resistance. Its etiology is based on the one hand on polymorphisms within genes affecting the vitamin D system, causing susceptibility towards developing low vitamin D responsiveness and autoimmune diseases; on the other hand it is based on a blockade of vitamin D receptor signaling, e.g. through pathogen infections. In this paper, we review observational and mechanistic evidence for the acquired vitamin D resistance hypothesis. We particularly focus on its clinical confirmation from our experience of treating multiple sclerosis patients with the so-called Coimbra protocol, in which daily doses up to 1000 I.U. vitamin D3 per kg body weight can be administered safely. Parathyroid hormone levels in serum thereby provide the key information for finding the right dose. We argue that acquired vitamin D resistance provides a plausible pathomechanism for the development of autoimmune diseases, which could be treated using high-dose vitamin D3 therapy.

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“…To achieve this goal, total daily insulin doses exceeding 100 I.U. can be utilized ( 87 ). These are doses that would normally be toxic in the absence of an underlying insulin resistance.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Resistance as a Possible Cause of Autoimmune Diseases: A Hypothesis Confirmed by a Therapeutic High-Dose Vitamin D Protocol

et al. 2021

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Glycemic Outcomes of Hospitalized Patients on Ambulatory Humulin-R U-500 Insulin

Kanbour

Yenokyan²,

Snyder³

et al. 2022

Endocrine Practice

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Inpatient diabetes management

Demidowich,

Stanback,

Zilbermint

2024

Annals of the New York Academy of Sciences

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Diabetes mellitus is currently approaching epidemic proportions and disproportionately affects patients in the hospital setting. In the United States, individuals living with diabetes represent over 17 million emergency department visits and 8 million admissions annually. The management of these patients in the hospital setting is complex and differs considerably from the outpatient setting. All patients with hyperglycemia should be screened for diabetes, as in‐hospital hyperglycemia portends a greater risk for morbidity, mortality, admission to an intensive care unit, and increased hospital length of stay. However, the definition of hyperglycemia, glycemic targets, and strategies to manage hyperglycemia in the inpatient setting can vary greatly depending on the population considered. Moreover, the presenting illness, changing nutritional status, and concurrent hospital medications often necessitate thoughtful consideration to adjustments of home diabetes regimens and/or the initiation of new insulin doses. This review article will examine core concepts and emerging new literature surrounding inpatient diabetes management, including glycemic targets, insulin dosing strategies, noninsulin medications, new diabetes technologies, inpatient diabetes management teams, and discharge planning strategies, to optimize patient safety and satisfaction, clinical outcomes, and even hospital financial health.

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A retrospective review of insulin requirements in patients using U-500 insulin hospitalized to a Veterans Affairs Hospital

Cited by 4 publications

References 22 publications

Vitamin D Resistance as a Possible Cause of Autoimmune Diseases: A Hypothesis Confirmed by a Therapeutic High-Dose Vitamin D Protocol

Vitamin D Resistance as a Possible Cause of Autoimmune Diseases: A Hypothesis Confirmed by a Therapeutic High-Dose Vitamin D Protocol

Glycemic Outcomes of Hospitalized Patients on Ambulatory Humulin-R U-500 Insulin

Inpatient diabetes management

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