Increasing Local Blood Flow by Warming the Application Site: Beneficial Effects on Postprandial Glycemic Excursions

Freckmann, Guido; Pleus, Stefan; Haug, Cornelia; Bitton, Gabriel; Nagar, Ron

doi:10.1177/193229681200600407

Cited by 18 publications

(17 citation statements)

References 28 publications

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“…Without comparable (i.e., identical) glucose/insulin levels in the last hour(s) prior to the intervention (i.e., ingestion of the meal/insulin application), the validity of comparing the results obtained on different study days is compromised. With the UFIs presented here, some meal-related studies fulfilling these requirements have been performed demonstrating their benefits also in comparison with RAIAs (see the other related manuscripts 18,25,30,48,49,54 ). One can envisage head-to-head comparisons involving two or more of the approaches presented in a given study under identical UFI conditions that would allow one to make clear statements about the pros and cons of the studied developments.…”

Section: Discussion and Outlookmentioning

confidence: 99%

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Ultrafast-Acting Insulins: State of the Art

Heinemann

Muchmore

2012

J Diabetes Sci Technol

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Abbreviations: (AP) artificial pancreas, (ARIA) alternative routes of insulin administration, (CGM) continuous glucose monitoring, (CSII) continuous subcutaneous insulin infusion, (FDA) Food and Drug Administration, (GIR) glucose infusion rate, (GV) glycemic variability, (HbA1c) hemoglobin A1c, (HGP) hepatic glucose production, (ID) intradermal, (IMI) injection-meal interval, (NDA) new drug application, (PD) pharmacodynamic, (PK) pharmacokinetic, (PPG) postprandial glycemic excursion, (RAIA) rapid-acting insulin analog, (RHI) regular human insulin, (rHuPH20) recombinant human hyaluronidase, (SC) subcutaneous, (T1DM) type 1 diabetes mellitus, (T2DM) type 2 diabetes mellitus, (TI) Technosphere insulin, (UFI) ultrafast-acting insulin

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Section: Discussion and Outlookmentioning

confidence: 99%

“…The Israel-based company InsuLine (see the article by Freckmann and associates 18 in this special theme issue) has developed small patch devices to apply mild heat (38 °C) locally to the skin at the time of a SC insulin injection or bolus from an insulin pump.…”

Section: Increase Of Local Blood Flowmentioning

confidence: 99%

Ultrafast-Acting Insulins: State of the Art

Heinemann

Muchmore

2012

J Diabetes Sci Technol

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“…Prowadzono badania kliniczne z urządzeniem InsuPatch ogrzewającym miejsce iniekcji i zwiększającym ukrwienie, co przyczyniało się do szybszego wchłaniania insuliny. Urządzenie to w domyśle mogłoby zostać zintegrowane z pompą insulinową i poprawić jej działanie [6][7][8].…”

Section: Ultraszybkodziałające Analogi Insulinunclassified

“…Clinical trials have been conducted with an InsuPatch device heating the injection site and increasing blood supply, which resulted in more rapid insulin absorption. This device might be integrated with an insulin pump thus improving the functioning of the pump [6][7][8].…”

Section: Rapid-acting Insulinmentioning

confidence: 99%

Insulinoterapia — nowe kierunki poszukiwań

Cichocka

Wietchy²,

Nabrdalik

et al. 2016

Endokrynologia Polska

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Insulin therapy is the most effective method of lowering blood glucose. Over 100 years have passed the studies for the optimisation of insulin action. To date, subcutaneous insulin administration has been the basic route of insulin delivery. The search for insulin therapy is simultaneously conducted in the following directions: the optimisation of insulin action, automatisation, and the decrease in the invasiveness of insulin delivery methods. The optimisation of insulin action has led to the discovery of ultra-rapid-acting human insulin analogues, ultra-long-acting human insulin analogues, and biosimilar insulin. Automatisation referred to the "artificial pancreas" and closing the loop system in insulin pump therapy. The decrease in the invasiveness of insulin delivery methods is focused on alternative routes of insulin administration. StreszczenieInsulina to najskuteczniejszy lek obniżający glikemię. Od blisko 100 lat trwają badania nad optymalizacją insulinoterapii. Na chwilę obecną, nadal podstawową drogą podawania insuliny jest podaż podskórna. Badania w zakresie insulinoterapii wiodą w kilku kierunkach równocześnie: optymalizacji, automatyzacji i zmniejszenia inwazyjności podawania insuliny. Optymalizacja parametrów działania insuliny prowadzi do wprowadzenia ultraszybkodziałających analogów insuliny, nowych insulin bazowych oraz insulin biopodobnych. Automatyzacja terapii pompowej wiedzie do zamknięcia pętli i stworzenia "sztucznej trzustki". Zmniejszenie inwazyjności to wykorzystanie alternatywnych, innych niż podskórna, dróg podawania insuliny.

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“…Recent studies with this device have shown that infusion site warming in patients with type 1 diabetes increased local blood flow and reduced postprandial glycemic excursions. [7][8][9] Using the glucose clamp technique, improvements in the pharmacokinetics (PK) and pharmacodynamics (PD) of a standard bolus dose of aspart insulin were observed with infusion site warming in young, pumptreated patients with type 1 diabetes. 10 The InsuPad is an alternative skin-warming device that was designed for patients receiving basal-bolus multiple daily injection therapy.…”

mentioning

confidence: 99%

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

Bitton¹,

Feldman²,

A³

et al. 2015

J Diabetes Sci Technol

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Exaggerated postprandial glycemic excursions in the first hours after a meal and an increased risk of late postprandial hypoglycemia are commonly observed following bolus injections of regular human insulin due to the delayed peak and the prolonged duration of action of this insulin preparation. 1 In contrast, plasma insulin concentrations peak earlier (generally thought to be within the first hour) and plasma insulin concentrations return to baseline more quickly with rapid-acting insulin analogs (RAIAs).2 Nevertheless, even with the more favorable absorption characteristics of RAIAs, postmeal hyperglycemia remains difficult to control in insulin-requiring diabetic patients due to delays in the peak action of these analogs to 120 or more minutes after injection. The time to peak insulin concentrations following bolus injections of both human regular and RAIAs are dose dependent, 3 with higher doses leading to delayed peaks and prolonged duration of action of these insulins. Moreover, the FDA-approved prescribing information package inserts for RAIAs state that the time course of action of these insulins may vary in different individuals or at different times in the same individual. 4 Such variations in insulin action are dependent on many conditions, including the site of injection, local blood supply and local skin temperature. 4 The impact of the site of injection on the rate of absorption of regular insulin (ie, abdomen > arm > leg) was first described by Koivisto and Felig in 1980. 5 They also demonstrated that increasing the skin temperature to 30°C to 37°C via sauna use increased the rate of insulin absorption and 578881D STXXX10.1177/1932296815578881Journal Abstract Background: Delays in the time-action profiles of premeal boluses of rapid-acting insulin analogs contribute to early postmeal hyperglycemia in patients with diabetes. We tested whether applying local heat to skin around the injection site to increase the rate of insulin absorption reduces postprandial hyperglycemia in patients with type 2 diabetes. Methods: Fourteen patients with type 2 diabetes (4 females; age 61.6 ± 8.4 years, HbA1c 8.42 ± 1.13%; BMI 29.10 ± 5.61 kg/m 2 ) on intensified insulin therapy underwent 5-hour meal tolerance tests (MTTs) with a standardized liquid meal after an overnight fast on 2 study days. Subjects injected 0.2 U/kg of insulin aspart or lispro subcutaneously into the abdominal skin on both days with and without the use of the InsuPad device. Results: Following the premeal bolus injection of rapid-acting insulin analog, infusion site warming led to a rise in plasma insulin levels to peak concentrations that were significantly earlier than without skin warming (mean ± SD 52 ± 26.7 vs 80 ± 51.3 minutes, P < .005) as well as increase in plasma insulin levels during the first hour after injection (mean ± SD 63.5 ± 32.7 IU vs 48.0 ± 25.0 uU.min/ml, P = .019). As a result, the area under the curve of the postprandial glucose excursion during the first 2 hours (the primary study outcome) and the entire 5 hours after ...

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Increasing Local Blood Flow by Warming the Application Site: Beneficial Effects on Postprandial Glycemic Excursions

Cited by 18 publications

References 28 publications

Ultrafast-Acting Insulins: State of the Art

Ultrafast-Acting Insulins: State of the Art

Insulinoterapia — nowe kierunki poszukiwań

Improved Postprandial Glucose Control Using the InsuPad Device in Insulin-Treated Type 2 Diabetes

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