Using New Insulin Strategies in the Outpatient Treatment of Diabetes

DeWitt, Dawn E.; Dugdale, David C.

doi:10.1001/jama.289.17.2265

Cited by 88 publications

(26 citation statements)

References 16 publications

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“…More intensive insulin therapy with fast-acting insulins and self-monitoring might have led to better results (17). The mean FBG and A1C values of our patients were similar to those reported in other studies (11)(12)(13), although most studies did not report the percentage of patients who reached the established cut-off points for A1C.…”

Section: Glycemic Controlsupporting

confidence: 87%

Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin

Júnior

Sá

Guedes

et al. 2006

Braz J Med Biol Res

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Fifty-seven type 2 diabetic patients with metabolic syndrome and on insulin were assessed by a paired analysis before and 6 months after addition of metformin as combination therapy to evaluate the impact of the association on glycemic control, blood pressure, and lipid profile. This was a historical cohort study in which the files of type 2 diabetic patients with metabolic syndrome on insulin were reviewed. The body mass index (BMI), waist circumference, lipid profile, A1C level, fasting blood glucose level, daily dose of NPH insulin, systolic blood pressure, and diastolic blood pressure were assessed in each patient before the start of metformin and 6 months after the initiation of combination therapy. Glycemic control significantly improved (P < 0.001) after the addition of metformin (1404.4 ± 565.5 mg/day), with 14% of the 57 patients reaching A1C levels up to 7%, and 53% reaching values up to 8%. There was a statistically significant reduction (P < 0.05) of total cholesterol (229.0 ± 29.5 to 214.2 ± 25.0 mg/ dL), BMI (30.7 ± 5.4 to 29.0 ± 4.0 kg/m 2 ), waist circumference (124.6 ± 11.7 to 117.3 ± 9.3 cm), and daily necessity of insulin. The reduction of total cholesterol occurred independently of the reductions of A1C (9.65 ± 1.03 to 8.18 ± 1.01%) and BMI and the reduction of BMI and WC did not interfere with the improvement of A1C. In conclusion, our study showed the efficacy of the administration of metformin and insulin simultaneously without negative effects. No changes were detected in HDL-cholesterol or blood pressure.

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Section: Glycemic Controlsupporting

confidence: 87%

Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin

Júnior

Sá

Guedes

et al. 2006

Braz J Med Biol Res

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“…Currently available recombinant insulin products are designed to have dramatically different pharmacokinetic profiles to facilitate multiple strategies for outpatient glucose management [2,3].…”

Section: What Types Of Insulin Are Routinely Available For Outpatientmentioning

confidence: 99%

“…The effects of both intermediate-acting and long-acting insulin may last up to 24 h. Rapid-acting insulins are used in insulin pumps, which are discussed in greater detail below. Proprietary mixes of prandial and basal insulins are also available to minimize the number of doses that patients must administer daily for those on a regimen of multiple daily injections [3]. Available products are compared in Table 1.…”

Section: What Types Of Insulin Are Routinely Available For Outpatientmentioning

confidence: 99%

Case Files of the Harvard Medical Toxicology Fellowship at Children’s Hospital Boston: An Insulin Overdose

Skolnik

Ewald

2010

J. Med. Toxicol.

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A 16-year-old boy with a history of type I diabetes mellitus being managed with an insulin pump presented to the emergency department in cardiac arrest. Per report from the patient's mother, the patient had noticed that his insulin cartridge, containing insulin lispro, was empty the night prior to admission so he had replaced it at approximately 7:00 PM. He had used his glucometer through the night with recorded values of 225-389 mg/dL and had administered a total of 14.5 units of insulin via his pump. At around 6:30 AM, the morning of admission, his mother attempted to wake him for school and found him cyanotic and motionless. She attempted to obtain a fingerstick glucose measurement but was unable to do so and administered glucagon, as well as activating Emergency Medical Services (EMS). When EMS arrived, the patient was pulseless. Cardiopulmonary resuscitation was initiated, and the patient was endotracheally intubated. Point-of-care glucose determination was 81 mg/dL. He received epinephrine, atropine, naloxone, and an ampule of 50% dextrose (25 g) during his prehospital care. He was defibrillated twice at 200 J for ventricular fibrillation. He was transferred to the emergency department with cardiopulmonary resuscitation in progress. EMS reported that an empty insulin syringe had been seen underneath the patient's bed. After approximately 1 h of resuscitative efforts, during which the patient received additional epinephrine, sodium bicarbonate, and hydrocortisone, he had return of spontaneous circulation. His initial arterial blood gas revealed a pH of 6.8, PaCO 2 of 70 mmHg, and PaO 2 of 335 mmHg. His serum glucose at that time was 377 mg/dL, and the anion gap was 39 mEq/L with urine negative for ketones. He underwent computed tomography scan of the head, chest, abdomen, and pelvis that demonstrated left upper lobe consolidation and gastric distention but was otherwise normal. He was transferred to a tertiary-care children's hospital where his serum glucose on arrival was 50 mg/dL. He received 25 g of intravenous dextrose, and an infusion of 10% dextrose in normal saline was started. A toxicology consult was obtained.

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“…Unlike other basal dosing schemes, 38,39 this regimen has been shown to be clinically effective in a treat-to-target trial. 37 The protocol by Fritsche and colleagues 36 does not specify a dose decrement if hypoglycemia occurs, but the similar Riddle et al 37 protocol specifies a small dose decrement of 2-4 U/day if the fasting plasma glucose (FPG) is below 3.0 mmol/liter.…”

Section: Basal Insulin Titration Regimenmentioning

confidence: 99%

In Silico Simulation of Long-Term Type 1 Diabetes Glycemic Control Treatment Outcomes

Wong

Chase

Hann

et al. 2008

J Diabetes Sci Technol

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Using New Insulin Strategies in the Outpatient Treatment of Diabetes

Cited by 88 publications

References 16 publications

Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin

Effects of metformin on the glycemic control, lipid profile, and arterial blood pressure of type 2 diabetic patients with metabolic syndrome already on insulin

Case Files of the Harvard Medical Toxicology Fellowship at Children’s Hospital Boston: An Insulin Overdose

In Silico Simulation of Long-Term Type 1 Diabetes Glycemic Control Treatment Outcomes

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