Case Of Severe Hypoglycemia Research Articles

Hypoglycemia and Glucagon Utilization in Insulin-Treated Diabetic Patients.

First choice of therapy for severe hypoglycemia outside hospital environment is glucagon injection, an undertaught and underused remedy. Aim of this study was to investigate knowledge about glucagon therapy, possession rate and usage rate in insulin-treated diabetic patients, with special emphasis on history of hypoglycemia and severe hypoglycemia episodes. In this cross-sectional study, 300 insulin-treated diabetic patients (146 males and 154 females, mean age 61.1±16.4 years) were recruited from comprehensive Diabetes Center in Croatia. Specialized self-administered, 13-item questionnaire regarding glucagon therapy and history of hypoglycemia was obtained from each patient, as well as data collected from medical history documentation. Experience of hypoglycemic episode was reported by 233 (77.7%), and severe hypoglycemia by 73 (24.3%) patients. Participants with experience of hypoglycemia have significantly longer diabetes duration (17.2±11.2 vs. 11.9±8.5 years, P<0.001) and lower BMI values (26.38±3.97 vs. 31.11±7.17 kg/m2, P<0.001). Knowledge about glucagon therapy had 55.3% patients, 44.7% obtained it from the pharmacy, while glucagon was used in 35.6% cases of severe hypoglycemia. Glucagon knowledge was better in patients that attended at least one diabetes lecture (P=0.038), while educational level showed no statistical significance (P=0.286). Main significant positive predictor of glucagon knowledge was history of severe hypoglycemia (OR 4.71, 95% CI 1.38 - 16.02, P=0.013). Glucagon therapy was underused in treating severe hypoglycemia. It is highly important to emphasize value of quality education as one of the fundamentals of good diabetes management.

Fatal Side Effect of Treprostinil - Hypoglycemia: A Case Report

Treprostinil is generally safe and efficacious prostacyclin analog that is recommended for patients with NYHA class III/IV pulmonary hypertension. The reported side effects of standard dosing of treprostinil include fatigue, facial flush, headache, chest pain, dyspnea, right ventricular heart failure and pallor. Other side effects include abdominal cramping, diarrhea, jaw pain, edema, vasodilation and nausea. Hypoglycemia as a side effect of treprostinil is extremely rare. We report the first case of severe hypoglycemia after using treprostinil in a patient with severe idiopathic pulmonary arterial hypertension.

Efectividad de un protocolo basado en la evidencia para el control de la hiperglucemia por estrés en cuidados intensivos

AimTo assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia. MethodProspective “pre-post” quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl. ResultsWe analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001). ConclusionsOur experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.

Switching from biosimilar (Basalin) to originator (Lantus) insulin glargine is effective in Chinese patients with diabetes mellitus: a retrospective chart review

Background: This study investigated the effectiveness and safety of switching from Basalin® to Lantus® in Chinese patients with diabetes mellitus (DM). Methods: A retrospective chart review conducted using the electronic medical records of patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2005 to 2016. All patients were diagnosed with DM and underwent switching of insulin from Basalin to Lantus during hospitalization. Data collected included fasting (FBG), pre- and post-prandial whole blood glucose, insulin dose, reasons for insulin switching and hypoglycemia. Four study time points were defined as: hospital admission, Basalin initiation, insulin switching (date of final dose of Basalin), and hospital discharge. Blood glucose measurements were imputed as the values recorded closest to the dates of these four time points for each patient. Results: Data from 73 patients (70 patients with type 2 diabetes, 2 with type 1, and 1 undisclosed) were analyzed. At admission, mean glycated hemoglobin (HbA1c) and FBG were 8.9% (SD=1.75) and 9.98 (3.22) mmol/L, respectively. Between Basalin initiation and insulin switch, mean FBG decreased from 9.68 mmol/L to 8.03 mmol/L (p<0.0001), over a mean 10.8 (SD=6.85) days of Basalin treatment, and reduced further to 7.30 mmol/L at discharge (p=0.0116) following a mean 6.6 (7.36) days of Lantus. The final doses of Basalin and Lantus were similar (0.23 vs. 0.24 IU/kg/day; p=0.2409). Furthermore, reductions in pre- and post-prandial blood glucose were also observed between Basalin initiation, insulin switch and hospital discharge. The incidence of confirmed hypoglycemia was low during Basalin (2 [2.4%]) and Lantus (1 [1.2%]) treatment, with no cases of severe hypoglycemia. Conclusion: In this study population, switching from Basalin to Lantus was associated with further reductions in blood glucose, although the dose of insulin glargine did not increase. Further studies are required to verify these findings and determine the reason for this phenomenon.

Switching from biosimilar (Basalin) to originator (Lantus) insulin glargine is effective in Chinese patients with diabetes mellitus: a retrospective chart review.

Background: This study investigated the effectiveness and safety of switching from Basalin® to Lantus® in Chinese patients with diabetes mellitus (DM). Methods: A retrospective chart review conducted using the electronic medical records of patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2005 to 2016. All patients were diagnosed with DM and underwent switching of insulin from Basalin to Lantus during hospitalization. Data collected included fasting (FBG), pre- and post-prandial whole blood glucose, insulin dose, reasons for insulin switching and hypoglycemia. Four study time points were defined as: hospital admission, Basalin initiation, insulin switching (date of final dose of Basalin), and hospital discharge. Blood glucose measurements were imputed as the values recorded closest to the dates of these four time points for each patient. Results: Data from 73 patients (70 patients with type 2 diabetes, 2 with type 1, and 1 undisclosed) were analyzed. At admission, mean glycated hemoglobin (HbA1c) and FBG were 8.9% (SD=1.75) and 9.98 (3.22) mmol/L, respectively. Between Basalin initiation and insulin switch, mean FBG decreased from 9.68 mmol/L to 8.03 mmol/L (p<0.0001), over a mean 10.8 (SD=6.85) days of Basalin treatment, and reduced further to 7.30 mmol/L at discharge (p=0.0116) following a mean 6.6 (7.36) days of Lantus. The final doses of Basalin and Lantus were similar (0.23 vs. 0.24 IU/kg/day; p=0.2409). Furthermore, reductions in pre- and post-prandial blood glucose were also observed between Basalin initiation, insulin switch and hospital discharge. The incidence of confirmed hypoglycemia was low during Basalin (2 [2.4%]) and Lantus (1 [1.2%]) treatment, with no cases of severe hypoglycemia. Conclusion: In this study population, switching from Basalin to Lantus was associated with further reductions in blood glucose, although the dose of insulin glargine did not increase. Further studies are required to verify these findings and determine the reason for this phenomenon.

Medical intensive care unit patients with hyperglycemia: is it possible a hypoglycemic risk close to zero?

In patients with diabetic or stress hyperglycemia hospitalized for acute cardiovascular disease, the occurrence of hypoglycemia increases the risk of mortality and morbidity without this being counterbalanced by a reduction in events related to a tighter glycemic control. The guidelines on this topic agree in excluding intensive treatment, but are very discordant in recommending a conventional (<180 mg/dl) or milder (<200 mg/dl) blood glucose control. In 1256 hyperglycemic patients (mean age 74 ± 12 years) admitted to the medical intensive care unit (MICU) for acute coronary syndrome or acute heart failure, we adopted a nurse-led protocol of mild blood glucose control with subcutaneous administration of insulin, called "BBC200" (basal-bolus correction insulin regimen with glycemic target <200 mg/dl), with the aim at maintaining average blood glucose <200 mg/dl and an indication for intravenous insulin only for blood glucose >350 mg/dl. A retrospective analysis was carried out for assessing the occurrence of hypoglycemic episodes (blood glucose <70 mg/dl) and therapeutic failure (persistent hyperglycemia with values >240 mg/dl). Mean blood glucose was 261 ± 72 mg/dl on admission and 173 ± 50 mg/dl during treatment. Five patients (0.2%) required intravenous insulin infusion. There was only one case of severe hypoglycemia (≤40 mg/dl) due to an error of administration, and 2 cases of moderate hypoglycemia (41-70 mg/dl), with a total hypoglycemia rate of 0.24%. Transient therapeutic failure occurred in 27% of cases. In MICU hyperglycemic patients, the simple, intuitive and economical "BBC200" protocol could lead to a hypoglycemic risk very close to zero (0.24%), with a significant reduction in hypoglycemia-related clinical events and a modest increase in persistent hyperglycemic phenomena.

Hipoglicemia em diabéticos tipo 2 praticantes de exercício físico

Introduo: A hipoglicemia , de fato, o mais frequente efeito secundrio do tratamento da diabetes, e o principal obstculo para a otimizao do controle glicmico. Objetivo: O Objetivo deste estudo foi identificar episdios de hipoglicemia em diabticos tipo 2 praticantes de exerccio fsico. Mtodos: Pesquisa descritiva, quase-experimental. Amostra foi composta por 18 mulheres com diabetes tipo 2, participantes do Projeto Doce Vida-Programa de Exerccio Fsico Supervisionado para Diabticos da ESEF/UPE. O programa de treinamento aerbio, resistido e combinado, teve durao de 38 semanas. A monitorizao da glicemia foi realizada antes e imediatamente aps as sesses de treino. Anlise estatstica foi descritiva, com avaliao da frequncia absoluta. Resultados: Aps anlise de todos os treinamentos, identificou-se 233 hipoglicemias, sendo 19 hipoglicemias moderadas, 214 hipoglicemias leves. No ocorreram casos de hipoglicemias grave. Concluso: Por fim, conclui-se que o treinamento fsico aerbio, resistido e combinado podem causar hipoglicemias de leves a moderadas em diabticos tipo 2 desta amostra, principalmente o treinamento fsico aerbio, que obteve um maior nmero de hipoglicemias.

Glucocorticoids And Cornstarch Therapy For Non–Islet Cell Tumor Hypoglycemia: A Case Report

ABSTRACT Objective: We present a case of severe hypoglycemia in a patient with recurrent solitary fibrous tumor or non–islet cell tumor, maintained successfully in a euglycemic state with a combination of glucocorticoids and oral intake of uncooked cornstarch. Methods: Case report and literature review. Results: An 80-year-old Caucasian female with a history of solitary fibrous tumor of the lung treated with left lower lobectomy in 2009 had a recurrence in 2015 with a retroperitoneal tumor mass. She presented to our hospital with a syncopal episode and capillary blood glucose of 18 mg/dL. Routine laboratory studies were unrevealing. Fasting insulin-like growth factor 1 (IGF-1) was 228 ng/mL (normal range, 54 to 205 ng/mL), insulin-like growth factor 2 (IGF-2) was 541 ng/mL (normal range, 333 to 967 ng/mL), and the IGF-2:IGF-1 ratio was 2.3 (normal, <3.8). Large amounts of infused glucose barely maintained glycemia, and a trial of octreotide failed. Therefore, she was begun on uncooked cornstarch and predn...

New risk and protective factors for severe hypoglycaemia in people with type 1 diabetes

AimsTo evaluate risk factors for severe hypoglycaemia (SH) in patients with type 1 diabetes (T1DM). Methods and ResultsRetrospective observational and comparative study. All SH occurring between 2007 and 2014 in a German population (Lippe-Detmold) were captured. Characteristics of patients with T1DM and SH were compared with a control group being equivalent concerning age, diabetes duration, HbA1c, comorbidity, and β-blocker treatment. SH was defined as a symptomatic event requiring treatment with intravenous glucose or glucagon administration and being confirmed by a blood glucose measurement of <2.8 mmol/l. Predictive factors for SH were analysed by a multivariable regression model. As many as 405 cases of SH in T1DM occurred in 206 subjects; 50% of episodes were related to 31 patients who experienced ≥3 SH. Need for nursing care (OR 4.88), treatment with NPH (OR 3.68), and impaired hypoglycaemia awareness (OR 2.06) were the strongest risk factors for SH (all p < 0.05, all pFDR-adjusted < 0.10; false discovery rate (FDR)). Depression (OR 0.14), treatment with CSII (OR 0.39) and short-acting insulin analogues (OR 0.31) appeared to be protective (all p < 0.10; FDR-adjusted). The probability of SH onset was significantly higher in patients who had previously experienced recurrent SH episodes. β-Blocker treatment did not appear to be a risk factor. ConclusionThe complex risk for SH in people with T1DM can be reduced by treatment with CSII and short-acting analogues. Future structures of diabetes care will be challenged by the need of treating increasingly geriatric subjects with T1DM having a high risk of SH.

Acute glycaemic effects of co-trimoxazole at prophylactic dose in healthy adults.

BackgroundCases of severe hypoglycaemia were reported in HIV/AIDS patients receiving high dose of the sulfonylurea co-trimoxazole for opportunistic infections. Whether co-trimoxazole at prophylactic dose would induce similar side effects is unknown. We aimed to investigate the acute effects of co-trimoxazole at prophylactic dose on glucose metabolism in healthy adults.MethodsWe enrolled 20 healthy volunteers (15 males and 5 females) aged 23.0 (SD 2.0) years, with mean BMI of 22.3 (SD 3.6) Kg/m2 with normal glucose tolerance, hepatic and renal function. We performed a 75-g oral glucose tolerance test (OGTT) with and without concomitant oral co-trimoxazole administered 60 min before the test. Blood glucose response was measured using a capillary test at baseline and at 30, 60, 90, 120 and 180 min following oral glucose load on the two occasions. C-peptide response was also measured. Absolute values of blood glucose and C-peptide with and without co-trimoxazole were compared using the Wilcoxon test.ResultsDuring the OGTT without co-trimoxazole (control) vs. the OGTT with co-trimoxazole (test), the glycaemia varied from 4.83 (SD 0.39) mmol/l vs. 4.72 (SD 0.28) mmol/l at T0 (P = 0.667), to 8.00 (SD 1.11) mmol/l vs. 7.44 (SD 0.78) mmol/l at T30 (P = 0.048), 8.00 (SD 1.17) mmol/l vs. 7.67 (SD 1.00) mmol/l at T60 (P = 0.121), 7.33 (SD 0.94) mmol/l vs. 7.11 (SD 0.83) mmol/l at T90 (P = 0.205), 6.78 (SD 1.00) mmol/l vs. 6.67 (SD 1.00) mmol/l at T120 (P = 0.351) and 4.72 (SD 1.39) mmol/l vs. 4.72 (SD 1.56) mmol/l at T180 (P = 0.747). The ratio of area under the glycaemia curve during the control and test investigation was 96.7 %, thus a 3.3 decreased glycaemic response (p = 0.062). A decrease of glycaemia by more than 10 % occurred in 6/20 participants at T30, 7/20 participants at T60 and 1/20 participant at T30 and T60. None of the volunteers experienced co-trimoxazole-induced hypoglycaemia. At the same time, the C-peptide response during the control vs. the test investigation varied from 278.1 (SD 57.5) pmol/l vs. 242.8 (SD 42.5) pmol/l at T0 (P = 0.138), to 1845.6 (SD 423.6) pmol/l vs. 2340.6 (SD 701.3) pmol/l at T60 (P = 0.345) and 1049.8 (SD 503.1) pmol/l vs. 1041.63 (SD 824.21) pmol/l at T180 (P = 0.893).ConclusionNinety minutes after its administration, co-trimoxazole induced a significant reduction of the early glycaemic response to oral glucose in parallel with a 27-% increase in insulin secretory response. Co-trimoxazole induced within 120 min a more than 10-% blood glucose reduction in 2/3 of participants. However none of the volunteers experienced hypoglycaemia.

Safety and effectiveness of different herbal medicine dosage of Gegen Qinlian Decoction in Chinese patients with type 2 diabetes: a double-blind, two-part, randomised controlled trial

BackgroundGegen Qinlian Decoction, a Chinese herbal medicine, has been shown to be effective and safe for patients with type 2 diabetes, yet the roles of its main components, Radix Puerariae and Coptis chinensis, in diabetes is uncertain. We aimed to observe the relationship between dosage-changing of these herbal medicines of Gegen Qinlian Decoction and effectiveness in patients with type 2 diabetes. MethodsWe did a randomised, double-blind, two-part, parallel-dose controlled clinical trial. Patients with type 2 diabetes inadequately controlled by diet and exercise from Guang'anmen Hospital were enrolled in the phase 1 trial. Patients who had been treated for diabetes within 1 month were excluded from the trial. Patients were randomly allocated (1:1:1) via a computer-generated randomisation sequence to receive three different doses (24 g, 72 g, and 120 g) of Radix Puerariae of Gegen Qinlian Decoction for 12 consecutive weeks. Patients and clinicians were masked to group assignment. The primary outcomes were changes from baseline in HbA1c, fasting plasma glucose, and 2 h glucose after oral glucose tolerance test at week 12 in each group, and the outcomes were analysed in the per-protocol population who complied with the protocol and had no violations. Secondary endpoints included concentrations of fasting insulin and lipids, bodyweight, BMI, and waist circumference. If the relationship between dosage-changing in Radix Puerariae of Gegen Qinlian Decoction and HbA1c-decreasing was null, the new patients with diabetes were enrolled in the phase 2 trial, which had patients randomly allocated (1:1:1) to receive three different doses Coptis chinensis of Gegen Qinlian Decoction for 12 consecutive weeks. The efficacy evaluation was identical to the phase 1 trial. This study is registered with ClinicalTrials.gov, number NCT01219803. FindingsBetween Aug 8, 2011, and April 23, 2012, we enrolled 120 patients into the phase 1 trial. 97 patients were included in the per-protocol analysis (32 for high dose, 30 for middle dose, and 35 for low dose Radix Puerariae of Gegen Qinlian Decoction). At week 12, No significant difference among the groups was reported compared with week 0: the mean change in HbA1c was −0·58% in the high-dose group (SD 0·87), −0·28% in the middle-dose group (1·17), and −0·55% in the low-dose group (0·85; the difference between groups p=0·52, 95% CI −0·53 to 0·55). In the phase 2 trial, we enrolled another 122 patients between Nov 14, 2012, and Aug 29, 2013, and 103 of them were included in the per-protocol analysis. Compared with the HbA1c level from week 0, the mean change was −0·75% in the high-dose group (SD 0·82), −0·34% in the middle-dose group (0·71), and −0·26% in the low-dose group (0·79) at week 12. There was a significant HbA1c reduction in the groups after 12 weeks (p=0·0492, 95% CI −0·78 to −0·02). No cases of severe hypoglycaemia were reported in either trial. InterpretationChanging the dose of Coptis chinensis of Gegen Qinlian Decoction has a dose–effect relationship with glycaemic control. Coptis chinensis is the major drug of Gegen Qinlian Decoction for treating patients with type 2 diabetes. FundingNational Basic Research Program of China (973 Program).

Incretin-based drugs for type 2 diabetes: Focus on East Asian perspectives.

Type 2 diabetes in East Asians is characterized primarily by β‐cell dysfunction, and with less adiposity and less insulin resistance compared with that in Caucasians. Such pathophysiological differences can determine the appropriate therapeutics for the disease. Incretins, glucose‐dependent insulinotropic polypeptide and glucagon‐like peptide‐1, are secreted in response to meal ingestion, and enhance insulin secretion glucose‐dependently. Incretin‐based drugs, dipeptidyl peptidase‐4 inhibitors (DPP‐4i) and glucagon‐like peptide‐1 receptor agonists, that ameliorate β‐cell dysfunction with limited hypoglycemia risk are now widely used in type 2 diabetes management. Recent meta‐analyses of clinical trials on DPP‐4i and glucagon‐like peptide‐1 receptor agonists found that the drugs were more effective in Asians, most likely because of amelioration of β‐cell dysfunction. In addition, we found increased glycated hemoglobin‐lowering effects of DPP‐4i to be associated with intake of fish in type 2 diabetes, which suggests that dietary customs of East Asians might also underlie the greater efficacy of DPP‐4i. Despite the limited risk, cases of severe hypoglycemia were reported for DPP‐4i/sulfonylureas combinations. Importantly, hypoglycemia was more frequent in patients also receiving glibenclamide or glimepiride, which activate exchange protein directly activated by cyclic adenosine monophosphate 2, a critical mediator of incretin signaling, and was less frequent in patients receiving gliclazide, which does not activate exchange protein directly activated by cyclic adenosine monophosphate 2. Prevention of insulin‐associated hypoglycemia by DPP‐4i has gained attention with regard to the enhancement of hypoglycemia‐induced glucagon secretion by insulinotropic polypeptide, but remains to be investigated in East Asians. Despite the safety issues, which are paramount and must be carefully monitored, the incretin‐based drugs could have potential as a first choice therapy in East Asian type 2 diabetes patients.

Adverse effects during the oral glucose tolerance test in post-bariatric surgery patients.

The oral glucose tolerance test (OGTT) is used in the screening of gestational diabetes, in diagnosis of type 2 diabetes in conjunction with fasting blood glucose and glycated hemoglobin. The aim of this study was to examine the incidence and risk factors of adverse effects of OGTT in patients who underwent bariatric surgery, in addition to proposing standardization for ordering the OGTT in these patients. This study assessed the incidence of adverse effects in 128 post-bariatric surgery patients who underwent the OGTT. Descriptive and logistic regression analysis were performed, the dependent variables were defined as the presence of signs (tremor, profuse sweating, tachycardia), symptoms (nausea, diarrhea, dizziness, weakness), and hypoglycemia (blood glucose ≤ 50 mg/dL). One hundred and seventeen participants (91.4%) were female; 38 (29.7%) participants were pregnant. High incidence (64.8%) of adverse effects was observed: nausea (38.4%), dizziness (30.5%), weakness (25.8%), diarrhea (23.4%), hypoglycemia (14.8%), tachycardia (14.1%), tremor (13.3%), profuse sweating (12.5%) and one case of severe hypoglycemia (24 mg/dL). The presence of signs was associated with hypoglycemia (OR = 8.1, CI 95% 2.6-25.1). The arterial hypertension persisted as a risk factor for the incidence of signs (OR = 3.6, CI 95% 1.2-11.3). Fasting glucose below 75 mg/dL increased the risk of hypoglycemia during the test (OR = 9.5, CI 95% 2.6-35.1). In this study, high incidence of adverse effects during the OGTT was observed in post-bariatric surgery patients. If these results are confirmed by further studies, the indication and regulation of the OGTT procedure must be reviewed for these patients.

A Case of Severe Hypoglycemia Caused by Sulfonylurea Self-Administration in a Non-Diabetic Elderly Subject

A Case of Severe Hypoglycemia Caused by Sulfonylurea Self-Administration in a Non-Diabetic Elderly Subject

Insulin Lispro with Continuous Subcutaneous Insulin Infusion is Safe and Effective in Patients With Type 2 Diabetes: A Randomized Crossover Trial of Insulin Lispro Versus Insulin Aspart

This study provides clinical information regarding the use of insulin lispro versus insulin aspart in continuous subcutaneous insulin infusion (CSII) in adult patients with type 2 diabetes mellitus (T2D). After a 2-week lead-in period, 122 subjects treated with CSII therapy were randomized to 32 weeks of treatment during 2 separate 16-week treatment periods (TPs) with crossover beginning with insulin lispro (n = 60) or insulin aspart (n = 62). Glycated hemoglobin A1c (HbA1c), total daily insulin dose, and weight were recorded at the end of TP1 and TP2. Adverse events (AEs) and hypoglycemic events (overall, documented symptomatic, nocturnal, or severe) were recorded throughout the TPs. Data were analyzed using statistical methods that accounted for repeated measurements. A total of 107 subjects completed the study; 7 discontinued in TP1 and 8 discontinued in TP2. Insulin lispro was noninferior to insulin aspart in endpoint (weeks 16 and 32) HbA1c over TP1 and TP2 combined. Total daily insulin dose, weight change, and incidence and rates of hypoglycemia were not statistically significantly different between treatments. One case of severe hypoglycemia and 1 of diabetic ketoacidosis was observed with insulin aspart. One case of severe infusion site abscess was noted with insulin lispro. Overall, both insulin lispro and insulin aspart were well tolerated with similar AEs reported. Insulin lispro and insulin aspart performed similarly after 16 weeks of treatment, with noninferiority for HbA1c and no significant difference in parameters measured. These findings indicate that insulin lispro and insulin aspart can both be used safely and effectively in patients with T2D using CSII.

Sulfonylurea Induced Severe Hypoglycemia in a Diabetic with Renal Failure— A Case Report

Introduction: Persistent hypoglycemia in the setting of acute renal insufficiency while on sulfonylureas is potentially a life-threatening complication. A case of severe hypoglycemia in a diabetic with acute on chronic renal insufficiency while on glimepiride is described here. Case Report: A seventy-six years old man presented to our emergency department with gradually progressive generalized weakness, dyspnea on exertion and lightheadedness. His medical history included congestive heart failure, hypertension and chronic kidney disease from non-insulin dependent diabetes. He reported good compliance with his medications which included glimepiride, 2 mg daily. Patient’s spouse reported a blood sugar reading of 22 mg/dL at home which prompted the emergency department visit. On presentation, the patient was tachycardic, tachypneic and diaphoretic. Initial glucose meter reading was found to be 36 mg/dL and a blood glucose level on the metabolic panel was 49 mg/dL. Patient serum creatinine was 2.5 mg/dL, increased from a baseline of 1.8 mg/dL. While in the emergency room, the patient received 50% dextrose intravenously eventually requiring an intravenous infusion of 10% dextrose. Despite this treatment, the patient remained persistently hypoglycemic with blood sugars less than 80 mg/dL. A decision was made at this point to administer 50 micrograms of octreotide subcutaneously. Two hours later, the patient’s blood sugar started to improve and the intravenous 10% dextrose was discontinued. Eight hours later, the patient received another dose of 50 micrograms of octreotide and remained consistently euglycemic. Upon discharge, he was asked to discontinue glimepiride. Conclusion: Severe refractory hypoglycemia is a serious complication of sulfonylurea therapy in diabetics with renal insufficiency. Prompt recognition and initiation of octreotide are effective in reversing hypoglycemia in these instances rapidly and safely.

Two Cases of Severe Hypoglycemia in Diabetic Patients Treated With Insulin Degludec

Two Cases of Severe Hypoglycemia in Diabetic Patients Treated With Insulin Degludec

Efficacy and safety of the glucagon-like peptide-1 receptor agonist lixisenatide versus the dipeptidyl peptidase-4 inhibitor sitagliptin in young (

ObjectiveTo compare the efficacy and safety of the once-daily prandial glucagon-like peptide-1 receptor agonist lixisenatide with the dipeptidyl peptidase-4 inhibitor sitagliptin in patients aged <50 years affected by obesity and type 2 diabetes mellitus (T2DM). Materials and methodsThis was a 24-week, double-blind, randomized, parallel-group study. Obese patients with T2DM inadequately controlled on metformin were randomized to lixisenatide 20 μg once-daily injection (n = 158) or once-daily oral sitagliptin 100 mg (n = 161). The primary endpoint was the proportion of patients with a glycated hemoglobin (HbA1c) <7% and ≥5% weight loss at 24 weeks. ResultsThe proportion of patients that achieved the primary endpoint was 12.0% for lixisenatide versus 7.5% for sitagliptin; weighted average of proportion difference: 4.6%, p = 0.1696). A total of 40.7% of patients achieved HbA1c <7% with lixisenatide versus 40.0% with sitagliptin. Lixisenatide produced greater reductions in body weight (LS mean difference: −1.3 kg, p = 0.0006) and postprandial plasma glucose after a standardized meal test (LS mean difference: −34.4 mg/dL [−1.9 mmol/L], p = 0.0001) versus sitagliptin. There was a similar incidence of treatment-emergent adverse events (63.9% vs. 60.9%) and serious treatment-emergent adverse events (1.9% vs. 1.9%), with low rates of symptomatic hypoglycemia (0.6% vs. 1.9%) for lixisenatide and sitagliptin, respectively, and no cases of severe hypoglycemia. ConclusionIn obese patients aged <50 years with T2DM, the proportion of patients with an HbA1c <7% with weight loss ≥5% was similar between groups. Lixisenatide, however, resulted in significantly greater reductions in body weight and postprandial plasma glucose excursions than sitagliptin. Tolerability was similar between groups.

LOTUS2: The observational study of the effectiveness and safety of insulin glargine (lantus) in the routine clinical practice for the patients with type 2 diabetes mellitus failing to achieve the targeted glycemic control using insulin detemir

The present study included patients presenting with type 2 diabetes mellitus (DM2) of less than 10 years in duration having the HbA1c levels between 7.0% and 10.0%. They were treated with insulin detemir (once or twice daily) in combination with oral hypoglycemic agents (OHGA) and transferred thereafter to therapy with insulin glargine (Lantus, SoloSTAR) administered once daily. The patients were advised to adjust the dose of insulin glargine in order to achieve the desired fasting blood glucose level (FBGL) below 5.6 mmol/l. The HbA1c levels and FBGL, insulin doses, body weight, frequency of hypoglycemic episodes and adverse reactions were measured within 3 and 6 months after inclusion in the study; simultaneously, the patients and doctors' satisfaction with the treatment was estimated. A total of 915 patients were available for the examination (mean age 57.9±9.2 years, mean duration of DM2 5.9±2.3 years, average BMI 31.0±5.1 kg/m2). The number of the patients presenting with the HbA1c levels below 7% within 6 months after the onset of therapy amounted to 46.5% of the total. During the same period, percentage of the patients experiencing nocturnal and daytime glycemic episodes decreased. No cases of severe hypoglycemia were documented. Moreover, the body weight of the patients somewhat decreased (by 0.9±2.9 kg; p&lt;0.001) by the 6 month. The majority of the patients and their doctors reported the effects of described therapy as "good" or "very good". It is concluded that the substitution of the treatment with insulin detemir in combination with OHGA by therapy with insulin glargine in the patients with DM2 and suboptimal glycemic control under conditions of the routine clinical practice may improve the quality of glycemic control without a substantial body weight gain and with the low frequency of hypoglycemic episodes.

A case of severe hypoglycaemia in a patient with hyperthyroidism

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