Glucose In Diabetic Patients Research Articles

Catalytic effects of magnetic and conductive nanoparticles on immobilized glucose oxidase in skin sensors

Wearable skin sensors is a promising technology for real-time health care monitoring. They are of particular interest for monitoring glucose in diabetic patients. The concentration of glucose in sweat can be more than two orders of magnitude lower than in blood. In consequence, the scientific and technological efforts are focused in developing new concepts to enhance the sensitivity, decrease the limit of detection (LOD) and reduce the response time (RT) of glucose skin sensors. This work explores the effect of adsorbed superparamagnetic magnetite nanoparticles (MNPs) and conductive nanoparticles (CNPs) on carbon nanotube substrates (CNTs) used to immobilize glucose oxidase enzyme in the working electrode of skin sensors. MNPs and CNPs are made of magnetite and gold, respectively. The performance of the sensors was tested in standard buffer solution, artificial sweat, fresh sweat and on the skin of a healthy volunteer during an exercise session. In the case of artificial sweat, the presence of MNPs accelerated the RT from 7 to 5 s at the expense of increasing the LOD from 0.017 to 0.022 mM with slight increase of the sensitivity from 4.90 to 5.09 μAm M−1 cm−2. The presence of CNPs greatly accelerated the RT from 7 to 2 s and lowered the LOD from 0.017 to 0.014 mM at the expense of a great diminution of the sensitivity from 4.90 to 4.09 μAm M−1 cm−2. These effects were explained mechanistically by analyzing the changes in the concentration of free oxygen and electrons promoted by MNPs and CNPs in the CNTs and its consequences on the the glucose oxidation process.

The Influence of Sleep on Glycated Hemoglobin in Pregnancy With Gestational Diabetes

Background: Sleep disturbances have been associated with poor glycemic control in differential clinical settings. Both short and long sleep duration, influence insulin resistance and blood glucose in diabetic patients. Pregnancy is an additional risk for reduced sleep quality and quantity, and the presence of hyperglycemia, as a complicating factor, has being increasingly frequent. Different measures of sleep evaluation, both objectively and subjectively, can provide additional information about the influence of sleep in metabolic control in Gestational Diabetes Mellitus (GDM). Objective: To investigate the influence of sleep quality and objective sleep measures on glycated hemoglobin (HBA1C) in patients with GDM. Methodology: This is a cross-sectional study examining patients with GDM from 2nd to 3rd trimester of pregnancy. Clinical data and behavior questionnaires were collected by a face-to-face interview. Self-Rated Sleep Quality was evaluated by Pittsburgh Sleep Quality Index- (PSQI). In order to improve the accuracy of the information, a 14-day sleep log was obtained, and objective sleep measurements were registered by actigraphic record (5 to 7 days). Results: Overall, GDM patients (N=311), aged from 20 to 46 y (33.1±5.6) were evaluated. Sleep duration ≤6 hours/night was found in 43.4%, and 63.9% reported poor sleep quality (PSQI>5). Sleep duration measured by actigraphy was correlated with sleep duration registered by sleep log (r=.45, p=.04), and with PSQI (r=-.33, p=.002). Sleep quality and sleep duration registered by either actigraphy or sleep log were not correlated with Hba1c. Amongst all, Hba1c varied from 4.3 to 7.0 mg/dL (5.9 ±.53). Sleep fragmentation, measured by the length of time patient spends awake after sleep onset (WASO) was correlated withHba1c level in patients with GDM (r=.41, p=0.04). Conclusion: Sleep duration obtained from the sleep log was a reliable measure correlating with objective sleep parameters registered by actigraphy and with sleep quality. In GDM patients, increased wake time after sleep onset was correlated with higher Hba1c.

CGM for insulinoma screening: a prospective and observational case-control study.

Insulin release index (IRI) based on 72-h fasting test has been used for the definitive diagnosis of insulinoma; however, hospitalization and subsequent costs contribute to the disadvantage of IRI. Therefore, a simple and cost-effective screening procedure for the diagnosis of insulinoma for outpatients are crucially needed. Continuous glucose monitoring (CGM) has been widely used for monitoring high level of glucose in diabetic patients. The aim of the study is to determine the potential contribution or implementation of CGM in the screening of the insulinoma. We performed a single-center prospective study with the demographics and laboratory data including 28 patients with the pathological diagnosis of insulinoma and 25 patients with functional hypoglycemia as control group. The analysis showed that areas under the receiver operating characteristic (ROC) curve of coefficient of variation (CV) was 0.914. The CV cutoff point was 19% with the Youden 62.1%, the corresponding sensitivity and specificity were 82.1 and 80%, respectively. In patients with CV greater than the median, more than 60% of insulinomas were located in the head of the pancreas; most Ki-67 values were more than 2% and when compared with the group with CV smaller than the median, the average tumor size was 2.7 times larger. In conclusion, CGM can be used as a valuable tool in not only monitoring high glucose levels in diabetic patients but also identifying the etiology of insulinoma. CV greater than 19% can be highly effective for the screening of insulinoma in outpatients.

Hardware-in-the-loop control of glucose in diabetic patients based on nonlinear time-varying blood glucose model

Diabetes Mellitus (DM) is identified as one of the most serious public health challenges which need engineering science to deal with and prevent complications. In this paper, a model of the glucose-insulin system for the virtual type 1 diabetic patient is controlled, which considers factors such as the physical and mental characteristics of the patient. The purpose of this paper is to consider a nonlinear time-varying model of diabetic patients which is affected by Exercise, stress, fatigue, meals, snacks, and sensitivity of insulin (SI) and design an appropriate controller based on the backstepping (BS) technique. In order to make the backstepping controller robust to uncertainties in reality, the level of food, snack, and exercise are considered as unknown continuous functions and the controller is designed such that it can cope with these uncertainties while the blood glucose level is regulated. To verify the performance of the designed controllers, a sample insulin pump is manufactured and the Hardware-In-The-Loop (HIL) experiment is carried out. The result of the HIL test is compared to the in-silico simulation which shows the success of the controller in regulating blood glucose level and preventing the patient from complications of hyperglycemia and hypoglycemia.

The Potential of Noni (Moringa citrifolia) in Lowering Blood Glucose Levels in Diabetes Mellitus Patients

Background: Diabetes Mellitus is a chronic metabolic disorder caused by insulin resistance. Noni juice has the potential as herbal medicine which believed to reduce blood glucose levels. This study aims to determine the effect of noni juice on blood sugar levels on diabetic patients. Methods: This study used 16 respondents. They divided two groups, a control group and a treatment group. Each group consists of 8 respondents. The intervention group received 150 ml of noni juice which was given once a day for ten days. Glucose testing was carried out by the glucose-check method. The blood was taken from the respondent's fingertips capillary. The blood glucose levels between the control group and the intervention group were analyzed using independent t-test. Results: The average blood glucose level in the intervention group was 199.88 mg/dl, while the control group was 326.25 mg/dl. The test results of the mean blood glucose levels between the control group and the intervention group had a significant difference with a value of p = 0.003 (p ≤ 0.05). This indicates a significant effect between blood glucose levels in the control group and the intervention group. Conclusion: Noni can reduce blood glucose levels because it contains flavonoid. It has a hypoglycemic effect. Health workers can suggest consuming noni juice to decrease blood glucose in diabetic patients.
 

The Effect of Herbal Medicine on Blood Glucose in Type 2 Diabetes Patients: A Retrospective Study

Objective: This study was conducted to evaluate the effect of herbal medicine on blood glucose in diabetic patients. Methods: The subjects were patients with diabetes mellitus (DM) who had been admitted to Kyung Hee University Korean Medicine Hospital for more than 8 weeks for a primary diagnosis other than DM and who had taken herbal medicine for more than 8 weeks from January 2010 to February 2020. The medical records were analyzed retrospectively to confirm the characteristics of the subjects, and examination results included hemoglobin A1c (HbA1c), total cholesterol, triglyceride, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine. Changes in HbA1c before and after taking herbal medicine and changes according to subgroups were analyzed. Results: A total of 149 subjects with type 2 DM were selected as participants. After taking the herbal medicine, the HbA1c value was significantly decreased, and the statistical significance was maintained even when the effect of controlling antidiabetic agents was excluded. The decrease in HbA1c was higher in the poor glycemic control group. Liver and kidney functions did not show any significant changes after taking the herbal medicine. Conclusions: Administration of herbal medicine for a long period of 8 weeks or longer did not increase HbA1c in patients with DM complicated by other various diseases. Keywords: diabetes mellitus (DM), herbal medicine, blood glucose, Hemoglobin A1c (HbA1c)

Amphiphilic Polyacrylamide Excipients Lead to a Record-Breaking Fast-Acting Insulin

Fast-acting insulins are central to the regulation of prandial glucose in diabetic patients. Current fast-acting insulins require 20-30 min for the onset and longer for the peak blood concentrations. The recent work by Mann et al. used high-throughput synthesis and screening of polyacrylamide-based excipients to yield a formulation with pharmacokinetics that is faster than the currently available fast-acting insulins.

Microfluidics by Additive Manufacturing for Wearable Biosensors: A Review.

Wearable devices are nowadays at the edge-front in both academic research as well as in industry, and several wearable devices have been already introduced in the market. One of the most recent advancements in wearable technologies for biosensing is in the area of the remote monitoring of human health by detection on-the-skin. However, almost all the wearable devices present in the market nowadays are still providing information not related to human ‘metabolites and/or disease’ biomarkers, excluding the well-known case of the continuous monitoring of glucose in diabetic patients. Moreover, even in this last case, the glycaemic level is acquired under-the-skin and not on-the-skin. On the other hand, it has been proven that human sweat is very rich in molecules and other biomarkers (e.g., ions), which makes sweat a quite interesting human liquid with regards to gathering medical information at the molecular level in a totally non-invasive manner. Of course, a proper collection of sweat as it is emerging on top of the skin is required to correctly convey such liquid to the molecular biosensors on board of the wearable system. Microfluidic systems have efficiently come to the aid of wearable sensors, in this case. These devices were originally built using methods such as photolithographic and chemical etching techniques with rigid materials. Nowadays, fabrication methods of microfluidic systems are moving towards three-dimensional (3D) printing methods. These methods overcome some of the limitations of the previous method, including expensiveness and non-flexibility. The 3D printing methods have a high speed and according to the application, can control the textures and mechanical properties of an object by using multiple materials in a cheaper way. Therefore, the aim of this paper is to review all the most recent advancements in the methods for 3D printing to fabricate wearable fluidics and provide a critical frame for the future developments of a wearable device for the remote monitoring of the human metabolism directly on-the-skin.

Robust observer-based adaptive control of blood glucose in diabetic patients

The objective of this paper is to design a robust observer-based adaptive controller for an intravenous glucose tolerance test (IVGTT) model of Type 1 Diabetes Mellitus (T1DM) patients. The model is assumed to be nonlinear and uncertain. The robust observer estimates the states of the uncertain T1DM model. Once the states are estimated, an adaptive control technique based on Lyapunov's second method is proposed to achieve the desired closed-loop performance for an uncertain system. The results presented here depict that the design philosophy can avoid severe hypoglycaemia (glucose concentration level below 50 mg/dl), bringing down the glucose concentration to a safe level within a specified time of 120 min. Restoring and maintaining the plasma glucose concentration in T1DM patients in the euglycaemic range (70–180 mg/dl) by appropriate insulin infusion under meal disturbances and parametric variations of are effectively handled with the proposed controller. The realistic situation for the patient model like consideration of (i) only one measurable state, and (ii) uncertain as well as time-varying model parameters addressing inter- and intra-patient variability, respectively, are taken into account. The complexity of the T1DM model leads to a new integrated design methodology, combining robustness and adaptive philosophy for the first time.

The effects of mindfulness training on the level of happiness and blood sugar in diabetes patients.

The present study aimed at investigating the effect of mindfulness training on the level of happiness and blood glucose in diabetic patients in Zarghan city, Iran. This quasi-experimental study was conducted in 2018 in Fars province, Iran. 136 diabetic patients who were eligible (had diabetes for more than one year, older than 18years, willingness to participate in the research, and reside in Zarqan city) were selected based on convenience sampling method. Next the participants were randomly divided into two groups, each comprising 68 individuals. Both of the study samples and statistical analyser were blinded to intervention group (mindfulness training) and control group (without intervention). Before and three month after the intervention the patients' levels of happiness (based on Oxford Happiness Questionnaire), fasting blood sugar (FBS) and Glycated Hemoglobin test (HbA1c) were measured. The results indicated that after the sessions, the level of happiness in the Intervention group was significantly higher than the control group (p value <0.001). Also, the level of blood glucose and HbA1c after the sessions was significantly lower in the Intervention group compared to the control group (p value<0.001, p value = 0.004). After the intervention, there was a significant correlation between mean blood glucose levels and mean HbA1c levels in the Intervention group and their level of happiness (p value<0.01 and p value<0.001). The findings revealed that the mindfulness-based educational intervention can increase happiness in people with diabetes and regulate their blood glucose.

Using Sliding Mode Controller and Eligibility Traces for Controlling the Blood Glucose in Diabetic Patients at the Presence of Fault

Some people suffering from diabetes use insulin injection pumps to control the blood glucose level. Sometimes, the fault may occur in the sensor or actuator of these pumps. The main objective of this paper is controlling the blood glucose level at the desired level and fault-tolerant control of these injection pumps. To this end, the eligibility traces algorithm is combined with the sliding mode control. The eligibility traces algorithm is one of the newest solving methods of the Reinforcement Learning approach. The major disadvantage of the sliding mode control method is the chattering phenomenon. In this paper, the novel idea is the combination of these methods to remove the chattering phenomena in simulation results. To demonstrate the superiority of the proposed method, it is compared with another combinatory method that is the sliding mode control and Artificial Neural Networks. Simulation results reveal that the combination of the eligibility traces algorithm and the sliding mode control can control the blood glucose level and insulin with a higher speed and bring them to the desired level, even in the case the sensor and actuator faults are present in the system. When the proposed hybrid method is used, the injected dosage of the drug is lower, which will result in reduced side effects. Finally, the noise, as well as the uncertainty in system parameters and initial conditions are applied to the system to investigate the performance of the proposed controller, under the faulty condition.

Ficus deltoidea extract down-regulates protein tyrosine phosphatase 1B expression in a rat model of type 2 diabetes mellitus: a new insight into its antidiabetic mechanism.

Ficus deltoidea var. deltoidea Jack (FD) is a well-known plant used in Malay folklore medicine to lower blood glucose in diabetic patients. For further research of the antihyperglycemic mechanisms, the protein tyrosine phosphatase 1B (PTP1B)-inhibitory effect of FD was analysed both in vitro and in vivo. To optimise a method for FD extraction, water, 50, 70, 80, 90 and 95% ethanol extracts were prepared and determined for their total phenolic and triterpene contents, and PTP1B-inhibition capacity. Among the tested extracts, 70% ethanol FD extract showed a significant PTP1B inhibition (92·0% inhibition at 200 µg/ml) and high phenolic and triterpene contents. A bioassay-guided fractionation of the 70% ethanol extract led to the isolation of a new triterpene (3β,11β-dihydroxyolean-12-en-23-oic acid; F3) along with six known compounds. In vivo, 4 weeks' administration of 70% ethanol FD extract (125, 250 and 500 mg/kg/d) to streptozotocin-nicotinamide-induced type 2 diabetic rats reversed the abnormal changes of blood glucose, insulin, total Hb, GLUT2, lipid profile, and oxidative stress in liver and pancreas. Moreover, FD reduced the mRNA expression of the key gluconeogenic enzymes (phosphoenolpyruvate carboxykinase and glucose 6-phosphatase) and restored insulin receptor and GLUT2 encoding gene (Slc2a2) expression. In addition, FD significantly down-regulated the hepatic PTP1B gene expression. These results revealed that FD could potentially improve insulin sensitivity, suppress hepatic glucose output and enhance glucose uptake in type 2 diabetes mellitus through down-regulation of PTP1B. Together, our findings give scientific evidence for the traditional use of FD as an antidiabetic agent.

Structural characterization and α-glycosidase inhibitory activity of a novel polysaccharide fraction from Aconitum coreanum

α-Glycosidase is an essential target for the management of postprandial serum glucose in diabetic patients. Therefore, the interest has been growing in the screening of α-glycosidase inhibitor from natural resource. In the present study, the structure and α-glycosidase inhibitory activity of a polysaccharide (named as ACPP-1) from Aconitum coreanum were investigated. Based on the results from high performance gel permeation chromatography, GC–MS and 1D/2D nuclear magnetic resonance spectroscopy, ACPP-1 was a highly-linear polysaccharide with a molecular weight of 34.0 kD and containing over 90 % of glucose. It was composed of (1→4)-α-d-Glcp and α-Araf. ACPP-1 exhibited a dose-dependent inhibitory eff ;ect against α-glycosidase activity in vitro and the IC50 value was ∼0.8 mg/mL. In oral starch tolerance test, treatment with ACPP-1 (800 mg/kg) significantly improved the starch tolerance in mice. Taken together, this study provided a potential intervention and management for postprandial hyperglycemia by the polysaccharide fraction from A. coreanum.

Histological evidence of chitosan-encapsulated curcumin suppresses heart and kidney damages on streptozotocin-induced type-1 diabetes in mice model

High blood glucose in diabetic patients often causes cardiovascular diseases (CVDs) that threats to human life. Curcumin (Cur) is known as an antioxidant agent, possesses anti-inflammatory activity, and prevents CVDs. However, the clinical application of curcumin was limited due to its low bioavailability. This study aimed to investigate the ameliorative effects of chitosan-encapsulated curcumin (CEC) on heart and kidney damages in streptozotocin-induced type-1 diabetes C57BL/6 mice model. The results showed that Cur- and CEC-treatments downregulated the blood sugar and total cholesterol level as well as enhanced insulin secretion. However, blood pressure, triglycerides content, and very low-density lipoprotein-cholesterol content were not changed. Histochemistry analysis revealed that both curcumin and chitosan-encapsulated curcumin ameliorated cell hypertrophy and nucleus enlargement in the left ventricular of heart and reduced fibrosis in the kidney, especially after the chitosan-encapsulated curcumin treatment. Our study suggested that chitosan can effectively enhance the protective effect of curcumin on the heart and kidney damages in type-1 diabetes mice model.

Vanadium compounds induced damage of human umbilical vein endothelial cells and the protective effect of berberine.

This study was conducted to investigate the damage caused by vanadium compounds and to explore the protective effects of berberine (BBR) in human umbilical vein endothelial cells (HUVECs). BBR is a biologically active small molecule found in Coptis rhizome, a remedy used in traditional Chinese medicine to treat diabetes. BBR has also been shown to lower blood glucose in diabetic patients. MTT assay was performed to observe the influence of bis(acetylacetonato)-oxidovanadium [VO(acac)2] or sodium metavanadate (NaVO3) and BBR on viability of HUVECs. The monolayer permeability of the HUVECs was assessed by measuring the transendothelial electrical resistance (TER). The endothelial nitric oxide synthase (eNOS) activity was detected by ELISA. Flow cytometry was performed to detect the generation of reactive oxygen species (ROS). The results showed that the viability of HUVECs was decreased by treatment with vanadium compounds 50-400μM in a concentration-dependent manner, while 0.01-1μM BBR effectively protected HUVECs from the inhibitory effects of vanadium compounds on cell viability. Also 100 and 200μM VO(acac)2 induced high permeability and decreased eNOS activity in HUVECs. While 0.01-1μM BBR showed no improvement in the permeability, and failed to reverse the VO(acac)2-induced changes of eNOS activity, but BBR treatment increased the eNOS activity in control cells. The addition of 200μM VO(acac)2 significantly induced ROS generation in HUVECs, while 0.01 or 0.1 μM BBR reversed the change of ROS. In summary, BBR has protective effects in HUVECs damage induced by vanadium compounds, which is not mediated by eNOS, but related to reduced intracellular ROS.

The Effect of Isopropyl Alcohol and Chlorhexidine Gluconate on the Blood Glucose in Diabetic Patients Referring to the Emergency Department

The Effect of Isopropyl Alcohol and Chlorhexidine Gluconate on the Blood Glucose in Diabetic Patients Referring to the Emergency Department

Motor-assisted Cycling and FES Cycling for Postprandial Glucose in Diabetic Patients With ADL Disability

Motor-assisted Cycling and FES Cycling for Postprandial Glucose in Diabetic Patients With ADL Disability

1878-P: Glucagon Is neither Necessary nor Sufficient for Ketosis in Mice

The current consensus mechanism for hepatic ketogenesis posits a key role for islet hormones, with insulin inhibiting and glucagon stimulating formation of ketone bodies. In this model the action of glucagon in the presence of low portal insulin concentrations causes ketosis. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are effective for lowering glucose in diabetic patients, and cause a relative insulinopenia. These agents have been described to increase ketone production, and have been associated with cases of diabetic ketoacidosis. SGLT2i have been recently reported to stimulate islet α-cells, suggesting the hypothesis that SGLT2i-induced glucagon secretion drives ketogenesis. To test this hypothesis, mice were given the SGLT2i dapagliflozin (dapa) in the presence or absence of glucagon signaling. Fasting-induced ketosis was used as a positive control. In both dapa-treated mice and 16 hour fasted mice, blood glucose decreased to the 4-5 mM range, β-OHB increased 2-3 fold, and NEFA rose 30-50%. Fasting had minimal effects on plasma glucagon, but dapa increased glucagon concentrations, albeit at a delayed rate compared to changes in glycemia, β-OHB, or NEFAs. Interruption of glucagon signaling with either: 1) a glucagon receptor antagonist (GRA); or 2) mice with a deletion of the proGlucagon gene had no effect on the development of ketosis in response to dapa or fasting, indicating that glucagon is not necessary for ketosis in these conditions. To test its sufficiency, glucagon (20µg/kg) was given to fed mice, 16 hour fasted mice, dapa-treated mice, and mice with insulin receptor blockade (IRB). Fasting, dapa and IRB all increased β-OHB significantly but glucagon did not add to this. In contrast, epinephrine significantly elevated ketone levels under these conditions. These findings indicate that the current model of the regulation of ketogenesis needs to be reconsidered, and that in mice glucagon does not have a significant role in this process. Disclosure M. Capozzi: None. R. Coch: None. J.B. Wait: None. J.J. Koech: None. J. Campbell: Research Support; Self; Eli Lilly and Company. Speaker's Bureau; Self; Merck Sharp &amp; Dohme Corp. D.A. D'Alessio: Advisory Panel; Self; Eli Lilly and Company. Research Support; Self; Eli Lilly and Company, Merck &amp; Co., Inc. Funding National Institutes of Health (F32-DK116542)

MON-152 Less Is More: Human Regular U-500 Insulin

Introduction: Human Regular U-500 Insulin is used to control high blood glucose in diabetic patients who need more than 200 units of insulin daily. High-dose insulin therapy may be limited because the volumes of insulin necessary to achieve these very high doses are difficult to administer subcutaneous and there is a decrease in the absorption rate. We report a case of a woman with DM2 and severe insulin resistance who achieved glycemic control using off-label U-500 via continuous subcutaneous insulin infusion (CSII) but with fixed bolus given manually by patient and remained controlled over the next six years. Clinical Case: A 66-year-old woman with DM2, HTN, metabolic syndrome and adiposity based chronic disease referred to endocrinologist office for glycemic control. Patient treated for diabetes with metformin and premixed insulin and HTN treated with CCB/ACE inhibitor and beta blocker/thiazide combinations. Clinical examination reveals an obese female (BMI: 37.9kg/m2) with acanthosis nigricans. Initial laboratory test showed HbA1c of 13.9%, FBS 293mg/dL, cholesterol 195mg/dL, TGs 147mg/dL and LDL 103mg/dL. Patient was treated with multiple insulin regimens, including U-500 insulin by subcutaneous route of administration and oral antihyperglycemic agents including followed up by nutritionist, where the lowest HbA1c was 9.1%. Patient total daily dose of insulin was 220 units. Although U-500 insulin is not FDA-approved for use in CSII and the ideal candidate should be intellectually able to deal with insulin pump therapy, this treatment was effective for our patient who required high insulin doses and failing other treatment regimen, achieving glycemic control and weight loss in six weeks. The only way this patient used this mode of insulin administration was on a single basal rate and fixed insulin bolus doses before each meal and with bedtime snack. All of these parameters were adjusted by 5 for the use of concentrated insulin in the pump device. HbA1c decreased from 10.5% to 8.5% with only six weeks of treatment and at one year decreased to even more 7.0%. Currently patient had been using CSII with U-500 for six years and patient HbA1c range is between 7.5-7.9% evaluated approximately every 3 months. Conclusion: The increase in the prevalence of obesity and diabetes has been an issue in treating patients who require high doses of insulin. The use of U-500 for CSII allows for better absorption of high insulin doses and improvement of glycemic control thus improving quality of life, weight loss, decreasing multiple daily injections and preventing diabetes complications. To our knowledge this is the first case report demonstrating long-term glycemic control with U-500 via CSII and on a fixed dose regimen on CSII without using carb counting or corrections to make this regimen easier for certain patients without the knowledge for complicated regimens.

Effect of Fenugreek Use on Fasting Blood Glucose, Glycosylated Hemoglobin, Body Mass Index, Waist Circumference, Blood Pressure and Quality of Life in Patients with Type 2 Diabetes Mellitus: A Randomized, Double-Blinded, Placebo-Controlled Clinical Trials.

Background: Diabetes mellitus is a major cause of death globally. It causes multiple problems in various organs and incurs heavy costs for patients and the community health system.The present study was conducted to evaluate the effect of fenugreek intake on fasting blood sugar (FBS), HbA1C, body mass index (BMI), waist circumference, blood pressure and quality of life of type 2 diabetes mellitus (T2DM) patients. Materials and Methods: This randomized, double-blinded clinical trial study was conducted on patients with T2DMin Tehran, Iran in 2018. The treatment group received 5 g of fenugreek powder,and the placebo group received 5 g of wheat flour twice daily for two months before meals. Results: This study was performed on 62 patients (50% male and 50% female). Both groups had similar demographic characteristics. The results showed a significant difference between the mean FBS (P<0.001), HgA1C (P<0.001), BMI (P<0.001), waist circumference (P<0.001), diastolic blood pressure (P=0.005), and quality of life (P=0.015). There was no significant difference in mean systolic blood pressure (P=0.189) between groups. Conclusion: Given the positive effect of fenugreek on FBS, hemoglobin, HbA1C, BMI, waist circumference, blood pressure and quality of life, it can be recommended for controlling blood glucose in diabetic patients.