Multiple Subcutaneous Insulin Injections Research Articles

Perioperative Insulin Pump Therapy Decreases Readmission Risk and Improves Outcomes in Patients with Diabetes.

To evaluate the impact of temporary insulin pump use during hospitalization on glycemia, postoperative complications, and cost/utilization in perioperative patients with diabetes. Patients (n=159) with type 2 diabetes and hospitalized for elective surgery were recruited from three hospitals. Subjects were categorized into the insulin pump group and the multiple daily subcutaneous insulin injection group according to their treatment therapy. Data were collected at admission, discharge, and 3 months post-discharge. Subjects in the CSII group who were still on insulin therapy transitioned from CSII to MDII; however, their daily insulin dosages were lower than those in the MDII group (15.31±10.98 U/d vs. 23.48±17.02 U/d, P=0.015) after discharge. In terms of medical costs, the CSII group had significantly higher hospitalization costs than the MDII group (112.36±103.43 thousand RMB vs. 82.65±77.98 thousand RMB, P=0.043). After 3 months, the CSII group had significantly lower outpatient costs than the MDII group (3.17±0.94 thousand RMB vs. 3.98±1.76 thousand RMB, P ˂ 0.001). In the MDII group, 10 patients reported severe postoperative complications requiring re-hospitalization; there were no similar reports in the CSII group. Temporary use of insulin pump therapy for perioperative patients with diabetes results in a reduction in blood glucose and blood glucose fluctuation during hospitalization, HbA1c, and the risk of postoperative complication and readmission, thus significantly decreasing costs in this complex patient cohort. Further work is needed to better understand indications for utilizing pump therapy based on diabetes phenotype and the complexity of planned surgical intervention.

Efficacy and safety of different insulin infusion methods in the treatment of total parenteral nutrition-associated hyperglycemia: a systematic review and network meta-analysis.

To systematically evaluate the efficacy and safety of different insulin infusion methods in the treatment of total parenteral nutrition (TPN)-associated hyperglycemia based on published literature and the data of completed clinical trials using a network meta-analysis. A comprehensive search of PubMed, Elsevier, Web of Science, EMBASE, Medline, clinicaltrials.gov, Cochrane Library, and three Chinese databases (Wanfang Data, China National Knowledge Infrastructure, and SINOMED) up to December 15, 2022, was performed to collect information on different insulin infusion methods used for the treatment of TPN-associated hyperglycemia, and the Cochrane systematic review method was used to screen the literature, evaluate the quality of the included literature, and extract clinical characteristics for a network meta-analysis. Clinical outcomes included mean blood glucose (MBG), hypoglycemia, hospital length of stay, hyperglycemia, surgical site infection (SSI) and mean total daily insulin. A total of 21 articles, including 1,459 patients, were included to analyze 6 different routes of insulin infusion, including continuous intravenous insulin infusion (CVII), continuous subcutaneous insulin infusion (CSII), subcutaneous glargine insulin (s.c. GI), the addition of regular insulin to the PN mixture (RI-in-PN), multiple subcutaneous insulin injections (MSII) and 50% of insulin administered as RI-in-PN + 50% of insulin administered as s.c. GI (50% RI-in-PN + 50% s.c. GI). The results of the network meta-analysis showed that MSII was the least effective in terms of MBG, followed by CVII. The 6 interventions were basically equivalent in terms of the hypoglycemia incidence. In terms of the length of hospital stay, patients in the CVII group had the shortest hospital stay, while the MSII group had the longest. CVII was the best intervention in reducing the incidence of hyperglycemia. The incidence of SSI was the lowest in the CSII and CVII groups, and the mean daily insulin dosage was the lowest in the CVII group. Current literature shows that for the treatment of TPN-associated hyperglycemia, CVII is the most effective, reducing the incidence of hyperglycemia and shortening the length of hospital stay without increasing the incidence of hypoglycemia. MSII has the worst efficacy, leading to a higher MBG and longer hospital stay, and RI-in-PN, CSII, s.c. GI and 50% RI-in-PN + 50% s.c. GI are better in terms of efficacy and safety and can be substituted for each other. https://www.crd.york.ac.uk/prospero/, identifier CRD42023439290.

LBSUN207 Efficacy And Safety Of Degludec U100 Versus Glargine U300 For The Hospital Management Of Patients With Type 2 Diabetes: A Prospective, Open-label, Non-inferiority Randomized Controlled Trial

Abstract Aims No head-to-head comparisons of two ultra-long acting insulins, degludec-100 and glargine-300, have been reported in the inpatient setting. We compared the efficacy and safety of these two insulins for the hospital management of patients with type 2 diabetes (T2D). Methods This target-to-treat, randomized controlled trial enrolled patients with T2D admitted for coronary artery bypass graft surgery (CABG). On the day of transition (day 2 of surgery) from intravenous insulin infusion to multiple subcutaneous insulin injections, patients were randomly assigned (1: 1) to receive a basal-bolus regimen using either degludec-100 or glargine-300 as basal and glulisine as bolus before meals. Insulin was adjusted daily to maintain a fasting blood glucose (BG) <140 mg/dL and pre-meal BG <180, while avoiding hypoglycemia <70 mg/dL. The primary endpoint was non-inferiority in mean differences between groups in their daily BG concentrations measured during the duration of the hospital stay and a week post-discharge, up to 12 days (point-of-care measurements, pre-breakfast, pre-lunch, pre-dinner and nighttime [0300 hours]: non-inferiority was deemed a difference <18 mg/dL). The major safety outcome was the occurrence of hypoglycemia. Secondary outcome measures included mean differences between groups in their daily BG concentrations, time in range (TIR, %), time below range (TBR, %), and time above range(TAR, %), as assessed by continuous glucose monitoring system (CGMS, n = 142). Results Between October 12, 2021, and February 10, 2022, 324 consecutive patients with T2D undergoing CABG were screened, 239 patients were randomly assigned to treatment; 122 to degludec-100 group and 117 to glargine-300 group. The mean daily BG concentration in the degludec-100 group (157 mg/dL [SD 25]) was not inferior to that in the glargine-300 group (162 mg/dL [SD 24]), with a mean BG difference of -5 mg/dL (95% CI, -11 to 2, p = 0.18). There were no differences between degludec-100 group and glargine-300 group in mean percentage of readings within target BG of 70-180 mg/dL (74% ± 29% vs. 73% ± 30%, p = 0.19), daily basal insulin dose (19 ± 8 vs. 21 ± 9 units/day, p = 0.13), length of stay in hospital (median [IQR]: 9 [8-11] vs. 9 [8-11] days, p = 0.51), or hospital complications (21.3% vs. 21.4%, p = 0.99). There were no differences in the proportion of patients with BG <70 mg/dL (15.6% vs. 23.1%, p = 0.14) or <54 mg/dL (1.6% vs. 4.3%, p = 0.226) between degludec-100 and glargine-300 groups. There was no difference between groups in mean daily BG concentrations (141 ± 26 vs. 142 ± 28 mg/dL, p = 0.88), TIR (72. 0% vs. 72.9%, p = 0.71), TBR (5.9% vs. 5.2%, p = 0.50) and TAR (22. 0% vs. 21.8%, 0.93) as assessed by CGMS. Conclusions Treatment with degludec-100 as a basal insulin is as effective and safe as glargine-300 for the hospital management of patients with T2D admitted to cardiac surgery service in the non-intensive care unit setting. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Effect of Reuse of Insulin Needle on Glycaemic Control and Related Complications in Children with Type 1 Diabetes Mellitus: A Prospective Observational Study.

Background:Children with type 1 diabetes (T1D) take multiple subcutaneous injections of insulin daily to survive. It is controversial whether the insulin needles can be reused safely or not. This study assesses the effect of the reuse versus single-use of insulin needle on glycaemic control and injection-related complications.Methods:Nearly 121 children (<15 years) with T1D were prospectively observed for existing practice of needle reuse for first 3 months and then were asked to practice single-use for the next 3 months.Results:It was found that 78% participants were reusing needles more than three times. After 3 months of needle reuse, 91.3% patients had lipodystrophy. Frequency of reuse positively correlated with local redness, bleeding and leakage of insulin. The patients achieving HbA1c ≤7.5% was significantly low among those reusing needles more than four times. After 3 months of single-use, no significant difference was found in mean HbA1c. However, hyperglycaemic episodes, lipodystrophy and local complications reduced significantly. There was a significant reduction in mean HbA1c among those using needles more than six times earlier.Conclusion:Reuse of insulin needles up to six times does not affect the glycaemic control significantly. To achieve target HbA1c (<7.5%) the needle reuse should be restricted to three times only, which can also reduce injection-related local complications.

Costs and economic impacts of type-1 diabetes from the Dominican patient perspective

Objective: Estimate the economic burden of type 1 diabetes (T1D) in the Dominican Republic and its impact on treatment adherence and patients’ quality of life (QoL). Materials and Methods: Cross-sectional observational study about T1D treatment cost and adherence plus patients QoL. The total monthly cost of treatment regimes was calculated through microcosting analysis and correlated with a national minimum wage (NMW) and average household income. Sociodemographic, clinical, treatment adherence, and QoL data were obtained through an online questionnaire. In an exploratory approach, all variables were compared with the categorization of household income. Results: Fixed doses (FD) regime has the lowest cost (46% of the NMW) and continuous subcutaneous insulin infusion (CSII) the highest (540% of the NMW). The lower household income group had less insurance coverage (P= 0.034), purchased fewer diabetes management supplies for cost-related reasons (P= 0.014), performed less glycemic monitoring (P= 0.016), and had more cost-related factors limiting appropriate treatment and follow-up (P= 0.030). Also, the FD treatment modality predominated in this group, while Multiple Daily Injections and constant subcutaneous insulin injection prevailed in the higher income group (P= 0.005). The QoL mean scores were 31.63 (SD 8.02) in the lower-income group and 32.52 (SD 8.81) in the higher-income one. Conclusions: T1D has a high monthly economic impact, potentially worsening treatment adherence and QoL, especially in the lower socioeconomic status population. Efforts must be made by the healthcare system to enhance the economic support and management of this disease. KEYWORDS: Type 1 diabetes, Microcosting, Dominican Republic, Public Health, Treatment adherence.

Insulin protocol to control post-pancreatectomy diabetes

Diabetes is a disease by which blood glucose level is elevated by defects in insulin secretion or by resistance to insulin. As pancreatectomy inevitably results in the reduction of the total islet mass, the majority of clinicians tended to believe that pancreatectomy itself would immediately cause blood glucose elevation and subsequent diabetes development. In partial pancreatectomy surgery (distal pancreatectomy or PPPD), however, not all patients develop diabetes for at least a number of years after. This is because the remnant pancreatic islets can produce relatively enough amount of insulin to maintain blood glucose level. After this compensatory time period passes after partial pancreatectomy, the pancreas eventually undergoes atrophy after surgery and the insulin secretory function decreases in the remnant islet. This will lead to delayed development of diabetes after pancreatectomy. Under these situations, insulin injection together with oral anti-diabetic medication would be critical for controlling the blood glucose level. In contrast, patients who undergo total pancreatectomy will develop diabetes immediately after the surgery because of the absolute deficiency of insulin. In this situation, the patients will need a tightly-controlled, delicate insulin injection protocol with multiple subcutaneous insulin injections. Recently, with only a small patch applied to the body, continuous glucose monitoring system (CGMS) enables the reporting of the blood glucose level into the patient's smartphone every 1-5 minutes. The CGMS has gained popularity, is clinically helpful, and is even supported by the health insurance system for type 1 diabetes patients (the patients who undergoes total pancreatectomy can be categorized as type 1 diabetes by the Health Insurance Review System). In this lecture, I will be addressing the different glucose management protocols and/or methods in a variety of pancreatectomy cases and will also introduce the usefulness of CGMS for total pancreatectomy patients.

Placental morphology in different types of diabetes mellitus

AIM: The aim of this study was to compare placental morphological features from women with different types of diabetes mellitus considering method of DM correction.&#x0D; MATERIALS AND METHODS: A retrospective, single-center, cohort study was carried out. We analyzed morphological examination results of 3300 placentas, which made uр the following comparison groups: type 1 diabetes mellitus on continuous subcutaneous insulin infusion (n = 60), type 1 diabetes mellitus on multiple subcutaneous insulin injections (n = 446), type 2 diabetes mellitus on diet (n = 95), type 2 diabetes mellitus on insulin therapy (n = 134), gestational diabetes mellitus on diet (n = 1652), gestational diabetes mellitus on insulin therapy (n = 735), preeclampsia (n = 39), and the control group (n = 139). The examined placentas were weighed, with their sizes (two diameters and thickness), cotyledon structure and defects assessed. We determined the umbilical cord junction and external characteristics of extraembryonic membranes. Fragments of the placenta (5 pieces) were fixed in 10% neutral buffered formalin (pH 7.2), processed with the Leica TP1020 tissue processor and embedded in paraffin. Histological sections (3-4 m thick) were prepared and stained with hematoxylin-eosin. Statistical analysis was performed using the SPSS 23.0 and GraphPad Prism 8.0 software.&#x0D; RESULTS: Following characteristics were typical for all types of diabetes mellitus: increased placental mass metrics, chronic placental insufficiency, dissociated villous maturation disorder with prevalent immaturity, as well as involutive-dystrophic and circulatory disorders of varying severity. Placentas from women with type 1 diabetes mellitus had the specific sings: the predominance of intermediate immature villi and stem villi stromal fibrosis. The frequency of placental infarcts and fibrinoid content in the intervillous space were comparable to those in placentas from women with type 2 diabetes mellitus. Inflammatory changes and moderate placental calcification were most consistently associated with type 2 diabetes mellitus, while gestational diabetes mellitus was characterized by soft damages. Placentas with preeclampsia showed higher prevalence of premature villous maturation, compensated placental insufficiency, and fibrinoid depositions in the intervillous and subchorionic spaces.&#x0D; CONCLUSIONS: Understanding relationships between placental histological features and clinical aspects of diabetes mellitus makes it possible not only to clarify the pathophysiological processes occurring in this pathology but also to optimize the algorithm for the rational management of the neonatal period of children from mothers with diabetes mellitus.

Effectiveness of diabetes education including insulin injection technique and dose adjustment through telemedicine in hospitalized patients with COVID-19

Aims:To study the feasibility of diabetes education through telemedicine in patients with diabetes mellitus (DM) hospitalized for coronavirus disease 2019 (COVID-19) management. Methods:This was a prospective study of 100 patients with DM who were admitted in a COVID isolation ward for management of COVID-19. Patients managed with multiple subcutaneous insulin injections were eligible. During teleconsultation, diabetes education including insulin injection technique was given by a diabetes educator via a phone call (audio and video) during hospitalization. They were also re-assessed after 2 weeks of discharge from the hospital via teleconsultation or in-person. Results:Out of 100 patients, 72.0% had prior history of diabetes while 28.0% were newly diagnosed. The median age of our cohort was 56 years and median duration of diabetes was 7.0 years. Telemedicine as a mode of consult for diabetes education was accepted by 96.0% of patients during hospitalization. At 2 weeks’ follow-up, 77.0% patients were following insulin instructions correctly and were satisfied with this mode of consultation. Conclusion:Diabetes education using telemedicine as a technology is feasible, acceptable, and effective in the management of most patients with DM. Telemedicine appears to be an effective way to replace routine visits in special situations.

880-P: Insulin Regimen and Glycemic Control in People with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) is a progressive disease with many patients requiring insulin treatment. Basal insulin (BI) is often added first followed by escalation to a multiple subcutaneous insulin injection (MSI) regimen. However, many patients with T2DM struggle managing the MSI regimen. As a result, their glycemic control remains poor after starting MSI. Our study investigates whether switching back to BI alone would improve glycemic control. Patients with T2DM and A1C ≥9.0% on MSI regimen seen in our clinic over two years were included in this analysis. Main study outcome was the A1C after ≥3 months of switching back to BI as compared to continuing MSI. We found 24 patients who were switched from MSI to BI and compared them with 58 patients who were continued on MSI (see Table). There were no significant differences at baseline between the two groups. On follow-up, the BI group had a mean change in A1C (%) of -1.6 ± 2.0 compared to -0.7 ± 1.5 in the MSI group. In addition, the daily dose of prescribed insulin on follow-up was lower in the BI group at 46 ± 14 units/day compared to 90 ± 70 units/day in the MSI group. Hypoglycemia rates were also lower in the BI group at 12% compared to 20% in the MSI group. We conclude that simplification of insulin regimen may improve A1C and decrease the risk of hypoglycemia in patients poorly controlled on MSI regimen. The improved glycemic control is likely related to improved adherence and lower risk of errors. Disclosure A. Arunachalam: None. R. Garg: None.

Insulin-delivery methods for children and adolescents with type 1 diabetes

Efforts directed toward restoring normal metabolic levels by mimicking the physiological insulin secretion, thereby ensuring safety, efficacy, minimal invasiveness and conveniences, are of great significance in the management of type 1 diabetes among children and adolescents. Regardless of the various technologies being discovered in addressing invasiveness and enhancing medication adherence in the management of type 1 diabetes, yet limited success had been observed among children and adolescents. The multiple daily subcutaneous insulin injections route using vial and syringe, and occasionally insulin pens, remain the most predictable route for insulin administration among children and adolescents. However, this route has been associated with compromised patient compliance, fear of injections and unacceptability, resulting in poor glycemic control, which promote the demand for alternative routes of insulin administration. Alternative routes for delivering insulin are being investigated in children and adolescents with type 1 diabetes; these include the hybrid closed-loop ‘artificial pancreas’ system, oral, inhalation, intranasal routes, and others. This review article explores the current advances in insulin-delivery methods that address the needs of children and adolescents in the treatment of type 1 diabetes.

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

Severe Hypercortisolism with Hypokalemic Alkalosis Mimicking Ectopic Cushing Syndrome in a Patient with Cushing Disease Due to Pituitary Microadenoma.

Late Controlled Type 2 Diabetes Mellitus with Severe Acute Systemic Infection

Abstract Background: The last International Diabetes Federation statement showed that in 2015, there were 415 million people diagnosed with diabetes and the expectation for 2040 is around 642 million people all over the world. Diabetes Mellitus is a disease associated with major negative consequences due to its acute and chronic complications with chronic hyperglycemia playing a major role. Method: We are presenting a case of 52 year old male patient, known with Type 2 Diabetes Mellitus for 10 years without treatment due to personal decision, who was admitted through the Emergency Unit in Neurology Department for bilateral myalgia of hips and arms, proximal force deficiency of bilateral lower limbs, acute retention of urine, fever, simptomatology which started about 48 before admission. The suspected diagnosis was acute polyradiculoneuritis but the paraclinical investigations performed on Neurology Unit excluded it and evaluated the present disease as Acute Diabetic Neuropathy. Through the passing days, the patient developed paraplegia and major unbalanced glycemic control (although he received multiple rapid human subcutaneous insulin injection) so they’ve decided to transfer him into Diabetology Department. At the moment of admission into Diabetology Unit, the patient had high fever, superficial and deep sensitivity disorders, urethral catheter and no faeces for 7 days. We’ve continued our investigations and came with a positive diagnosis of Unballanced and Complicated Type 2 Diabetes Mellitus with insulin therapy, Parainfectious Acute Transverse Myelitis, Prostatic and Seminal Vesicles Abces with rectal fistula, Sepsis, Acute Retention of Urine, Urina Infection with Pseudomonas Aeruginosa. Conclusion: The diagnosis of Unballanced Diabetes Mellitus involves differential diagnosis due to lack of specific simptomatology in Diabetic Neuropathy and associated immune deficiency.

Diabetic Ketoacidosis in a Patient with Type 1 Diabetes on Sodium-glucose Co-transporter-2 Inhibitors—a Case Report

We describe a case of a 26-year-old female with long-standing type 1 diabetes (T1D), on multiple subcutaneous insulin injections, who had been taking empagliflozin for the past year. She was detected to have severe diabetic ketoacidosis (DKA) with relatively lower blood glucose values during hospitalisation for dengue fever. The factors that precipitated the DKA are discussed, along with the unique challenges in the management of her metabolic status. While sodium-glucose co-transporter-2 (SGLT2) inhibitors have several potential benefits as adjunctive add-on therapy to insulin in T1D, the evidence is limited to short-term studies. However, their off-label use is increasing and there have been concerns related to increased risk of diabetic ketoacidosis. At present, SGLT2 inhibitors are not approved for use in T1D, and the risks should be discussed at length with the patient.

Pregnancy Outcomes in Women with Type 1 Diabetes Depending on the Different Modes of Insulin Therapy

The aim of the study was to evaluate the features of the effect of different modes of insulin therapy on pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) with different levels of albuminuria. The study involved 155 women with T1DM during pregnancy, using various modes of insulin, and 42 infants born to women with T1DM. In order to identify a possible relationship between the level of proinflammatory cytokines and growth factors in pregnant women with T1DM and terms of delivery, we measured the daily urinary excretion of IL-1β, MCP-1, and TGF-β1 in 21 women at different trimesters of pregnancy. The use of continuous subcutaneous insulin infusion (CSII) in pregnant women with T1DM allows to prolong the pregnancy for 2–4 weeks as compared to the timing of delivery of pregnant women with T1DM receiving multiple subcutaneous injections of insulin (MPII). Pregnant women with MPII in 100% cases of the presence of microalbuminuria and proteinuria had premature delivery. Elevated levels of proinflammatory cytokines (IL-1β and MCP-1) and TGF-β1 may possibly serve as a predictor of pre-term delivery in pregnant women with diabetes type 1, starting with the early stages of pregnancy. The use of insulin by CSII in pregnant women with T1DM reduces the percentage of pre-term deliveries, regardless of the stage of diabetic nephropathy. It improves the condition of infants born at term in women with T1DM using a therapy with insulin pumps compared to that with MPII such as less common manifestation of diabetic fetopathy as macrosomia and hypoglycemia at birth, reducing the need for resuscitation in newborns.

Technosphere insulin: inhaled prandial insulin

Introduction: Insulin therapy is a mainstay for treatment of diabetes mellitus; however, many barriers to insulin exist. Insulin human inhalation powder (technosphere insulin) is a new FDA-approved alternative to subcutaneous bolus insulin.Areas covered: This is an overview of technosphere insulin (TI). Pharmacokinetics, clinical efficacy, safety and tolerability are discussed.Expert Opinion: TI is more quickly absorbed than subcutaneous insulin therapies and has a shorter duration of action. It appears to be noninferior compared with subcutaneous insulin regimens, and is associated with less hypoglycemia. Thus, it may serve as an alternative insulin agent in patients reluctant to administer multiple subcutaneous injections of insulin daily or in patients who experience late postprandial hypoglycemia with subcutaneous insulin. Cough is the most common side effect, but tends to be mild and transient. A small decrease in the forced expiratory volume has been demonstrated, but does not appear to progress and is reversible. Patients should have periodic pulmonary function tests. TI is contraindicated in patients with chronic lung disease. The long-term risk of lung cancer is being monitored but at this point does not appear to be higher than the expected incidence of lung cancer in this population.

Inhaled technosphere insulin: a novel delivery system and formulation for the treatment of types 1 and 2 diabetes mellitus.

Complications from uncontrolled diabetes mellitus were reduced significantly with the introduction of insulin more than 90 years ago. Despite the proven benefits of normal glycemic levels, patients are deterred by the inconvenience and perceived pain related to multiple daily subcutaneous insulin injections. Inhaled insulin was first approved by the U.S. Food and Drug Administration (FDA) in 2006, but because profit margins did not achieve expectations, the drug manufacturer discontinued sales 2years later. The second-generation inhaled insulin, developed with Technosphere technology, received FDA approval in 2014. The pharmacology, pharmacokinetics, drug interactions, clinical safety and efficacy, patient satisfaction, dosage and administration, warnings, precautions, contraindications, adverse effects, and place in therapy of inhaled Technosphere insulin are reviewed in this article.

Case of fulminant type 1 diabetes mellitus associated with parvovirus B19 infection.

A man aged in his 60′s was admitted to Kobe Rosai Hospital, Kobe, Japan, because of impaired consciousness. One week before admission, he manifested erythema on his trunk and extremities that was associated neither with fever nor with flulike symptoms. Thirst and nausea developed within a few days of erythema onset. Whereas the erythema disappeared spontaneously, the thirst and nausea worsened. A family member noticed abnormal behavior of the patient and took him to the emergency room of the hospital, where his consciousness was found to be impaired. He manif-ested ketonuria and metabolic acidosis with marked hyperglycemia, a slightly increased hemoglobin A1c content (National Glycohemoglobin Standardization Program value calculated from the Japan Diabetes Society value,1) and a low serum C-peptide level (Table 1). His hemoglobin A1c at an annual health check-up carried out 17 days previously was 5.5%. Serum levels of amylase and lipase were high, and liver and kidney function were slightly and severely attenuated, respectively. Computed tomography showed no morphological abnormalities of abdominal organs including the pancreas. The patient was immediately admitted to the hospital, and treated according to standard care for diabetic ketoacidosis by intravenous supplementation with electrolyte fluid and insulin. His consciousness returned to normal as the hyperglycemia and acidosis were ameliorated. On the day of admission, the serum titer of antibodies to glutamic acid decarboxylase was borderline high, but it had returned to a normal level on a second test carried out 2 weeks later. Tests for islet cell antibodies and antibodies to anti-insulinoma-associated protein-2 antibody were negative. Human Leukocyte antigen typing revealed the patient to harbor DRB1*09:01-DQB1*03:03 and DRB1*04:05-DQB1*04:01alleles, the latter of which confers susceptibility to fulminant type 1 diabetes mellitus2. The patient was diagnosed with fulminant type 1 diabetes mellitus and discharged 36 days after admission with multiple daily subcutaneous insulin injections. We examined antibody titers for various viruses in serum obtained on the first and 21st days of hospitalization (Table S1). Among those examined, only immunoglobulin M class antibodies to parvovirus B19 changed substantially during the first 3 weeks of hospitalization, decreasing from 1.32 (normal range <0.8) to 0.96, suggestive of a recent infection with parvovirus B19. Given that erythema is a common clinical manifestation of parvovirus B19 infection3, the skin rash experienced by the present patient 1 week before admission might have been caused by infection with the virus. It is of note that parvovirus B19 infection is known to trigger a variety of autoimmune disease-like conditions including systemic lupus erythematosus, rheumatoid arthritis and autoimmune cytopenia3. Similarity in amino acid sequence between parvovirus B19 proteins and human proteins thought to be related to such diseases has been implicated in the pathogenesis of autoimmune disorders triggered by this virus3. Although the pathophysiology of fulminant type 1 diabetes mellitus remains unclear, immunologic processes triggered by viral infection have been implicated4. Further accumulation of clinical evidence for the association of viral infection with fulminant type 1 diabetes mellitus together with basic studies of the mechanistic link between viral infection and β-cell destruction should provide further insight into the pathogenesis of this condition. The authors declare no conflict of interest. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Nursing care for patients with inslin pump to improve failed response to sulfonylureas

Objective To explore the effect of clinical nursing care for patients undergoing continuous subcutaneous insulin infusion (CSII) to improve failed response to sulfonylureas.Methods 128 patients with failed response to sulfonylureas were randomly divided into two groups to receive CSII or multiple subcutaneous insulin injection (MSII),64 for each group.The clinical efficacy,adverse reactions,and the nursing effect were observed in the two groups.Results After a course of 3-week treament in both groups,monitoring control index of blood sugar,CSII group than in MSII group standard after intensive treatment effect was obvious (P＜ 0.05).Reach the target also significantly shorten the time needed for blood sugar,significantly lower adverse reactions; Nursing effect was obvious,with a significant difference between the two group (P＜0.05).The incidende of skin redness,swelling,and itching was higher in CSII group than in MSII group.Conclusions CSII therapy can effectively control blood sugar,reduce the occurrence of hypoglycemia,decline the development of complications,improve quality of life in patients,reduce the workload of nursing staff,and improve patient satisfaction. Key words: Insulin pump; Patients with failed response to sulfonylureas; Nursing observation

Clinical study of application of insulin pump on diabetes mellitus patients with cataract during perioperative period

Objective To discuss the application value of insulin pump in the perioperative nursing of cataract diabetic patients. Methods 25 diabetic patients used the insulin pump for continuous subcutaneous insulin injection (CSII) during perioperative period were taken as the CSII group, the other 25 patients used multiple subcutaneous insulin injection (MSII) at the same time were taken as the MSII group.The patients' blood sugar undulations, the time of reaching the goal blood sugar, hospital stay, incidence of hypoglycemia, patient satisfaction degree were compared between the two groups. Results Blood sugar at various time points of the two groups reduced effectively, and the time of controlling the blood sugar, the incidence of hypoglycemia, hospital stay, patient satisfaction degree in the CSII group were obviously lower than the MSII group. Conclusions The insulin pump could control the blood glucose effectively, safely,rapidly and smoothly, which guarantees the safety of operation with standard nursing. Key words: Continuous subcutaneous insulin injection; Diabetes; Perioperative period; Nursing

Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus?

Research Article| October 01 2010 Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus? AAP Grand Rounds (2010) 24 (4): 46. https://doi.org/10.1542/gr.24-4-46 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Is Continuous Insulin Infusion 1st Line Rx for Diabetes Mellitus?. AAP Grand Rounds October 2010; 24 (4): 46. https://doi.org/10.1542/gr.24-4-46 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All AAP SitesAll PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP News Search Advanced Search Topics: diabetes mellitus, diabetes mellitus, type 1, infusion procedures, insulin, prescriptions, drug, subcutaneous insulin delivery, insulin administration Source: Sulmont V, Souchon P-F, Gouillard-Darnaud C, et al. Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: continuous subcutaneous insulin infusion as a first line treatment? J Pediatr. 2010; 157(1): 103– 107; doi: https://doi.org/10.1016/j.jpeds.2009.12.034Google Scholar Investigators from Reims, France studied the long-term metabolic outcomes of children with type 1 diabetes mellitus diagnosed prior to their 6th birthday with a treatment duration of at least five years. The participants fell into two groups: Group A consisted of 34 children who were initially treated with multiple daily subcutaneous insulin injections (MDI) and Group B consisted of 32 children who were treated by continuous subcutaneous insulin infusion (CSII) from the time of initial diagnosis. Children assigned to Group A received MDI treatment initially... Copyright © 2010 by the American Academy of Pediatrics2010 You do not currently have access to this content.