Number Of Insulin Units Research Articles

Immunopathological changes in case of the diabetes of the first type. The impact of the mother’s diabetes of the first type on the emryogenesis and fetogenesis of the fetus (Literature review, part II)

In the following article we have presented main risk factors of the development of the Diabetes Mellitus of the I type, as well as modern statistical data towards its correlation in a structure of the disease. We have revealed main markers of the disease, connected with the HLA system. We have also considered leading links in the pathogenesis of immunodeficiency development in case of patients with the Diabetes Mellitus of the I type relatively to the duration of the disease, presence of vascular complications as well as number of insulin units per day. We have provided clear criteria towards changes in the T-lymphocytes populations, what is prescribing changes in the helper-suppressor ratio. In addition, we have postulated that the autoimmune disorders, which are typical for the Diabetes Mellitus of the I type (DM of the I type) are leading to the increase in a number of apoptotically alteredd forms of T-lymphocytes, what is contributing to the deeping of changes in the immune system. Authors have studied main features of the interleukin-producing activity in case of patients with the DM of the I type. Namely: increased number of pro-inflammatory interleukins on the background of decrease of anti-inflammatory ones. The precise analysis has revealed, that there are circulating immune complexes in the blood of patients with DM of the I type, which are leading microcirculation’ disorders. The alterations, that were postulated and described relatively to the organism of patients with DM of the I type, are indicating deep disorders in the immune system and the morphological features of the thymus has to be studied, as far as the thymus as a central organ of the immunogenesis in case of fetuses from mothers, who are suffering from the DM of thr I type, in the aim of development of immunodeficiency in patients.
 Alongside with the description of changes in the immune system in case of patients with the DM of the I type, in the following article we have provided a scientific views on changes in the embrion- and fetogenesis of the fetus under the influence of mother’s DM of the I type. In addition, we have described morphological features of the placenta structure in case of this pathology, as well as pathomorphological changes in the strucutre of internal organs of fetus under the influence of this pathology in the mother’s organism. It was postulated, that in case of children, who were born from mothers, who are suffering from the DM of the I type, there is a syndrome of diabetic feto- and embryopathy, which is developing and leading to the poliorganic failure in the subsequent ontogenesis.

Combined Experimental and Molecular Simulation Study of Insulin–Chitosan Complexation Driven by Electrostatic Interactions

Protein-polysaccharide complexes constructed via self-assembly methods are often used to develop novel biomaterials for a wide range of applications in biomedicine, food, and biotechnology. The objective of this work was to investigate theoretically and to demonstrate via constant-pH Monte Carlo simulations that the complexation phenomenon between insulin (INS) and the cationic polyelectrolyte chitosan (CS) is mainly driven by an electrostatic mechanism. Experimental results obtained from FTIR spectra and ζ-potential determinations allowed us to complement the conclusions. The characteristic absorption bands for the complexes could be assigned to a combination of signals from CS amide I and INS amide II. The second peak corresponds to the interaction between the polymer and the protein at the level of amide II. INS-CS complexation processes not expected when INS is in its monomeric form, but for both tetrameric and hexameric forms, incipient complexation due to charge regulation mechanism took place at pH 5. The complexation range was observed to be 5.5 < pH < 6.5. In general, when the number of INS units increases in the simulation process, the solution pH at which the complexation can occur shifts toward acidic conditions. CS's chain interacts more efficiently, i.e. in a wider pH range, with INS aggregates formed by the highest monomer number. The charge regulation mechanism can be considered as a previous phase toward complexation (incipient complexation) caused by weak interactions of a Coulombic nature.

1076-P: Increased Time-in-Range (TIR) Observed after Introduction of a Connected Insulin Pen

The capture and visualization of insulin injection patterns together with blood glucose data has potential to improve dialogue between patients and HCPs about dose, injection time and missed injections. This may improve glycemic control. The objective of this non-interventional study was to investigate how a connected insulin pen (NovoPen®6) influences glycemic control in patients with T1DM in a real-world setting. Patients were recruited from 12 Swedish diabetes clinics. At baseline patients received a NovoPen®6, which logs time of injection and number of insulin units. HCP visits were conducted according to clinical practice. At each visit, pen data were downloaded at the clinic to support patient-HCP dialogue. Adults with T1DM (n=94) using NovoPen®6 for basal and/or bolus and CGM were included in the analyses. The effect on TIR was based on a 14-day interval after each visit using a linear mixed-effects model. A significant increase in TIR from baseline to after ≥5 HCP visits (median time in study 6 months) of 1.9 hours/day (9.2 to 11.1 hours/day) was found (p=0.0009). Accordingly, significant reduction in time spent in hyper- and L2 hypoglycemia (-1.8 hours/day p=0.003; -0.3 hours/day p=0.005) was observed. There was no change in time in L1 hypoglycemia (p=0.181). These real-world findings in patients with T1DM highlight the potential benefit on glycemic control when accurate connected pen data contribute to patient-HCP dialogue. Disclosure P. Adolfsson: Advisory Panel; Self; Eli Lilly and Company, Novo Nordisk A/S, Roche Pharma. Employee; Self; Region Halland. Research Support; Self; Region Halland. N.V. Hartvig: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. A. Kaas: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. N. Nygård Knudsen: Employee; Self; Novo Nordisk A/S. A. Mårdby: Employee; Self; Novo Nordisk A/S. Stock/Shareholder; Self; Novo Nordisk A/S. J. Hellman: Advisory Panel; Self; Abbott, Boehringer Ingelheim Pharmaceuticals, Inc., Eli Lilly and Company, Merck Sharp &amp; Dohme Corp., Novo Nordisk A/S, Sanofi. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S, Sanofi. Funding Novo Nordisk A/S

Be aware of potential issues with new basal insulin/GLP-1 fixed combinations

Soliqua 100/33 and Xultophy 100/3.6, two newer products indicated to treat type 2 diabetes, each combine a basal insulin with a glucagon-like peptide-1 (GLP-1) agonist and are administered once daily. Soliqua 100/33, a Sanofi product, provides 100 units of insulin glargine per mL and 33 mcg of lixisenatide per mL in a 3-mL single-patient-use pen. Novo Nordisk’s Xultophy 100/3.6 provides 100 units of insulin degludec per mL and 3.6 mg of liraglutide per mL, also in a 3-mL single-patient-use pen. Soliqua 100/33 and Xultophy 100/3.6 differ from other insulin-containing products and present new potential safety issues. One potential safety issue is that practitioners may mistakenly think these products contain only insulin. This is one reason computer system drop-down lists and pharmacy communications about these products should use the ratio expressions (i.e., Xultophy 100/3.6 and Soliqua 100/33) to help indicate to users that the products contain two different ingredients. The ratio expression is designed to express the ratio of insulin to GLP-1 agonist per mL (e.g., Soliqua 100/33 contains 100 units of insulin glargine and 33 mcg of lixisenatide per mL). In contrast to the ratios used for insulin–insulin combination products such as insulin aspart protamine/insulin aspart (NovoLog Mix 70/30—Novo Nordisk) or insulin lispro protamine/insulin lispro (Humalog Mix 50/50—Lilly), the ratio expressions for Soliqua 100/33 and Xultophy 100/3.6 do not sum up to 100%, which should also help practitioners differentiate them from insulin-only products. If your system uses generic names, make sure both ingredients are displayed and not truncated. However, keep in mind that the first name practitioners will see is “insulin.” This may contribute to practitioners mistaking these as insulin-only products. Using the brand names, but with a hover-over presentation of the complete generic names, could reduce the risk of an error. Also, counsel patients when initiating Soliqua 100/33 and Xultophy 100/3.6 so they understand that the products contain both insulin and a GLP-1 agonist. Dosing of these products is expressed based on the number of insulin units (the pen dials the dose in insulin units only). The package insert for each product has a table that indicates the amount of GLP-1 agonist per insulin unit, but including the GLP-1 agonist dose is not recommended when prescribing these products. If an order is communicated without the ratio expression (“Soliqua 40 units” or “Xultophy 35 units”), practitioners could think it’s a new insulin product and not recognize there is a GLP-1 agonist contained within. This could lead to someone prescribing a separate GLP-1 agonist to go along with what is thought to be the patient’s insulin dose. These products are not recommended for use in combination with any other product containing a GLP-1 agonist (see table) because of the risk of overdose. To help avoid overdose, test your computer system to see if a duplicate therapy alert is generated if one of these combination products is entered along with another GLP-1 agonist–containing product. Also, the package insert recommends using alternative antidiabetic products if patients require a Soliqua 100/33 daily dosage of less than 15 units or more than 60 units. For Xultophy 100/3.6, use alternative antidiabetic products if patients persistently require less than 16 units or more than 50 units.Tabled 1Approved GLP-1 agonist–containing products for type 2 diabetesGeneric nameBrand name (manufacturer)Insulin degludec and liraglutideXultophy 100/3.6 (Novo Nordisk)Insulin glargine and lixisenatideSoliqua 100/33 (Sanofi)AlbiglutideTanzeum (GSK)DulaglutideTrulicity (Lilly)ExenatideBydureon (AstraZeneca)Byetta (AstraZeneca)LiraglutideVictoza (Novo Nordisk)LixisenatideAdlyxin (Sanofi-Aventis)Adlyxin Starter Pack (Sanofi-Aventis) Open table in a new tab Because these errors could occur when prescribing, dispensing, and administering these new products, emphasize the importance for prescribers, diabetes educators, and pharmacists to provide patient education. All patients taking these products should be counseled before the products are dispensed.

Efficacy of Additional Canagliflozin Administration to Type 2 Diabetes Patients Receiving Insulin Therapy: Examination of Diurnal Glycemic Patterns Using Continuous Glucose Monitoring (CGM).

IntroductionThe efficacy of administering a sodium–glucose cotransporter 2 inhibitor during insulin therapy has not been established. In this study, we examined its effects based on diurnal glycemic patterns using continuous glucose monitoring (CGM).MethodsThe subjects were 15 patients who had received insulin therapy for 1 year or more. A CGM device was attached to all subjects for 1 week. The administration of canagliflozin at 100 mg was started 4 days after attachment. The mean glucose concentrations, standard deviation (SD), mean amplitude of glycemic excursions (MAGE), mean of daily difference of blood glucose (MODD), and area under the curve (AUC) (≥180, <70 mg h/dL) after the start of administration were compared with the pretreatment values. In addition, we compared changes in the number of insulin units between basal and bolus insulin. Furthermore, we investigated the influence of canagliflozin on oxidative stress markers and cytokines using 8-hydroxy-2′-deoxyguanosine (8-OHdG), tumor necrosis factor-α (TNF-α), and adiponectin as parameters.ResultsThe mean glucose concentrations decreased from 161.1 to 139.1 mg/dL (P < 0.01). The SD decreased from 36.5 to 29.6 mg/dL (P = 0.05). The MAGE decreased from 89.2 to 77.4 mg/dL (P < 0.01), and the MODD decreased from 34.3 to 25.5 mg/dL (P < 0.05). All parameters showed significant improvements in diurnal changes. AUC of ≥180, i.e., the total area of blood glucose levels at or above 180 on the blood glucose curve of CGM, decreased from 339.1 to 113.6 mg/dL (P < 0.05). AUC of <70, i.e., the total area of blood glucose levels below 70 on the blood glucose curve of CGM, slightly decreased from 1.6 to 0.3 mg/dL (P = 0.08). The total number of basal insulin units decreased from 128 to 76, and that of bolus insulin decreased from 266 to 154; the dose of insulin could be markedly decreased. In addition, the mean 8-OHdG level decreased from 11.4 to 10.8 ng/mg Cre (P < 0.05), and the mean TNF-α level decreased from 2.31 to 1.79 pg/mL (P = 0.10). The mean adiponectin level increased from 5.01 to 5.53 μg/mL (P < 0.05).ConclusionCanagliflozin improved blood glucose changes in type 2 diabetes using insulin. In addition, the results suggest its antioxidant actions.Trial RegistrationUniversity Hospital Medical Information Network (UMIN no. 000019429).

Effects of diabetes mellitus on health-related quality of life at a tertiary hospital in South Africa: A cross-sectional study.

Diabetes mellitus (DM) is a chronic metabolic disease that potentially causes debilitating and life-threatening complications, demands a lifestyle change, and has important implications with regard to wellbeing and health-related quality of life (HRQOL). To: (i) determine the HRQOL of a sample of patients with type 2 diabetes; (ii) describe the demographics (age, gender, and smoking and alcohol use) of the population studied; (iii) document the following parameters, which are important in determining the control and severity of type 2 diabetes: (a) glycosylated haemoglobin (HbA1C), (b) total amount of insulin required per day (if on insulin therapy), (c) body mass index (BMI), and (d) exercise compliance; (iv) determine whether there was an association between any or all of the above parameters and the HRQOL of these patients; and (v) determine whether coexisting diseases (hypertension (HT) and dyslipidaemia) were present, and compare HRQOL between diabetic patients with and without these diseases. This was a cross-sectional and descriptive study of 200 patients attending the diabetes clinic at Helen Joseph Hospital, Johannesburg, South Africa. HRQOL assessments were made using the Diabetes 39 (D-39) questionnaire, which patients filled in once consent had been obtained and if they fulfilled the inclusion criteria. Patients' questionnaire forms were then analysed with regard to their demographics (age and gender), exercise regimen, smoking and alcohol history, employment status, living arrangements, age of diagnosis of DM, and concurrent use of antihypertensive and cholesterol-lowering drugs. The patients' files were analysed and various clinical parameters were noted (HbA1C, lipogram, BMI, number of insulin units used per day, and whether any antihypertensive and/or lipid-lowering drugs were used). There was an association between HRQOL and HbA1C, and between HRQOL and HT and dyslipidaemia. No association was found between HRQOL and other clinical parameters, namely number of insulin units used per day, exercise, BMI, lipogram and the use of oral hypoglycaemic agents. Demographic parameters (age, gender, age at diagnosis, employment status and living arrangements) were also shown to have no impact on HRQOL. We found no association between HRQOL in patients who consumed alcohol and smoked cigarettes and in those who did not.

Key elements for successful intensive insulin pump therapy in individuals with type 1 diabetes

ObjectiveClinical trials have demonstrated that in individuals with type 1 diabetes the use of CSII pump resulted in better glucose control. Advantages of pumps therapy include many features such as the bolus calculators (wizard). These features are optional and therefore it is important to determine whether their use is associated with better glucose control. Thus, the aim of this analysis was to assess which features and parameters of insulin pump use are associated with better glucose control. MethodsData regarding consecutive patients with type 1 diabetes treated with an insulin pump and attending a tertiary referral for intensive glucose control was included in this analysis. The relationship between glycemic indices and treatment parameters (number of insulin units, number of glucose readings, bolus calculator use etc.) was assessed. ResultsA statistically significant relationship was found between glycemic indices and wizard use. Thus, individuals that used the wizard function in 50% of their boluses had an A1C, mean blood glucose values that were 0.6% (p=0.008) and 25mg/dL (p=0.000) lower respectively. ConclusionThe use of the bolus calculator feature was associated with better glucose control. Larger prospective clinical trials are needed in order to further validate this finding.