Tight Blood Sugar Control Research Articles

A Case Report on the Ayurvedic Management of Diabetic Peripheral Neuropathy

Diabetic neuropathy is one of the most common microvascular complications of diabetes mellitus. It has a significant impact in lowering quality of life (QOL) of diabetic patients. Currently, there is no effective management rather than tight blood sugar control. Hence an effective management for diabetic peripheral neuropathy (DPN) has to be deduced. A 41‑year‑old female patient, who was a known case of diabetes mellitus presenting with the symptoms of diabetic peripheral neuropathy was treated with a combination of Ayurvedic internal as well as external therapies, considering the treatment protocol of Prameha upadrava and Vatarakta chikitsa. The symptoms were assessed before and after treatment using the Toronto Clinical Scoring System. Significant improvement was seen in all the scores after the treatment. This case elicited that DPN can be successfully managed by Ayurvedic treatment.

Does Dolutegravir-Based Treatment in HIV-Infected Diabetic Individuals Require More Intensive Cardiovascular Health Monitoring: A Point of Concern for Developing Nations

We are all aware that obesity is a growing health problem globally. An estimated 600 million adults are affected with some form of obesity-related metabolic complications worldwide. It increases cardiovascular disease, diabetes mellitus, chronic kidney disease, nonalcoholic fatty liver disease, and cancer in the long run. Human immunodeficiency virus (HIV) infection is a common occurrence throughout the World. Developed countries can access early diagnosis, standardized treatment protocols, and close monitoring. It not only prevents incidences of opportunistic infections but also takes care of non-infective complications. On the contrary, lack of education, awareness, and access to good healthcare facilities are often responsible for delayed diagnosis and advanced disease at presentation. Even those who are initiated on therapy also have persistent modifiable risk factors for cardiovascular events. The Importance of regular exercise, a healthy diet, and tight control of blood sugar, hypertension, and dyslipidemia are often under-practiced and must be stressed.

Cervical Insufficiency May Be Aggravated by Glucose Intolerance: A Case Report

Background: Cervical insufficiency occurs in the second trimester. Herein, we report a successful term pregnancy in a woman with glucose intolerance and a history of cervical insufficiency after two consecutive preterm deliveries in the second trimester. Case Presentation: We present a 35-year-old woman, G3P2L0, with a history of two preterm deliveries in the second trimester. In the second pregnancy, vaginal cerclage at the 18th gestational week did not prevent premature delivery. Following two pregnancies with borderline fasting blood sugar (FBS) results, we decided to further evaluate the gestational diabetes mellitus (GDM) state with a two-hour postprandial (2 hpp) glucose test and glucose tolerance test (GTT). By impaired 2 hpp and GTT results, an insulin regimen was started with subsequent vaginal cerclage in the third pregnancy. She delivered a healthy 2,750-g girl at 38 weeks of gestation by tight blood sugar control. Conclusions: More attention should be paid to evaluating glucose intolerance in pregnancy, especially in patients with cervical insufficiency. Blood glucose control in these patients can probably improve pregnancy outcomes.

SUN-074 Hereditary Hypertriglyceridemia and Recurrent Pancreatitis: The Role of Insulin Drip

Introduction Type I hyperlipoproteinemia is a rare autosomal recessive disorder stemming from homozygous deficiency of lipoprotein lipase activity (LPL) leading to accumulation of serum chylomicrons, eruptive xanthomas and recurrent pancreatitis due to severe hypertriglyceridemia with significant cardiovascular burden. The only effective therapy in these patients is strict low-fat diet, however during hospitalization aggressive medical intervention including high cost plasma apheresis in efforts to minimize multi-organ failure. Insulin drip is often used to lower TG by enhancing LPL thus decreases release of free fatty acids (FFA), however current evidence for this subtype of patients are lacking. Herein we sought to present a case of recurrent severe type 1 hypertriglyceridemia-induced pancreatitis (HTGP). Case 65 year old white male with long standing history of familial type I hyperlipoproteinemia diagnosed in 1970s, previously received multiple plasma exchange in the past for TG levels of nearly 9000, insulin dependent type 2 diabetes with complicated peripheral neuropathy, extensive vasculopathy, recently discharged from hospital following acute on chronic HTGP with associated pancreatic calcifications, pseudocysts and necrotic tissue on CT scan, presented to ED as a seventh admission within the past 7 months with recurrent epigastric pain, nausea and vomiting concerning for recurrent HTGP. Patient was found to have lactescent serum with TG levels of 1700, previously 3000+, elevated lipase with mild neutrophilic leukocytosis and pseudohyponatremia . Patient was immediately made NPO, started on aggressive IV fluid repletion therapy. Prior to commencing IV insulin drip repeat TG downtrended to nearly 1000 within a few hours of admission. Two days later his TG continued to improve at a slower rate and was subsequently discharged home on continued statin therapy, low-fat diet and tight blood sugar control. On prior admissions patient presented with TG 1200 which later downtrended to under 700 by being strictly NPO, yet continues to receive insulin. Discussion This case highlights the challenges of managing patients with recurrent HTGP refractory to lifestyle modification, resulting in excessive readmission rates, high cost associated with plasma apheresis. IV insulin drip has been used in other subclasses of lipoproteinemia, however it is continued to be used in patients with type 1 familial hyperlipoproteinemia despite lack of strong evidence in current literature. Due to absent LPL activity, the use of insulin is rendered questionable. More research is warranted in understanding the appropriate and cost-effective treatment. References Stefanutti C,Labbadia G,Morozzi C. Severe hypertriglyceridemia-related acute pancreatitis. Ther Apher Dial. 2013 Apr;17(2):130-7

Glycaemic profile in the second and third trimesters of normal pregnancy compared to non-pregnant adult females.

To assess the glycaemic profile and glycaemic variation in the second and third trimesters of normal pregnancies. Healthy pregnant women aged 19-35 years between 24 and 36 weeks of gestation were recruited for ambulatory glucose profile monitoring. A total of 18 women in the second trimester, 15 women in the third trimester and 9 healthy non-pregnant women were recruited providing, respectively, 205 days (19,680 data points), 147 days (14,112 data points) and 100 days (9,600 data points) for analysis. Mean blood glucose level was 20.2% lower in the second trimester and 10.6% lower in the third trimester than non-pregnant women (p < 0.001). In pregnancy, it took 15 to 20 minutes more to reach peak postprandial blood glucose levels compared to non-pregnant women (p = 0.003). Glycaemic variability was more in the third trimester (p < 0.001). There is tight blood sugar control along with lower mean blood glucose in healthy pregnant women compared to non-pregnant women. Despite this tight glycaemic control, glycaemic variability is higher during pregnancy.

Impact of Blood Sugar Control on Metabolites and Carbohydrate Metabolism in Type 1 Diabetes

In type 1 diabetes (T1D), long-term blood sugar control measured by HbA1c can vary over a wide range. Although metabolites are commonly studied in type 2 diabetes (T2D) as they relate to HbA1c, similar studies in T1D are few. Since the underlying etiologies of T1D and T2D are different, we explored the overall pathways of metabolism in T1D subjects with tight vs. poor blood sugar control. T1D subjects (n=50) were divided into two groups (n=25 each) based on low vs. high HbA1c (Screen 1, low: mean 6.7 ± 0.1%; high: mean 8.7 ± 0.3%). Serum samples were analyzed on a metabolomic GC/HPLC/MS platform and analyzed for differences in biochemicals between the groups. The screen was repeated with a second group of 50 patients for verification (Screen 2, mean 6.3 ± 0.1%; mean 8.0 ± 0.2%) and then both screens combined. For each detected biochemical, average scaled intensity was determined and statistical significance of differences was calculated using a two-tailed, unpaired Student’s T test (p-values) and False Discovery Rate (q-values). The platform distinguished 690 components in Screen 1 and 623 biochemicals in Screen 2. In Screen 1, two biochemicals, including glucose, showed significant differences (≦0.05) for both p and q value. In Screen 2, none of the biochemicals reached threshold. When the screens were combined (100 samples), 10 biochemicals were significant for both p and q. Three components (glucose, mannose and 1,5-AG) were carbohydrates related to blood sugar control and thus expected in a high and low HbA1c analysis. Significant biochemicals commonly found in T2D and related to blood sugar control were not significant in T1D for both p and q in the screens. We conclude that few metabolites are correlated in T1D with tight vs. poor blood sugar control compared to T2D. Unlike T2D, metabolites related to intracellular sugar utilization, the Krebs cycle and purine synthesis are unrelated to blood sugar control in T1D cohorts. Disclosure W. Kuhtreiber: None. S.E. Janes: None. M.W. Yang: None. D.L. Faustman: None.

A Delphi process to address medication appropriateness for older persons with multiple chronic conditions.

BackgroundFrameworks exist to evaluate the appropriateness of medication regimens for older patients with multiple medical conditions (MCCs). Less is known about how to translate the concepts of the frameworks into specific strategies to identify and remediate inappropriate regimens.MethodsModified Delphi method involving iterative rounds of input from panel members. Panelists (n = 9) represented the disciplines of nursing, medicine and pharmacy. Included among the physicians were two geriatricians, one general internist, one family practitioner, one cardiologist and two nephrologists. They participated in 3 rounds of web-based anonymous surveys.ResultsThe panel reached consensus on a set of markers to identify problems with medication regimens, including patient/caregiver report of non-adherence, medication complexity, cognitive impairment, medications identified by expert opinion as inappropriate for older persons, excessively tight blood sugar and blood pressure control among persons with diabetes mellitus, patient/caregiver report of adverse medication effects or medications not achieving desired outcomes, and total number of medications. The panel also reached consensus on approaches to address these problems, including endorsement of strategies to discontinue medications with known benefit if necessary because of problems with feasibility or lack of alignment with patient goals.ConclusionsThe results of the Delphi process provide the basis for an algorithm to improve medication regimens among older persons with MCCs. The algorithm will require assessment not only of medications and diagnoses but also cognition and social support, and it will support discontinuation of medications both when risks outweigh benefits and when regimens are not feasible or do not align with goals.

Driving and hypoglycemia

Qatar is one of the 20 countries of the IDF MENA region. Three hundred and eighty seven million people have diabetes worldwide and more than 37 million people in the MENA Region; by 2035 this will rise to 68 million. There were 303,700 cases of diabetes in Qatar in 2014. Large number of diabetic patients will seek or currently hold a license to drive. Most of these patients are either on oral medications or insulin to control their diabetes. Hypoglycemia is one of the major complications related to diabetes treatment. Many large studies have shown an increased risk of hypoglycemia with tight blood sugar control. Unfortunately most diabetes medication can cause hypoglycemia. Hypoglycemia has been associated with cardiac arrhythmia, a decreased ability to drive and driving mishap. Recent meta-analysis of 15 studies showed a risk road traffic collisions (RTC) of 12-19% greater than general populations. The most significant subgroup of persons with diabetes is those on insulin therapy. The single most significant factor associated with RTC appears to be history of recent severe hypoglycemia. Government regulations have not been established in most of GSC and MENA in general. All EU countries do have regulations for diabetes and driving. Many US states have a restrictive license program for drivers with medical conditions including diabetes. These regulations include more frequent medical examination to denial of driving license, e.g.in those patients with hypoglycemia unawareness. Also more restriction regulations have been established for drivers who are using insulin and buses and heavy goods trucks.

Cutaneous manifestations of diabetes mellitus

Abstract Cutaneous involvement is common in diabetes, with approximately 30% of patients experiencing some dermatological problem during the course of their illness. Skin manifestations may be the first presenting sign of diabetes or even precede the diagnosis by many years, but they generally appear during the course of the disease in patients known to have diabetes. The involvement of skin can be autoimmune in nature, such as necrobiosis lipoidica, acanthosis nigricans, scleredema, diabetic dermopathy, granuloma annulare or infectious like erythrasma, necrotizing fasciitis, and mucormycosis. Pharmacologic management of diabetes, in addition, can also result in skin changes, such as lipoatrophy and lipohypertrophy, at the site of injection of insulin, and oral antidiabetic agents can cause multiple skin reactions as adverse effects. The management of these cutaneous manifestations is modified depending upon the underlying pathophysiology, but a tight control of blood sugar is a prerequisite in all treatment approaches.

Pancreatico-duodenectomy for duodenal lesions: Indications and results

s / Pancreatology pancreas transplant is the treatment of choice in tight control of blood sugar for IDDM patients, and further to stabilize, prevent or even to reverse the diabetic complications. Aims: Wewill present our experience in pancreas transplant which was initiated on September 19, 2003. Patients & methods: From September 2003 to December 2013, there were 94 pancreas transplants performed for 90 patients at Taipei Veterans General Hospital, with 34 SPK, 10 PAK, 40 PTA and 10 PBK. Most (82.3%) of our pancreas transplants were for IDDM patients. Results: The blood sugar usually returned to normal level within 5 hours (median) after revascularization of the pancreas grafts. The fasting blood sugar maintained within normal range thereafter throughout the whole clinical course in most cases. There were 2 surgical mortality. The technical success rate was 94.9%. Excluding the 4 cases with technique failure, overall 1-year pancreas graft survival is 98.5% and 5-year is 94.1%, with 100% 1-year for SPK, 97.1% 1-year for PTA, 100% 1-year for PAK and 100% 1-year for PBK. Conclusion: Pancreas transplant provided an ideal insulin-free solution for DM, especially IDDM. Pancreas transplant could be performed with similar successful rate irrespective of the type of pancreas transplant at our hospital.

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus.

Intensive glucose control versus conventional glucose control for type 1 diabetes mellitus.

The role of carbohydrate drinks in preoperative nutrition: comment 1

Comment on Jones C, Badger SA, Hannon R. The role of carbohydrate drinks in preoperative nutrition for elective colorectal surgery. Ann R Coll Surg Engl 2011; 93: 504–507 doi 10.1308/147870811X13137608455136 I enjoyed reading and entirely agree with the findings of the review by Jones et al on the role of carbohydrate (CHO) drinks in preoperative nutrition for elective colorectal surgery but I offer a word of caution. No mention was made of the possible increased risk of surgical site infection (SSI) that may be caused by this action, even in non-diabetic patients. Tight control of perioperative blood sugar in patients who have diabetes is one of the high impact interventions advocated by the Department of Health to reduce the risk of SSI. 1 In addition, there is compelling evidence that poorly controlled, perioperative blood sugar, even in non-diabetic patients, may significantly increase deep sternal wound SSI rates in patients having cardiac surgery. 2 In these days of enhanced recovery after surgery (ERAS), the increasing use of a laparoscopic approach (particularly for elective colorectal surgery) and optimal use of anaesthesia 3 (both of which minimise the metabolic response to trauma) may make this caution unnecessary with regard to SSI. However, I should be interested to know if Jones et al found any increased incidence of SSI in their meta-analysis when preoperative CHO drinks had been used prior to open elective colorectal surgery. If this were found to be the case, closer control of blood sugar ought to be considered in the perioperative period.

Pancreas Transplant at Taipei Veterans General Hospital

Background: Insulin-dependent diabetes mellitus (IDDM) or Type 1 diabetes eventually leads to nephropathy, neuropathy, retinopathy and angiopathy after 10 - 30 years. Currently, pancreas transplant is the treatment of choice in tight control of blood sugar for IDDM patients, and further to stabilize, prevent or even to reverse the diabetic complications. According to the International Pancreas Transplant Registry (IPTR) and United Network for Organ Sharing (UNOS), over 25,000 cases of pancreas transplant have been performed worldwide, with an increase of more than 1,600 - 1,800 cases per year, mainly in the USA. The 1-year pancreas graft survival rate is 86.0% and 5-year is 69.8%, very close to those of kidney transplant. Among the whole pancreas transplants, 80% are simultaneous pancreas-kidney transplant (SPK), 15% pancreas after kidney transplant (PAK), and 5% pancreas transplant alone (PTA). Materials: From 2003 to 2011, there were 73 pancreas transplants performed for 69 patients at Taipei Veterans General Hospital, with 27 SPK, 7 PAK, 35 PTA and 4 PBK. Results: The blood sugar usually returned to normal level within 5 hours (median) after revascularization of the pancreas grafts. The fasting blood sugar maintained within normal range thereafter throughout the whole clinical course in most cases. The technical success rate was 95.5%. There were 8 graft loss, due to acute rejection in 1, chronic rejection in 2, technique failure in 3 and 2 died with functioning graft, and 4 of them received another successful re-transplant. All SPK patients are free from dialysis, but 1 primary nonfunction of kidney graft. Post-transplant infection disease included 5 CMV gastroenterocolitis, 1 CMV pneumonia, 4 UTI (urinary Tract Infection), 2 BK virus infection,3 herpes zoster infection, 1 pseudomembraneous colitis, 2 varicella zoster infection, 1 skin infection with MRSA and cryptococcus, 2 bacteria pneumonia, 1 sepsis. Conclusion: Pancreas transplant provided an ideal insulin-free solution for DM, especially IDDM. Pancreas transplant could be performed with similar successful rate of kidney transplant if they were done simultaneously.

Atherosclerosis: Current Status of Prevention and Treatment

The reality of regression of atherosclerotic plaques was established as long ago as 1987 by aggressive cholesterol reduction even before the era of statin therapy. Nevertheless, the most important aspect of patient benefit to prevent cardiovascular (CV) disease events is stabilization of these plaques so they will not rupture. Lowering of low-density lipoproteins is critical to this goal and can be considered the gold standard of preventive CV medicine. The major goal for the high-risk patient and the diabetic patient is lowering these harmful lipoproteins to less than 70 mg/dL. No discussion of CV disease prevention is complete without considering tobacco abuse and its elimination. Even secondhand smoke has been established as harmful. Control of hypertension is another major aspect of CV disease prevention, and a blood pressure less than 120/80 mm Hg is ideal. With obesity a major problem in the developed world, its role in the metabolic syndrome is of major significance as is the high prevalence of this so-called syndrome versus collection of specific risk factors in a population with poor health habits. Control of diabetes mellitus has established benefit from the standpoint of CV disease prevention except that some problems have been reported with extremely tight blood sugar control. Exercise was long considered good but now there are evidence-based reasons to recommend it as essential in CV disease prevention. There are many unforeseen frontiers in CV disease prevention but, for now, everything points to elevation of high-density lipoproteins as the next focus of this prevention.

Hypertensive Treatment and the Metabolic Syndrome

The prevalence of obesity, hypertension and type 2 diabetes mellitus-all part of the metabolic syndrome--is increasing in the US and worldwide. In this setting, it is important to understand the effects of antihypertensives on several components of the metabolic syndrome. Overall, has treatment of hypertension in diabetes been beneficial? To answer this question, the authors have reviewed pertinent clinical studies. The Action to Control Cardiovascular Risks in Diabetes Study (ACCORD) was a well-designed trial of 10,251 patients with type 2 diabetes mellitus that studied the effects of tight control of blood sugar, hypertension and lipids. Disappointingly, as compared with standard treatment, the use of intensive therapy to target normal glycated hemoglobin levels, tight lipid control by adding fenofibrate to a statin and aggressive blood pressure treatment with a goal of 120 mm Hg did not significantly reduce major cardiovascular events. Focusing on patients with hypertension, the authors compare these results to other studies of the same issues and speculate about reasons for the lack of benefit in ACCORD. Finally, the authors speculate on whether future treatment might be guided by genetic markers.

Tight blood sugar control or fibrates prevent retinopathy progression but not visual loss (ACCORD)

PrescriberVolume 22, Issue 4 p. 44-44 POEMFree Access Tight blood sugar control or fibrates prevent retinopathy progression but not visual loss (ACCORD) First published: 01 March 2011 https://doi.org/10.1002/psb.720AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume22, Issue419 February 2011Pages 44-44 RelatedInformation

Personalized nutrigenomics: tailoring the diet to the aging diabesity population

Personalized nutrigenomics: tailoring the diet to the aging diabesity population Douglas M Ruden1, Xiangyi Lu21Wayne State University, Department of Obstetrics and Gynecology, C. S. Mott Center for Human Growth and Development, Institute of Environmental Health Sciences, Detroit, MI, USA; 2Institute of Environmental Health Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Detroit, MI, USAAbstract: According to the International Diabetes Federation (IDF), 190 million people worldwide suffer from diabetes, and this number is estimated to double by the year 2025. Diabetes is especially prominent in the elderly population because the IDF indicates age above 45 years as a major risk factor for diabetes. The most common trials for controlling diabetes focus on tighter glucose control as a means to reduce the long-term complications. However, whether tight blood sugar control or other dietary or pharmaceutical interventions in the elderly are more appropriate is not known. Major changes have taken place in our diet over the past 10,000 years since the beginning of the Agricultural Revolution, but our genes have not changed. Furthermore, the large numbers of diabetic elderly in the population are a recent phenomenon, because those with diabetes have historically died young. Genetically speaking, humans today live in a nutritional environment that differs from that for which our genetic constitution was selected. For example a high omega-6/omega-3 ratio, found in today&rsquo;s Western diets, promotes the pathogenesis of many chronic diseases, including cardiovascular disease and diabetes. Knowing who is at risk would be useful if it meant that one could avoid the environmental triggers that convert susceptibility to disease. The prospect of targeting specific dietary treatments at the elderly, who are predicted to gain the most therapeutic benefits, clearly has important clinical and economic consequences. In this review, we will discuss modern molecular genetic and epidemiological techniques which are now, or soon will be, made available by inexpensive whole-genome sequencing and other whole genome approaches to treat the elderly diabetic population.Keywords: diabetes, elderly diabetic population, DNA, genome sequencing&nbsp;

The ACCORD Study: The Devil Is in the Details

Abstract The Action to Control Cardiovascular Risks in Diabetes Study (ACCORD) was a well-designed trial of 10,251 patients with type 2 diabetes mellitus that studied the effects of tight control of blood sugar, hypertension, and lipids. Disappointingly, as compared with standard treatment, the use of intensive therapy to target normal glycosylated hemoglobin (HbA1c) levels, tight lipid control by adding fenofibrate to a statin and aggressive blood pressure treatment with a systolic blood pressure goal of 120 mmHg did not significantly reduce major cardiovascular events. The authors compare these results to other studies of the same issues and speculate about reasons for the lack of benefit in ACCORD.

Approach to Managing Hypoglycemia in Elderly Patients with Diabetes

Hypoglycemia is a common clinical problem in elderly patients with diabetes. Aging modifies the counterregulatory and symptomatic responses to hypoglycemia. Hypoglycemia in the elderly is not only due to tight blood sugar control, but also due to a multitude of other factors. Hypoglycemia often occurs with insulin, sulfonylureas, or meglitinide therapy. However, other causes may also contribute to hypoglycemia, such as decreased cognition, renal impairment, or polypharmacy. The presenting features of hypoglycemia may be atypical and misinterpreted, resulting in delayed treatment. Morbidity is greater in elderly patients, and the risk of progression to severe hypoglycemia is high because of their altered symptom profile, diminished symptom intensity, and altered glycemic thresholds. Hypoglycemia seems to be the main limiting factor in their glycemic control. In this article we discuss strategies to prevent hypoglycemic episodes.

A simulation model of insulin saturation and glucose balance for glycemic control in ICU patients

Consistent tight blood sugar control in critically ill patients has proven elusive. Properly accounting for the saturation of insulin action and reducing the need for frequent measurements are important aspects in intensive insulin therapy. This paper presents a composite metabolic model, ‘Glucosafe’, that integrates models and parameters from normal physiology and accounts for the reduced rate of glucose gut absorption and saturation of insulin action in patients with reduced insulin sensitivity. Particularly, two different sites of reduced insulin sensitivity, before and after the non-linearity of insulin action, are explored with this model. These approaches are assessed based on the model’s accuracy in retrospectively predicting blood glucose measurements of 10 randomly chosen, hyperglycemic intensive care patients. For each patient, median absolute percent error is <25% for prediction times ≤ 270 min and modelling reduced insulin sensitivity after the non-linearity, compared to <29% for modelling reduced insulin sensitivity before the non-linearity. Scaling the insulin effect (after the non-linearity) is a suitable assumption in this model structure. These results are preliminary and subject to further and more extensive validation of the model’s capability to predict the longer term (>2 h) blood glucose excursion in critically ill patients.