focus on insulin therapy

... Presentation Overview • Insulin secretion – Beta-cell decompensation • Insulin – Types of Insulin (Basal and Bolus) – Action times – Insulin Analogs • Insulin Regimens – Rationale for selecting ... Combination Sulfonylurea (S) and Combination Sulfonylurea (S) and Glargine (G) Insulin Stage Glargine (G) Insulin Stage S–0–0–G S–0–0–G Serum insulin (mU/L) Sulfonylurea stimulated insulin secretion ... International Diabetes Center International Diabetes Center Conventional (Mixed) Insulin Stage R/N-0-R/N-0 or RA/N-0-RA/N-0 R/N Serum insulin (mU/L) R/N 50 Overinsulinization Overinsulinization 40...

Ngày tải lên: 12/08/2014, 20:58

... Concomitant administration of itraconazole and budesonide, for example, has been associated with a more than 4-fold increase in plasma concentrations of budesonide given by inhalation The concomitant ... Fowler SJ, Orr LC, Wilson AM, Sims EJ, Lipworth BJ: Dose-response for adrenal suppression with hydrofluoralkane formulations of fluticasone propionate and beclomethasone dipropionate Br J Clin Pharmacol ... 100-150 BID 200 BID Beclomethasone dipropionate MDI (Qvar, generics) Budesonide DPI (Pulmicort) Budesonide Nebulizer (Pulmicort) Ciclesonide MDI (Alvesco) Fluticasone propionate MDI/DPI (Flovent HFA,...

Ngày tải lên: 08/08/2014, 21:20

... questions) The IITQ appears in Additional file (scoring instructions appear in Additional file 2) An earlier version of the IITQ (the ITQ) included only 12 items assessing perceptions of insulin therapy, ... IITQ are: several perceptions of insulin therapy (difficulty taking insulin at the right time, and effect of insulin on overall glucose control, on high glucose levels, and on low glucose levels); ... administrations were included in this study Questionnaire development The IITQ assesses: Diabetes Worries (5 questions), Perceptions of Insulin Therapy (16 questions), Treatment System Satisfaction (3...

Ngày tải lên: 12/08/2014, 01:21

... proportion of type diabetic patients to use this powerful treatment option Thus, clearly, longitudinal data on the course of barriers towards insulin therapy after the initiation of insulin therapy ... Of the patients receiving insulin therapy, 27 (47.4%) had an insulin monotherapy and 30 patients received a combination therapy of insulin and oral antidiabetic medication The two subgroups did ... glycaemic control was significantly greater in patients who were switched to insulin therapy or remained on an oral regimen than in patients who remained on insulin therapy Barriers towards insulin therapy...

Ngày tải lên: 12/08/2014, 01:21

... effective longer-acting insulin analogs that approximate basal insulin secretion has been more challenging Insulin preparations with intermediate durations of action, lente insulin and NPH insulin ... Basal Insulin Therapy in Type Diabetes 201 tion of these longer-acting insulin preparations is generally believed to result from variability in the concentration of insulin in the suspension injected ... Properties for Different Insulin Preparations6,28 Insulin Preparation Lispro Aspart Regular NPH Lente Ultralente Glargine Onset of Action Peak Action (hours) Duration of Action (hours) to 15 minutes...

Ngày tải lên: 12/08/2014, 20:59

... are clear solutions whereas all long acting insulins like NPH, lente, or ultralente are cloudy solutions All insulins except conventional bovine have neutral pH Conventional bovine insulin was acidic ... B) Insulin concentration and dose 40 u/ml is faster absorbed as compared to 100 u/ml insulin Higher the dose, slower is the absorption Hence the onset and duration of action of same type of insulin ... All new patients requiring insulin for short period should be put on human insulin If patient already well controlled on conventional, no additional benefit with human insulins 292 Decrease intermediate...

Ngày tải lên: 12/08/2014, 20:59

... treated with the TABLE INSULIN THERAPY AND CONTROL GLUCOSE LEVELS.* VARIABLE Administration of insulin — no (%) Insulin dose — IU/day‡ Median Interquartile range Duration of insulin use — % of ICU ... complications that are common among patients requiring intensive care, including episodes of septicemia and a corresponding need for prolonged antibiotic therapy The higher risk in the conventional-treatment ... differ in the use of medications other than insulin and antibiotics, the latter most likely a consequence of the effect of intensive insulin therapy on septicemia Second, since the study involved...

Ngày tải lên: 12/08/2014, 20:59

... 600 Days after Admission to ICU Figure Effect of Intensive Insulin Therapy on Morbidity The effect of intensive insulin therapy on time to weaning from mechanical ventilation, time to discharge ... deterioration, convulsions, or other events were noted in association with any hypoglycemic event Mortality among patients in the ICU who had hypoglycemia was 66.7 percent in the conventional-treatment ... medications other than insulin Among the 386 patients in the intensive-treatment group, intensive insulin therapy for at least a third day, as compared with conventional therapy, accelerated weaning...

Ngày tải lên: 12/08/2014, 20:59

... insulin antibodies during continuous subcutaneous insulin infusion and multiple-injection therapy in contrast to conventional treatment Diabetes 36:1-5, 1987 Schwartz GJ, Brion LP, Spitzer A: The ... abnormalities in type-1 diabetes patients treated adequately with conventional insulin therapy (24,25) With poor control, when insulin administration is subnormal, plasma triglyceride, total cholesterol, ... increased to the control levels Since coronary artery disease is one of the most common causes of premature death in diabetics, secondary hyperlipidemia must be one of the goals of chronic diabetes...

Ngày tải lên: 12/08/2014, 20:59

... intensive insulin therapy in the critically ill: insulin dose versus glycemic control Crit Care Med 2003, 31:359366 Kanji S, Buffie J, Hutton B, Bunting PS, Singh A, McDonald K, Fergusson D, McIntyre ... below 2.2 mmol/l (40 mg/dl) at least once, compared to only 3.9% in the conventional group The safety monitoring board of the German multi-centre study VISEP considered a similar increase in the ... Ferdinande P, Lauwers P, Bouillon R: Intensive insulin therapy in the critically ill patients N Engl J Med 2001, 345:1359-1367 Angus DC, Abraham E: Intensive insulin therapy in critical illness...

Ngày tải lên: 12/08/2014, 23:23

... whereas control patients were managed to a 'conventional' target blood glucose of 10 to 11.1 mmol/L (conventional insulin therapy [CIT]) The study reported that the benefits of IIT were most pronounced ... Authors' contributions RS was responsible for conception and design of the study, data collection and analysis and interpretation of results, and drafted the manuscript CO advised on the design, ... advised on study design, analysis, interpretation and the draft PAG and RG advised on conception, design and interpretation RG advised on the draft All authors approved the final version of the...

Ngày tải lên: 13/08/2014, 03:21

... blood transfusion [1] additional costs for the more complex therapy and intensive monitoring are more than offset by the reduced overall resource consumption Con: Intensive insulin therapy targeting ... Gustavson SM, Chu CA, Nishizawa M, Farmer B, Neal D, Yang Y, Donahue EP, Flakoll P, Cherrington AD: Interaction of glucagon and epinephrine in the control of hepatic glucose production in the conscious ... Intensive insulin therapy and pentastarch resuscitation in severe sepsis N Engl J Med 2008, 358:125-139 Lang CH, Dobrescu C, Bagby GJ: Tumor necrosis factor impairs insulin action on peripheral...

Ngày tải lên: 13/08/2014, 08:21

... Impaired or absent ß cell function: ↓ insulin secretion • Normal insulin action: ↑ insulin sensitivity • The insulin deficiency results in unacceptable blood glucose control www.diabetesclinic.c ... Impaired ß cell function: ↓ insulin secretion • Impaired insulin action: ↑ insulin resistance • Results in unacceptable blood glucose control www.diabetesclinic.c Type & Diabetes: Key Concepts • Minimizing ... Goal of Insulin Therapy We are trying to duplicate how the pancreas works in releasing insulin for someone who doesn’t have diabetes www.diabetesclinic.c 39 Insulin Therapy Options • MDI therapy...

Ngày tải lên: 13/08/2014, 09:38

... glycemic control the ADA has recommendations for both glucose monitoring and A1c target levels [5] For persons with type diabetes, intensive insulin therapy (e.g., injections, pump therapy) is ... SMBG alone with intensive insulin therapy Additional material Additional file 1: Appendix for Cost-Effectiveness of Continuous Glucose Monitoring and Intensive Insulin Therapy for Type Diabetes ... [21] Assumption 20 Assumption 0.03 Assumption a Beta distribution assumed b Credible range of values from the 2.5th and 97.5th percentiles of the 10,000 second order Monte Carlo simulations c Gamma...

Ngày tải lên: 13/08/2014, 11:22

... Intensive insulin therapy and pentastarch resuscitation in severe sepsis N Engl J Med 2008, 358:125-139 Merz TM, Finfer S: Pro/con debate: is intensive insulin therapy targeting tight blood glucose control ... best method to control glucose level intensive insulin therapy, and/or limitation of nutritional intakes during acute phase, and/or antidiabetic drugs? However, the competition to develop the ... 12:R49 Wong XW, Singh-Levett I, Hollingsworth LJ, Shaw GM, Hann CE, Lotz T, Lin J, Wong OS, Chase JG: A novel, model-based insulin and nutrition delivery controller for glycemic regulation in critically...

Ngày tải lên: 13/08/2014, 11:22

... contribution to the interpretation of the data GvdB performed the statistics, had an essential contribution to the interpretation of data and the content of the manuscript References Conclusion ... contributions GH analysed the data, had a major contribution to the interpretation hereof and drafted the manuscript MS designed the study concept, collected data and had a major contribution ... CIP/CIM and prolonged mechanical ventilation CIP/CIM Total population, n = 620 Prolonged mechanical ventilation Total population, n = 541 CIP/CIM n = 345 No CIP/CIM n = 275 p- value Prolonged mechanical...

Ngày tải lên: 13/08/2014, 11:23

... randomized controlled trials to assess the benefit of intensive insulin therapy Glycemic control, mmol/La Insulin protocol application Mortality Conventional IIT Conventional IIT Conventional IIT ... 61/247 (24.7%) 0.74 aGlycemic control values are presented as mean ± standard deviation IIT, intensive insulin therapy; VISEP, Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis glycemia ... descending variations exceed the value of standard deviation of the blood glucose concentration in 24 hours However, MAGE estimation requires the use of continuous glucose sensors [23] and is only suitable...

Ngày tải lên: 13/08/2014, 16:20

... 190 Elizabeth Street, Toronto, Ontario, Canada M5G 2C4 2Critical Care and Medicine Departments, St Michael’s Hospital, 30 Bond Street, Bond Wing, Room 4-015 Bond, Toronto, Ontario, Canada M5B 1W8 ... of intensive insulin therapy on surgical critically ill patients [in Chinese] Zhonghua Wai Ke Za Zhi 2007, 45:1052-1054 Bilotta F, Caramia R, Cernak I, Paoloni FP, Doronzio A, Cuzzone V, Santoro ... R: A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the glucontrol study Intensive Care Med 2009, 35:1738-1748...

Ngày tải lên: 13/08/2014, 21:21