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A Randomised, Open-labelstudy Of Insulin Glargine Or Neutral Protamine Hagedorn Insulin In Chinese Paediatric Patients With Type 1 Diabetes Mellitus

A Randomised, Open-labelstudy Of Insulin Glargine Or Neutral Protamine Hagedorn Insulin In Chinese Paediatric Patients With Type 1 Diabetes Mellitus

A randomised, open-labelstudy of insulin glargine or neutral protamine Hagedorn insulin in Chinese paediatric patients with type 1 diabetes mellitus We aimed to describe the safety and efficacy of insulin glarginein Chinese paediatric patients with type 1 diabetes mellitus (T1DM). Neutral protamine Hagedorn (NPH) insulin was the reference therapy. This open-label, randomised, Phase III study was conducted at 10 sites in China. Children aged 6 to <18years with T1DM were randomised (2:1) to insulin glargine or NPH insulin asbasal insulinfor a 24-week treatment period. For all patients, insulin aspartwas given as bolus insulin. The primary endpoint was absolute change inglycated haemoglobin(HbA1c) from baseline to Week 24. Secondary endpoints included the percentage of patients reaching HbA1c <7.5% (<58.5mmol/mol), and safety. The study was registered at clinicaltrials.gov (NCT01223131). In total,196 patients were screened, and 162 were randomised (107 and 55 patients were randomised to insulin glargine and NPH insulin, respectively). The mean SD of absolute change in HbA1cwas0.25 1.68% (2.69 18.32mmol/mol) in the insulin glargine groupand 0.54 1.67% (5.55 20.32mmol/mol) in the NPH insulin group. At Week 24, 18.7 and 21.6% of patients in the insulin glargine and NPH insulin groups achievedHbA1c <7.5% (<58.5mmol/mol). Both treatments were generally well tolerated. A numerically lower rate of symptomatic hypoglycaemia per patient year was observed for insulin glargineversus NPH insulin (24.3 45.8 versus32.3 43.2); severe hypoglycaemia was rare (<2%). Initiation of insulin glargine can aid Chinese paediatric patients with T1DM to safely reduce their HbA1c levels. Chinese paediatric patientsInsulin glargineNPH insulinType 1 diabetes mellitus The prevalence of type 1 diabetes Continue reading >>

Changing Insulin Brands May Disrupt Diabetics

Changing Insulin Brands May Disrupt Diabetics

For nearly three years after a miniature pinscher named Ditty was diagnosed with diabetes, his owner successfully managed his blood-sugar levels by giving him regular shots of insulin. Then Ditty abruptly turned hypoglycemic. His owner brought the shaky, unsteady dog to his veterinary clinic in Poland, Maine. Dr. Derralyn Rennix quizzed Ditty’s owner about what might have changed in the dog’s daily routine. Different food? More exercise? That’s when the owner remembered: A week or two earlier, the Wal-Mart pharmacy where she purchased Ditty’s insulin had switched his brand of medication because of changes in pricing. “She was told by the pharmacist that they were the same,” Rennix told the VIN News Service. “...They switched — without calling us, without asking us, without telling us, they just told the owner it was the same.” The idea that different brands of the same type of insulin are readily interchangeable isn’t unusual. It’s a common understanding in the medical community. But while it may be true for most human diabetics, switching brands seems to spell trouble for some veterinary patients. On the Veterinary Information Network (VIN), an online community for the profession, numerous practitioners around the country have reported in recent months cases of dogs whose insulin brands were switched developing out-of-control blood glucose levels, a potentially life-threatening condition that can be expensive to remedy. Dr. Sherri Wilson, an internal medicine consultant at VIN, called the information “an eye-opener.” On a message board discussion in which multiple colleagues described cases of dysregulation, Wilson commented, “It has really changed how I think about this brand change ...” Asked about its policies and practices in substitut Continue reading >>

Similar Risk Of Malignancy With Insulin Glargine And Neutral Protamine Hagedorn (nph) Insulin In Patients With Type 2 Diabetes: Findings From A 5year Randomised, Open-label Study

Similar Risk Of Malignancy With Insulin Glargine And Neutral Protamine Hagedorn (nph) Insulin In Patients With Type 2 Diabetes: Findings From A 5year Randomised, Open-label Study

Similar risk of malignancy with insulin glargine and neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes: findings from a 5year randomised, open-label study 1University of Texas Southwestern Medical School, Dallas, TX USA 2Dallas Diabetes and Endocrine Center at Medical City, 7777 Forest Lane C-685, Dallas, TX 75230 USA 1University of Texas Southwestern Medical School, Dallas, TX USA 2Dallas Diabetes and Endocrine Center at Medical City, 7777 Forest Lane C-685, Dallas, TX 75230 USA 3Tulane University Medical Center, New Orleans, LA USA 4Washington University School of Medicine, St Louis, MO USA 5Oregon Health and Science University, Portland, OR USA 6Universit de Montral, Montral, QC Canada 7University of Western Ontario, London, ON Canada 9University of Wisconsin School of Medicine and Public Health, Madison, WI USA J. Rosenstock, Email: [email protected] . Received 2009 Jun 26; Accepted 2009 Jun 29. Keywords: Cancer, Insulin analogues, Insulin glargine, Insulin therapy, Malignancy, NPH insulin, Type 2 diabetes This article has been cited by other articles in PMC. To the Editor: We have reported a randomised, long-term safety study comparing the effects of using the insulin analogue glargine (A21Gly,B31Arg,B32Arg human insulin) versus human neutral protamine Hagedorn (NPH) insulin for 5years in the management of type 2 diabetes [ 1 ]. The study, in which 1017 patients were randomised and treated, was designed to assess ocular complications of diabetes: there was no excess of such effects with insulin glargine compared with NPH insulin treatment and there was a similar slow progression of diabetic retinopathy with both types of insulin. Because of recent concerns about postulated neoplastic effects of insulins [ 2 5 ], we report h Continue reading >>

Update On Insulin Therapy For Type 2 Diabetes

Update On Insulin Therapy For Type 2 Diabetes

Update on Insulin Therapy for Type 2 Diabetes Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287 Address all correspondence and requests for reprints to: Thomas Donner, M.D., Johns Hopkins University, 601 North Caroline Street, Suite 2008, Baltimore, Maryland 21287 Search for other works by this author on: Division of Endocrinology and Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287 Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 5, 1 May 2012, Pages 14051413, Thomas Donner, Miguel Muoz; Update on Insulin Therapy for Type 2 Diabetes, The Journal of Clinical Endocrinology & Metabolism, Volume 97, Issue 5, 1 May 2012, Pages 14051413, Type 2 diabetes is characterized by insulin resistance and impaired insulin secretion at diagnosis and by progressive -cell dysfunction over time. Insulin therapy is thus frequently required during the course of the disease to maintain glycemic control and prevent diabetes complications. Insulin should be initiated when alternative antihyperglycemic agents have failed or when symptomatic or marked hyperglycemia is present. Recent studies demonstrate that the addition of basal, prandial, basal/bolus, or premixed insulins to existing antihyperglycemic regimens effectively lowers glycosylated hemoglobin (HbA1c). The long-acting insulin analogs cause less nocturnal hypoglycemia than bedtime NPH, with comparable HbA1c reductions. Insulin detemir confers a weight advantage over glargine or NPH. Rapid-acting insulin analogs control postprandial hyperglycemia more effectively than regular insulin and modestly lower HbA1c. For selected patients with severe insulin resistance, U-500 is a less e Continue reading >>

Basal Insulin Treatment In Type 2 Diabetes

Basal Insulin Treatment In Type 2 Diabetes

Basal Insulin Treatment in Type 2 Diabetes University of Maryland School of Medicine, Baltimore, Maryland. Address correspondence to: Stephen N. Davis, MBBS, FRCP, FACP, Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, Room N3W42, Baltimore, MD 21201. E-mail: [email protected] This article has been cited by other articles in PMC. Insulin glargine is the first 24-h recombinant DNA insulin analog introduced to the market. Substitution of glycine for asparagine and addition of two arginine residues raise the isoelectric point of insulin glargine and result in microprecipitates, delaying absorption from subcutaneous tissue. This delayed absorption result in fairly flat 24-h insulin concentration profiles with no discernible peak. Large, multicenter, randomized, controlled trials in patients with type 2 diabetes show that although NPH insulin and insulin glargine are equally effective in lowering glycosylated hemoglobin (A1c) and fasting blood glucose, there is a clear advantage of insulin glargine over NPH insulin in reducing nocturnal and overall hypoglycemia. Lower risk of hypoglycemia with glargine was also consistently demonstrated by trials comparing insulin glargine and premixed analog insulins. These studies also showed greater reduction in A1c with twice-daily premixed insulins compared with glargine, when insulin glargine was administered without mealtime insulin coverage. Insulin glargine was also compared with another insulin analog, insulin detemir. Trials showed that both insulin analogs are equally effective in lowering A1c and have comparable risk of hypoglycemia. Trials comparing insulin glargine with glucagon-like peptide-1 agonists showed comparable significant reductions in A1c with both regimens. Ins Continue reading >>

Insulin Analogs: What Are The Clinical Implications Of Structural Differences?

Insulin Analogs: What Are The Clinical Implications Of Structural Differences?

US Pharm. 2010;35(5)(Diabetes suppl):3-7. In healthy adults, basal insulin concentrations of 5 to 15 µU/mL help to maintain fasting plasma glucose concentrations (FIGURE 1).1 Immediately following a meal, insulin concentration peaks at 60 to 80 µU/mL, returning to basal levels 1 to 3 hours later. In type 2 diabetes mellitus, progressive loss of beta cells results in the disruption of endogenous insulin secretion, in turn leading to requirement for insulin therapy. Considering that the daily pattern of normal insulin secretion is complex, close replication of this pattern is needed to address both fasting and prandial glucose control. In human insulin preparations, such as regular human insulin (RHI), insulin molecules typically self-aggregate to form dimers, which in turn stabilize around zinc ions to form hexamers.2 Following injection, the subcutaneous insulin depot is diluted by the interstitial fluid, causing hexamers to break down into dimers and biologically active monomers. The dissociation of hexamers into dimers and monomers is a rate-limiting step in absorption for all insulins and contributes to the delay in the effect of RHI. Because insulin hexamers are too bulky to be transported across the vascular endothelium, there is a 30- to 60-minute lag phase between injection and onset of action, which requires careful dose administration and food consumption. In addition to slow onset, a slow clearance can result in prolonged periods of elevated insulin and “delayed” hypoglycemia. Exogenous basal insulin delivery has traditionally involved single or twice-daily injections of neutral protamine Hagedorn (NPH) insulin, which is a formulation of protamine insulin in a zinc suspension. Protamine prolongs the absorption of NPH insulin, causing an intermediate dura Continue reading >>

Selecting An Insulin For Treating Diabetes Mellitus In Dogs And Cats

Selecting An Insulin For Treating Diabetes Mellitus In Dogs And Cats

Richard W. Nelson, DVM, Dipl ACVIM University of California Davis, California From: The 30th Annual Royal Canin/Ohio State University Symposium for the treatment of small animal diseases: Endocrinology, October 2006, Veterinarians often ask which insulin is the best for treating diabetes mellitus in dogs and cats. Unfortunately, this question is difficult to answer. All insulin types currently on the market have the potential to work well in some diabetic dogs and cats but not in others. Recommendations regarding the insulin of choice for treating diabetic dogs and cats are based on personal experiences and vary between clinicians. Some clinicians prefer NPH insulin while others prefer lente insulin for treating diabetic dogs. Some clinicians prefer PZI, some NPH, some lente, and some insulin glargine for treating diabetic cats. Which insulin is ultimately effective in a diabetic is unpredictable. The clinician’s role is to identify which type of insulin works best in the diabetic dog or cat currently being treated. Success with insulin therapy requires knowledge of currently available insulin preparations - their intended use, potency, trends regarding duration of effect, and potential impact of species of insulin origin on diabetic control. Overview of Insulin Types. Commercial insulin is categorized by promptness, duration, intensity of action, and origin. Short-acting prandial insulins include regular crystalline (Humulin R®, Eli Lilly, Indianapolis, IN), insulin lispro (Humulog®, Eli Lilly) and insulin aspart (Novolog®, Novo Nordisk, Princeton, NJ). Regular crystalline insulin is a recombinant human insulin while insulin lispro and insulin aspart are insulin analogs. Recombinant DNA technology has been used to alter the amino acid sequence of the insulin molec Continue reading >>

Similar Progression Of Diabetic Retinopathy With Insulin Glargine And Neutral Protamine Hagedorn (nph) Insulin In Patients With Type 2 Diabetes: A Long-term, Randomised, Open-label Study.

Similar Progression Of Diabetic Retinopathy With Insulin Glargine And Neutral Protamine Hagedorn (nph) Insulin In Patients With Type 2 Diabetes: A Long-term, Randomised, Open-label Study.

A comment on this article appears in " The longest ever randomised controlled trial of insulin glargine: study design and HbA(1c) findings. " Diabetologia. 2009 Oct;52(10):2234-5; author reply 2236-9. A comment on this article appears in " Diabetic retinopathy and insulin glargine. " Diabetologia. 2009 Oct;52(10):2233; author reply 2236-9. This long-term study was designed to further characterise the retinal safety profile of insulin glargine and human neutral protamine Hagedorn (NPH) insulin in patients with type 2 diabetes mellitus.An open-label, 5 year, randomised (1:1), multicentre, stratified, parallel-group study conducted in the USA and Canada enrolled individuals with type 2 diabetes and either no or non-proliferative retinopathy (less than severe; Early Treatment Diabetic Retinopathy Study [ETDRS] level less than 53 in both eyes) who were treated with oral hypoglycaemic agents (OHAs) alone, insulin alone or OHAs with insulin for >/=3 months prior to study entry and a baseline HbA(1c) level of 6.0-12.0%. Patients were randomised by the investigator according to the centralised interactive voice response system to receive twice-daily NPH insulin (n = 509) or once-daily basal insulin glargine (n = 515). The investigator was not blinded to the treatment group to which each participant had been assigned. The main objective of this study was to compare the progression of diabetic retinopathy between treatment groups by analysing the percentage of patients with three or more step progression in the ETDRS retinopathy patient-level severity scale after treatment with either basal insulin. Masked, centralised grading of seven-field stereoscopic fundus photographs was used.Similarly sustained glycaemic control was observed in both the insulin glargine and NPH insulin tre Continue reading >>

Nclex Style Practice Questions - Medsurg Diabetes

Nclex Style Practice Questions - Medsurg Diabetes

The guidelines for Carbohydrate Counting as medical nutrition therapy for diabetes mellitus includes all of the following EXCEPT: a. Flexibility in types and amounts of foods consumed b. Unlimited intake of total fat, saturated fat and cholesterol c. Including adequate servings of fruits, vegetables and the dairy group d. Applicable to with either Type 1 or Type 2 diabetes mellitus b. Unlimited intake of total fat, saturated fat and cholesterol The nurse working in the physician's office is reviewing lab results on the clients seen that day. One of the clients who has classic diabetic symptoms had an eight-hour fasting plasma glucose test done. The nurse realizes that diagnostic criteria developed by the American Diabetes Association for diabetes include classic diabetic symptoms plus which of the following fasting plasma glucose levels? When taking a health history, the nurse screens for manifestations suggestive of diabetes type I. Which of the following manifestations are considered the primary manifestations of diabetes type I and would be most suggestive of diabetes type I and require follow-up investigation? a. Excessive intake of calories, rapid weight gain, and difficulty losing weight b. Poor circulation, wound healing, and leg ulcers, c. Lack of energy, weight gain, and depression d. An increase in three areas: thirst, intake of fluids, and hunger D. An increase in three areas: thirst, intake of fluids, and hunger The primary manifestations of diabetes type I are polyuria (increased urine output), polydipsia (increased thirst), polyphagia (increased hunger). The nurse is working with an overweight client who has a high-stress job and smokes. This client has just received a diagnosis of Type II Diabetes and has just been started on an oral hypoglycemic agent. Continue reading >>

Medicine Buzz: Insulin

Medicine Buzz: Insulin

Renata Fruga (Pharmacy Student), Ashley Davis (Pharmacy Student), William Kirchain, PharmD, CDE, Director – Xavier University Health & Wellness Center What is Insulin? Many people with diabetes both Type 1 and Type 2 need to include insulin in their treatment plan. Insulin is a protein that is made naturally by the body in the pancreas. When a person eats a meal the sugars and fats absorbed from the bowels travel to the pancreas and trigger the release of insulin into the blood. The insulin quickly travels to several parts of the body where it signals a variety of cells to take in these new sugars floating in the blood. Some of this insulin pulse goes to the liver to turn off sugar production and turn on sugar storage, along with fat storage. Still another portion of the insulin goes to muscles and other tissues where it turns on the production of new tissues and muscle fibers. There are several different types of insulin. The different types are designed to dissolve into the blood at different rates. Combing different types of insulin is often needed to get the best control over a person’s blood sugar. Rapid acting insulins are intended to be used just before a meal and are targeted to control the sugar spike from that particular meal. Short acting insulin also known as regular insulin is targeted to control both the immediate meal plus a few hours after the meal. Intermediate acting insulins like NPH are targeted at controlling the lingering sugar from a meal while primarily keeping the in-between meal blood sugar lower. Long acting insulins are targeted solely at the in-between meal sugar level produced by liver. The effectiveness of the long acting insulin is best checked by fasting blood sugar readings. The effectiveness of the rapid acting insulins is bes Continue reading >>

Biphasic Insulin Aspart 30 Vs. Nph Plus Regular Human Insulin In Type 2 Diabetes Patients; A Cost-effectiveness Study

Biphasic Insulin Aspart 30 Vs. Nph Plus Regular Human Insulin In Type 2 Diabetes Patients; A Cost-effectiveness Study

Abstract The aim of this study was to compare the efficacy, safety, costs, and cost-effectiveness of biphasic insulin aspart 30 (BIAsp 30) with NPH plus regular human insulin (NPH/Reg) in patients with type 2 diabetes mellitus (T2DM). It was a Single-center, parallel-group, randomized, clinical trial (Trial Registration: NCT01889095). One hundred and seventy four T2DM patients with poorly controlled diabetes (HbA1c ≥ 8 % (63.9 mmol/mol)) were randomly assigned to trial arms (BIAsp 30 and NPH/Reg) and were followed up for 48 weeks. BIAsp 30 was started at an initial dose of 0.2–0.6 IU/Kg in two divided doses and was titrated according to the glycemic status of the patient. Similarly, NPH/Reg insulin was initiated at a dose of 0.2–0.6 IU/Kg with a 2:1 ratio and was subsequently titrated. Level of glycemic control, hypoglycemic events, direct and indirect costs, quality adjusted life year (QALY) and incremental cost-effectiveness ratio have been assessed. HbA1c, Fasting plasma glucose (FPG), and two-hour post-prandial glucose (PPG) were improved in both groups during the study (P < 0.05 for all analyses). Lower frequencies of minor, major, and nocturnal hypoglycemic episodes were observed with BIAsp 30 (P < 0.05). Additionally, BIAsp 30 was associated with less weight gain and also higher QALYs (P < 0.05). Total medical and non-medical costs were significantly lower with BIAsp 30 as compared with NPH/Reg (930.55 ± 81.43 USD vs. 1101.24 ± 165.49 USD, P = 0.004). Moreover, BIAsp 30 showed lower ICER as a dominant alternative. Despite being more expensive, BIAsp 30 offers the same glycemic control as to NPH/Reg dose-dependently and also appears to cause fewer hypoglycemic events and to be more cost-effective in Iranian patients with type 2 diabetes. Notes This study w Continue reading >>

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Hormone secreted by pancreatic beta-cells of the islets of Langerhans and essential for the metabolism and homeostasis of carbohydrate, fat, and protein. Insulin glargine is a once-daily basal insulin analog without pronounced peaks. BASAGLAR, Lantus, Lantus SoloStar, Toujeo SoloStar BASAGLAR/Lantus/Lantus SoloStar/Toujeo SoloStar Subcutaneous Inj Sol: 1mL, 100U, 300U For the treatment of type 1 diabetes mellitus and type 2 diabetes mellitus. For the treatment of type 1 diabetes mellitus. Subcutaneous dosage (100 units/mL, i.e., Lantus, Basaglar) Initially, administer one-third of the total daily insulin requirements/dose subcutaneously once daily. Titrate dosage to achieve blood glucose control and A1C goals in conjunction with a short-acting insulin. Give the dose at the same time every day, at any time. Administration in the morning may avoid nocturnal hypoglycemia. When transferring from once daily NPH insulin, the dose is usually not changed. However, when transferring from twice-daily NPH insulin to insulin glargine, the total daily dose of NPH insulin (or other twice daily basal insulin) should be reduced by 20% and administered as single dose once daily. When transferring from once-daily Toujeo to once-daily Lantus or Basaglar, the recommended initial Lantus or Basaglar dose is 80% of the Toujeo dose that is being discontinued. Thereafter, the dosage of insulin glargine should be adjusted to response. Children and Adolescents 6 years and older Insulin requirements are highly variable and must be individualized based on patient-specific factors and type of insulin regimen. During partial remission phase, total combined daily insulin requirement is often less than 0.5 units/kg/day. Prepubertal children (outside the partial remission phase) usually require 0.7 to Continue reading >>

Insulin Therapy For Challenging Patient Cases

Insulin Therapy For Challenging Patient Cases

Initiating and advancing insulin therapy in patients with type 2 diabetes mellitus can be challenging. However, with the availability of insulin analogs with more physiologic profiles, and with the initiation of simple insulin regimens (eg, the use of basal insulin administered once daily), an opportunity is created to empower patients to self-titrate their insulin. Self-titration can reduce the burden on the physician as well as improve glycemic control in patients. More options for intensifying insulin now exist, including gradually adding prandial insulin (referred to as a basal “plus” strategy) or using premixed insulin analogs for patients with relatively consistent lifestyles and habits. More-concentrated forms of insulin, such as U-500 insulin, may be helpful for patients requiring very large doses of insulin. The key is to match the insulin regimen to the patient; engage in dialogue to understand the patient's lifestyle, concerns, and skill sets; and develop, through a shared decision-making process, appropriate individualized treatment recommendations. The present review article focuses on the use of insulin replacement therapy in challenging patient cases. Approximately 26 million people in the United States have diabetes, and the vast majority have type 2 diabetes mellitus (T2DM).1 Even with the establishment of treatment goals and the development of considerable advancements in diabetes treatment,2 inadequate metabolic control is pervasive.3-5 The proportion of patients with glycated hemoglobin (HbA1c) levels that are at goal is still well below the diabetes indicators discussed in the Healthy People 2020 initiative.6 Available data show that many patients with T2DM still have poor glycemic control along with comorbid conditions that may complicate treat Continue reading >>

A Retrospective Study Comparing Neutral Protamine Hagedorn Insulin With Glargine As Basal Therapy In Prednisone-associated Diabetes Mellitus In Hospitalized Patients

A Retrospective Study Comparing Neutral Protamine Hagedorn Insulin With Glargine As Basal Therapy In Prednisone-associated Diabetes Mellitus In Hospitalized Patients

A RETROSPECTIVE STUDY COMPARING NEUTRAL PROTAMINE HAGEDORN INSULIN WITH GLARGINE AS BASAL THERAPY IN PREDNISONE-ASSOCIATED DIABETES MELLITUS IN HOSPITALIZED PATIENTS Subarna M. Dhital , MBBS,1 Yoram Shenker , MD,1 Melissa Meredith , MD,1 and Dawn Belt Davis , MD, PhD1,2 1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Madison, Wisconsin 1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Madison, Wisconsin 1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Madison, Wisconsin 1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Madison, Wisconsin 2William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin 1University of Wisconsin School of Medicine and Public Health, Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Madison, Wisconsin 2William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin Address correspondence to Dr. Dawn Belt Davis, 1685 Highland Ave, MC 5148, Madison, WI 53705. [email protected] The publisher's final edited version of this article is available at Endocr Pract See other articles in PMC that cite the published article. To compare glycemic outcomes in hospitalized patients with or without type 2 diabetes mellitus receiving neutral protamine Hagedorn insulin (NPH) vs glargine as basal insulin for management of glucocorticoid-associated hyperglycemia. We conducted a retrospective review of electronic medical records in prednisone-treated adult patients w Continue reading >>

A Review Of Insulin For The Treatment Of Diabetes Mellitus

A Review Of Insulin For The Treatment Of Diabetes Mellitus

A Review of Insulin for the Treatment of Diabetes Mellitus September 2016, Volume 34 Number 8 , p 416 - 423 This article has an associated Continuing Education component. Expires September 30, 2018. Go to CE Details Insulin is commonly used in the treatment of diabetes in the home care setting. Understanding the wide variety of insulin preparations available will assist the clinician in guiding people with diabetes and their caregivers through the complexities of self-care and promote safe and optimal glucose control. The purpose of this article is to review the various available insulin preparations and discuss their use in the treatment of diabetes mellitus. Insulin is the most effective means of lowering blood glucose, allowing the body to maintain glucose within a normal range. In people with diabetes, there is either a complete absence of this naturally occurring hormone (type 1 diabetes) or there is an issue with diminished insulin secretion and/or insulin resistance (type 2 diabetes). The treatment of gestational diabetes may also include insulin therapy as oral agents are generally not approved for use in pregnancy. Exogenous insulin improves the body's ability to metabolize carbohydrate, store glucose in the liver, and convert glycogen to fat storage ( Lilley et al., 2014 ). This article will review the various available insulin products and their use in the treatment of diabetes mellitus. Commercially produced insulin was not available in the United States until 1923 when short-acting regular insulin required multiple injections a day ( White, 2014 ). Prior to that time, people with type 1 diabetes died without insulin and those with type 2 slowly succumbed to multiple complications. Longer-acting insulin preparations were developed over the subsequent years Continue reading >>

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