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Insulin Infusion

Continuous Subcutaneous Insulin Infusiona Comprehensive Review Of Insulin Pump Therapy

Continuous Subcutaneous Insulin Infusiona Comprehensive Review Of Insulin Pump Therapy

A tremendous amount of data suggest that near-normal glycemic control prevents or delays complications of diabetes, which has led to a dramatic increase in continuous subcutaneous insulin infusion (CSII) or insulin pump use. In this article, the data supporting CSII in type 1 diabetes is reviewed, and the advantages and disadvantages of CSII are analyzed. In addition, CSII use in specific situations is examined, including during childhood and pregnancy and while exercising. The published articles suggest that CSII provides better glycemic control than does conventional therapy and comparable to or slightly better control than multiple daily injections. The use of CSII may be especially indicated during pregnancy or for preconception care and for diabetes presenting in childhood or adolescence. The Diabetes Control and Complications Trial (DCCT) demonstrated a dramatic reduction in the frequency and severity of complications of diabetes mellitus type 1 in adolescents and young adults by achieving and maintaining glucose control in the near-normal range.1 Comparable but less dramatic results were demonstrated in the UK Prospective Diabetes Study for people with type 2 diabetes.2 These studies established intensive management of diabetes as the standard of care, which has rekindled an interest in external insulin infusion pumps, referred to as continuous subcutaneous insulin infusion (CSII). The patients treated with CSII in the DCCT demonstrated slightly better glycemic control than those treated with multiple daily injections, and CSII therapy was well tolerated.3 Consequently, the popularity of CSII has increased dramatically. Approximately 50 000 to 70 000 adults in the United States are thought to be using CSII, representing about 8% of the adult population with type Continue reading >>

Continuous Subcutaneous Insulin Infusion And Hypoglycemia

Continuous Subcutaneous Insulin Infusion And Hypoglycemia

One of the major limiting factors in achieving glycemic control is hypoglycemia.1 The causes of hypoglycemia are often multifactorial, but it is commonly caused by excess insulin administration due to either an overestimation in the dosing of insulin or active insulin stacking in patients with diabetes who require insulin.2 Other causes can include delayed gastric emptying due to gastroparesis, medication, exercise, or alcohol. Hypoglycemic episodes are common for patients with type 1 diabetes and those with advanced type 2 insulin-dependent diabetes. One of the major limiting factors in achieving glycemic control is hypoglycemia.1 The causes of hypoglycemia are often multifactorial, but it is commonly caused by excess insulin administration due to either an overestimation in the dosing of insulin or active insulin stacking in patients with diabetes who require insulin.2 Other causes can include delayed gastric emptying due to gastroparesis, medication, exercise, or alcohol. Hypoglycemic episodes are common for patients with type 1 diabetes and those with advanced type 2 insulin-dependent diabetes. In type 1 diabetes, plasma glucose concentrations may be <50mg/dl for as much as 10% of the time.2 It has also been estimated that the average patient with diabetes can suffer up to two episodes of symptomatic hypoglycemia per week and one or more episodes of severe disabling hypoglycemia per year.2 Participants in the Diabetes Control and Complications Trial (DCCT) who followed a regimen of intensive insulin therapy reduced their risk for microvascular complications such as retinopathy. Patients in the DCCT study who had a glycated hemoglobin (HbA1c) level <7.5% experienced a threefold increased incidence in severe hypoglycemia.3 Therefore, optimal glucose control is often Continue reading >>

Continuous Perioperative Insulin Infusion Decreases Major Cardiovascular Events In Patients Undergoing Vascular Surgery:a Prospective, Randomized Trial | Anesthesiology | Asa Publications

Continuous Perioperative Insulin Infusion Decreases Major Cardiovascular Events In Patients Undergoing Vascular Surgery:a Prospective, Randomized Trial | Anesthesiology | Asa Publications

A GROWING body of evidence indicates that hyperglycemia is an independent predictor of increased cardiovascular risk and diabetes mellitus is a significant predictor of perioperative cardiovascular morbidity and mortality. Although the potential benefit of aggressive perioperative control of blood glucose concentrations in patients with or without diabetes has not been adequately evaluated, the results of several recent investigations suggest that mortality may be reduced by intensive glycemic control in cardiac surgical patients. 13 A multimodal approach using blockade and statins has been shown to reduce the incidence of cardiac events in high-risk surgical patients with peripheral vascular disease 4 ; however, the benefit of perioperative blood glucose control in this patient population has not previously been evaluated. Intensive insulin therapy (i.e. , maintenance of blood glucose concentrations between 80 and 110 mg/dl with insulin) significantly decreased in-hospital deaths, from 10.9% to 7.2%, in critically ill surgical patients. 5 Continuous intravenous insulin infusion to maintain blood glucose concentrations less than 150 mg/dl has been shown to decrease deep sternal wound infections in cardiac surgical patients. 6,7 Most previous studies have focused on cardiac surgical patients and, in particular, on the postoperative period in the intensive care unit. Quattara et al. 3 and Gandhi et al. 8 each evaluated strategies of perioperative tight blood glucose control beginning in the operating room and continuing through the postoperative period with the former favoring this strategy. Gandhi et al. suggested that addition of intraoperative tight glycemic control to postoperative tight glycemic control might lead to possible deleterious effects in cardiac surgical Continue reading >>

Insulin Infusion Protocol For Critical Care Units

Insulin Infusion Protocol For Critical Care Units

Insulin Infusion Protocol for Critical Care Units Dimple Dilkhush, Jeffry Lannigan, Tressa Pedroff, Anthie Riddle and Mary Tittle Am J Health Syst Pharm.2005;62(21):2260-2264. Sidebar: AppendixInitial Nursing Guidelines for i.v. Insulin Infusion The development of an insulin infusion protocol was initiated by key contributors from a team of nurses, dietitians, pharmacists, and physicians. The physician members were from various specialties, including family practice, internal medicine, endocrinology, and trauma surgery. It was felt that these disciplines, as a group, would be able to address all the factors that needed to be considered. The pharmacy clinical coordinator and the clinical nurse specialist of the SICU were instrumental in the initiation and facilitation of the insulin infusion protocol. Before the multidisciplinary group convened, these individuals met in May 2003 to review protocols being used in other facilities, current hospital standards on insulin use and monitoring of capillary blood glucose, patient populations served, and additional orders for treating patients on an insulin infusion protocol.[ 12 , 13 ] The pharmacy clinical coordinator and the clinical nurse specialist drafted a preliminary protocol taking into account the fact that insulin requirements in individual patients vary widely, depending on insulin production reserves, insulin sensitivity, nutritional intake, severity of illness, and concurrent medications.[ 12 ] After several other protocols were reviewed, it was decided that a protocol with different insulin-infusion algorithms (depending on the patient's perceived level of insulin resistance) would be confusing and difficult for the nursing staff to follow. Therefore, the protocol was written in a table format that allowed adjustme Continue reading >>

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients

The notion of tight glycemic control (GC) became more prominent in the critical care literature in 2001 when a landmark study by Van den Berghe and colleagues ( 1 ) demonstrated a significant mortality benefit when maintaining blood glucose (BG) between 80 and 110 mg/dL. Prior to that publication, GC was not a high priority in most intensive care unit (ICU) patients. Data have confirmed the observation that hyperglycemia is associated with an increase in death and infection, seemingly across the board among many case types in the ICU ( 2 , 3 ). Many centers have attempted to assess the feasibility of maintaining normoglycemia in critically ill patients and to further establish the potential risk or benefit of this approach in a variety of ICU patient subsets. While there have been conflicting results from numerous studies, the question is no longer whether GC is beneficial or not, but rather what is the appropriate degree of GC that can be accomplished safely and with justifiable utilization of resources. This Clinical Practice Guideline will evaluate the available literature and address aspects of implementation that permit safe and effective insulin infusion therapy. Methodology and assessment will be emphasized to help clinicians achieve the BG goal that is considered to have the greatest benefit and safety for their patient population while avoiding clinically significant hypoglycemia. Guidelines are limited by the available literature and the expertise of the writing panel and reviewers. The recommendations are not absolute requirements, and therapy should be tailored to individual patients and the expertise and equipment available in a particular ICU. The use of an insulin infusion requires an appropriate protocol and point-of-care (POC)monitoring equipment with Continue reading >>

Variable Rate Insulin Infusion

Variable Rate Insulin Infusion

Regular Insulin 100 units in 100 cc NS (1 u per 1 ml) Type II Diabetic or poor control: 2-3 units per hour Weight-based (use true weight, not Ideal Weight ) Consider starting with this dose in very large patients with high calculated doses Insulin bolus prior to starting Insulin Drip is controversial Use in adult Diabetic Ketoacidosis does not offer additional benefit over Insulin Infusion alone Coadminister D5W at 100 to 125 cc per hour Check Blood Glucose every 30 minutes to 1 hour Give 25 ml of D50 IV (or 10-12 grams Glucose ) Continue q2 hour Blood Glucose Monitoring Restart Insulin Drip when Blood Glucose >150 V. Discontinuation (e.g. Postoperatively) Administer patient's usual Insulin dose pre-meal Discontinue Insulin Infusion two hours after meal Marks (2003) Am Fam Physician 67(1):93-100 [PubMed] Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Variable Rate Insulin Infusion." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images Related Studies (from Trip Database) Open in New Window A short-acting form of insulin. Regular insulin is obtained from animal or recombinant sources. The onset of action of regular insulin occurs at 30-90 minutes after injection; its effect lasts for 6 to 8 hours. Endogenous human insulin, a pancreatic hormone composed of two polypeptide chains, is important for the normal metabolism of carbohydrates, proteins and fats; it has anabolic effects on many types of tissues. (NCI04) Insulin (51 aa, ~6 kDa) is encoded by the human INS gene. This protein is involved in the direct regulation of glucose metabolism. protein hormone secreted by beta cells of the pancreas; insulin plays a major role in the reg Continue reading >>

Prospective Evaluation Of A Dynamic Insulin Infusion Algorithm For Non Critically-ill Diabetic Patients: A Before-after Study

Prospective Evaluation Of A Dynamic Insulin Infusion Algorithm For Non Critically-ill Diabetic Patients: A Before-after Study

Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study Roles Data curation, Investigation, Writing original draft Affiliation CHU Clermont-Ferrand, Service dendocrinologie, diabtologie et maladies mtaboliques, Clermont-Ferrand, France Affiliation Ple Pharmacie, CHU Clermont-Ferrand, Clermont-Ferrand, France Roles Data curation, Formal analysis, Methodology, Project administration, Software Affiliation Dlgation la Recherche Clinique et l'Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France Roles Conceptualization, Investigation, Methodology, Project administration, Software, Validation Affiliation Dlgation la Recherche Clinique et l'Innovation (DRCI), CHU Clermont-Ferrand, Clermont-Ferrand, France Affiliation CHU Clermont-Ferrand, Service dendocrinologie, diabtologie et maladies mtaboliques, Clermont-Ferrand, France Roles Conceptualization, Data curation, Validation Affiliation CHU Clermont-Ferrand, Service de Pdiatrie Gnrale, Clermont-Ferrand, France Roles Data curation, Supervision, Validation Affiliation CHU Clermont-Ferrand, Service de Mdecine Digestive, Clermont-Ferrand, France Affiliation CHU Clermont-Ferrand, Service de Court sjour Griatrique, Riom, France Affiliation CHU Clermont-Ferrand, Service de Chirurgie vasculaire, Clermont-Ferrand, France Roles Conceptualization, Methodology, Supervision, Validation Affiliation CHU Clermont-Ferrand, Ple Urgences, Clermont-Ferrand, France Roles Conceptualization, Formal analysis, Supervision, Validation Affiliation Ple Pharmacie, CHU Clermont-Ferrand, Clermont-Ferrand, France Affiliation CHU Poitiers, Service de Mdecine interne, endocrinologie et maladies mtaboliques, Poitiers, France Roles Conceptualization, Data curation, Formal analysis, Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injection Regimens In Children And Young People At Diagnosis Of Type 1 Diabetes: Pragmatic Randomised Controlled Trial And Economic Evaluation

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injection Regimens In Children And Young People At Diagnosis Of Type 1 Diabetes: Pragmatic Randomised Controlled Trial And Economic Evaluation

Continuous subcutaneous insulin infusion versus multiple daily injection regimens in children and young people at diagnosis of type 1 diabetes: pragmatic randomised controlled trial and economic evaluation Continuous subcutaneous insulin infusion versus multiple daily injection regimens in children and young people at diagnosis of type 1 diabetes: pragmatic randomised controlled trial and economic evaluation BMJ 2019; 365 doi: (Published 03 April 2019) Cite this as: BMJ 2019;365:l1226 Joanne C Blair, consultant paediatric endocrinologist 1 , Keith Thornborough, paediatric diabetes nurse specialist 4 , Mohammed Didi, consultant paediatric endocrinologist 1 , Francesca Annan, paediatric dietician 4 , John W Gregory, professor in paediatric endocrinology 6 , Dyfrig A Hughes, lead health economist 3 , Carrol Gamble, professor of medical statistics 2 1Department of Endocrinology, Alder Hey Childrens NHS Foundation Trust, Liverpool L12 2AP, UK 2Clinical Trials Research Centre, University of Liverpool, Liverpool, UK 3Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK 4Department of Diabetes, Alder Hey Childrens NHS Foundation Trust, Liverpool, UK 5Department of Research, Alder Hey Childrens NHS Foundation Trust, Liverpool, UK 6Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK Correspondence to: J C Blair jo.blair{at}alderhey.nhs.uk Objective To compare the efficacy, safety, and cost utility of continuous subcutaneous insulin infusion (CSII) with multiple daily injection (MDI) regimens during the first year following diagnosis of type 1 diabetes in children and young people. Design Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. Setting 15 paediatric Nat Continue reading >>

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients

Guidelines For The Use Of An Insulin Infusion For The Management Of Hyperglycemia In Critically Ill Patients

Glycemic control (GC) can be difficult to manage. Glycemic variability may contribute to adverse outcomes. Over/under correction of blood glucose may occur. Hypoglycemia carries specific risks for the normal brain and a greater risk for the injured brain. Severe hypoglycemia (SH) can produce or exacerbate focal neurological deficits, encephalopathy, seizures or status epilepticus, permanent cognitive dysfunction, and death. Further, tight GC may induce regional neuroglycopenia in traumatic brain injury (TBI). While the first priority is patient safety through restoration of normoglycemia, rebound hyperglycemia due to excessive replacement should also be avoided, especially because the resulting increase in glycemic variability (GV) may contribute to adverse outcomes. Rating Scheme for the Strength of the Recommendations Grade 1 (Strong): A recommendation in favor of an intervention reflects that the desirable effects of adherence to a recommendation (beneficial health outcomes, less burden on staff and patients, and cost savings) will clearly outweigh the undesirable effects (harms, more burden and greater costs). Grade 2 (Weak): A recommendation in favor of an intervention indicates that the desirable effects of adherence to a recommendation probably will outweigh the undesirable effects, but the panel is not confident about these tradeoffs either because some of the evidence is low-quality (and thus there remains uncertainty regarding the benefits and risks) or the benefits and downsides are closely balanced. Guidelines are limited by the available literature and the expertise of the writing panel and reviewers. The recommendations are not absolute requirements, and therapy should be tailored to individual patients and the expertise and equipment available in a parti Continue reading >>

Continuous Insulin Infusion: When, Where, And How?

Continuous Insulin Infusion: When, Where, And How?

Go to: Inpatient Glycemic Targets After publication of the initial van den Berghe trial in surgical intensive care patients,1 several professional organizations published guidelines supporting near-normal glycemic targets.8,9 Subsequent trials documented an increased risk for hypoglycemia with tight glycemic control, suggesting that more modest glycemic targets may be optimal.10–13 The Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation (NICE-SUGAR) study,14 a large, randomized trial involving > 6,100 medical and surgical patients, documented higher 90-day mortality rates in patients managed with tight glycemic control than in those receiving conventional glucose management. Although hypoglycemia was more common among patients in the intensive treatment group, the association of hypoglycemia with an increased hazard ratio for death was similar in the two groups, suggesting that hypoglycemia contributed to the excess mortality in the intensively treated group.15 The increased risk for hypoglycemia and mortality with tight glycemic control does not justify ignoring glycemic control, but it does justify setting more moderate targets. The American Diabetes Association (ADA), the American Association of Clinical Endocrinologists (AACE), the Surviving Sepsis Campaign, and the Institute for Healthcare Improvement all updated their guidelines for glycemic control in 2009 in response to data from NICE-SUGAR.16-18 All four sets of guidelines recommend initiating insulin therapy in patients with persistent hyperglycemia (blood glucose > 180 mg/dl). After insulin is initiated, the target blood glucose range should be 140-180 mg/dl for the majority of patients. However, a more stringent goal of 110-140 mg/dl may be appropriate for certain patient Continue reading >>

Mixed Results For Insulin/dextrose Infusion Therapy

Mixed Results For Insulin/dextrose Infusion Therapy

Mixed results for insulin/dextrose infusion therapy In patients who had an acute myocardial infarction, treatment with insulin/dextrose infusion therapy did not significantly lower mortality risk. Insulin/dextrose infusion therapy does not appear to offer a reduction in mortality risk in patients who recently had an acute myocardial infarction, according to a study by Australian researchers. , was designed to examine whether improved glycemic control achieved through insulin/dextrose infusion therapy with a variable rate of insulin would help to reduce mortality in patients with hyperglycemia following an acute myocardial infarction. Previous studies have shown conflicting results regarding the benefits of various intravenous insulin therapies on this patient population. N. Wah Cheung, PhD, from the center for diabetes and endocrinology research at Westmead Hospital in Westmead, Australia, one of the studys researchers, told that the reduction in mortality among patients who were treated with insulin/dextrose infusion therapy was not as significant as the researchers were hoping. The major problem we had in our study was that the patients who were randomized to insulin infusion did not have their blood glucose levels driven down low enough, Cheung said. This was possibly because of undue concern regarding the possibility of hypoglycemia amongst the nursing staff, and therefore aggressive titration of insulin was not maintained. The researchers examined 240 patients who had had an acute myocardial infarction for this study. Patients eligible for the study had either diagnosed diabetes or did not have diabetes but had blood glucose levels >140.4 mg/dL. Patients were randomly divided into two groups. The first group received insulin/dextrose infusion therapy for at least Continue reading >>

Metformin Add-on Continuous Subcutaneous Insulin Infusion On Precise Insulin Doses In Patients With Type 2 Diabetes

Metformin Add-on Continuous Subcutaneous Insulin Infusion On Precise Insulin Doses In Patients With Type 2 Diabetes

Metformin add-on continuous subcutaneous insulin infusion on precise insulin doses in patients with type 2 diabetes Scientific Reportsvolume8, Articlenumber:9713 (2018) | Download Citation To investigate whether metformin add-on to the continuous subcutaneous insulin infusion (Met + CSII) therapy leads to a significant reduction in insulin doses required by type 2 diabetes (T2D) patients to maintain glycemic control, and an improvement in glycemic variation (GV) compared to CSII only therapy. We analyzed data from our two randomized, controlled open-label trials. Newly diagnoses T2D patients were randomized assigned to receive either CSII therapy or Met + CSII therapy for 4 weeks. Subjects were subjected to a 4-day continuous glucose monitoring (CGM) at the endpoint. Insulin doses and GV profiles were analyzed. The primary endpoint was differences in insulin doses and GV between the two groups. A total of 188 subjects were admitted as inpatients. Subjects in metformin add-on therapy required significantly lower total, basal and bolus insulin doses than those of control group. CGM data showed that patients in Met + CSII group exhibited significant reduction in the 24-hr mean amplitude of glycemic excursions (MAGE), the standard deviation, and the coefficient of variation compared to those of control group. Our data suggest that metformin add-on to CSII therapy leads to a significant reduction in insulin doses required by T2D patients to control glycemic variations. Since the emergence of continuous subcutaneous insulin infusion (CSII) therapy in 1997 1 , CSII has become the potential treatment for type 2 diabetes (T2D). Early implementation of a 2 to 3-week course of intensive insulin therapy leads to a prolonged glycemic control in newly diagnosed T2D 2 . The mechanism Continue reading >>

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An Error Occurred Setting Your User Cookie

An Error Occurred Setting Your User Cookie This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. Try a different browser if you suspect this. The date on your computer is in the past. If your computer's clock shows a date before 1 Jan 1970, the browser will automatically forget the cookie. To fix this, set the correct time and date on your computer. You have installed an application that monitors or blocks cookies from being set. You must disable the application while logging in or check with your system administrator. This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Continue reading >>

Decision Memo For Insulin Infusion Pump (cag-00041n)

Decision Memo For Insulin Infusion Pump (cag-00041n)

To: File: CAG-00041N Continuous Subcutaneous Insulin Infusion Pumps (CSII) From: Grant P. Bagley, MD, JD Director Coverage and Analysis Group John J. Whyte, MD, MPH Julie K. Taitsman, MD, JD Medical Officers Coverage and Analysis Group Subject: National Coverage Decision Date: August 26, 1999 This memo serves four purposes: (1) outlines the description and treatment of diabetes mellitus; (2) reviews the history of Medicare's coverage policies on diabetes management; (3) analyzes the relevant scientific data related to the continuous subcutaneous insulin infusion (CSII) pump; (4) delineates the reasons supporting a positive national decision to cover the device for type I diabetics. A. Pathophysiology Diabetes Mellitus is a disease of abnormal glucose metabolism characterized by a deficiency of insulin production, or by development of insulin-resistance, either of which results in abnormally high blood sugars. Diabetes Mellitus is generally subdivided into two categories: (1) Type I diabetes mellitus , (also known as insulin dependent diabetes mellitus [IDDM] or juvenile onset diabetes mellitus) and (2) Type II diabetes mellitus (also known as non insulin dependent diabetes mellitus [NIDDM] or adult onset diabetes mellitus)1 Type I diabetes may begin at any age but onset typically occurs in childhood or adolescence. Type I diabetes results from an immune mediated destruction of pancreatic islet beta cells causing decreased endogenous secretion of insulin and necessitating exogenous insulin therapy to maintain euglycemia. Type II diabetes is marked by peripheral resistance to the effect of insulin rather than absolute insulin deficiency. Approximately 16 million Americans have diabetes, although only slightly more than 10 million are diagnosed. Type I diabetes accounts fo Continue reading >>

Subcutaneous Administration Of Glargine To Diabetic Patients Receiving Insulin Infusion Prevents Rebound Hyperglycemia

Subcutaneous Administration Of Glargine To Diabetic Patients Receiving Insulin Infusion Prevents Rebound Hyperglycemia

The Journal of Clinical Endocrinology & Metabolism Subcutaneous Administration of Glargine to Diabetic Patients Receiving Insulin Infusion Prevents Rebound Hyperglycemia Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Search for other works by this author on: Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Search for other works by this author on: Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Search for other works by this author on: Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Search for other works by this author on: Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Search for other works by this author on: University of Colorado School of Medicine, and Denver Veterans Affairs Medical Center (N.R., C.W.), Denver, Colorado 80045 Search for other works by this author on: University of Colorado School of Medicine, and Denver Veterans Affairs Medical Center (N.R., C.W.), Denver, Colorado 80045 Search for other works by this author on: Department of Medicine, Division of Transplant Surgery, and Department of Surgery (I.K.), Denver, Colorado 80045 Search for other works by this author on: Division of Endocrinology (E.H., S.S., J.G., R.M.H., E.C., N.R., C.W., B.D.), Denver, Colorado 80045 Address all correspondence and requests for reprints to: Boris Draznin, M.D., Ph.D, University of Colorado, Denver, School of Medicine, Division of Endocrinology, Metabolism, and Diabetes, MS 8106, 12801 East 17th Avenue, RC1 South RM 7103, Aurora, Colorado 80045. Search for other works by this author on: The Journal of Clinic Continue reading >>

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