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Insulin Sensitivity Factor Uk

Associations Of Reallocating Sitting Time Into Standing Or Stepping With Glucose, Insulin And Insulin Sensitivity: A Cross-sectional Analysis Of Adults At Risk Of Type 2 Diabetes

Associations Of Reallocating Sitting Time Into Standing Or Stepping With Glucose, Insulin And Insulin Sensitivity: A Cross-sectional Analysis Of Adults At Risk Of Type 2 Diabetes

Objective To quantify associations between sitting time and glucose, insulin and insulin sensitivity by considering reallocation of time into standing or stepping. Participants Adults aged 30–75 years at high risk of impaired glucose regulation (IGR) or type 2 diabetes. 435 adults (age 66.8±7.4 years; 61.7% male; 89.2% white European) were included. Methods Participants wore an activPAL3 monitor 24 hours/day for 7 days to capture time spent sitting, standing and stepping. Fasting and 2-hour postchallenge glucose and insulin were assessed; insulin sensitivity was calculated by Homeostasis Model Assessment of Insulin Secretion (HOMA-IS) and Matsuda-Insulin Sensitivity Index (Matsuda-ISI). Isotemporal substitution regression modelling was used to quantify associations of substituting 30 min of waking sitting time (accumulated in prolonged (≥30 min) or short (<30 min) bouts) for standing or stepping on glucose regulation and insulin sensitivity. Interaction terms were fitted to assess whether the associations with measures of glucose regulation and insulin sensitivity was modified by sex or IGR status. Results After adjustment for confounders, including waist circumference, reallocation of prolonged sitting to short sitting time and to standing was associated with 4% lower fasting insulin and 4% higher HOMA-IS; reallocation of prolonged sitting to standing was also associated with a 5% higher Matsuda-ISI. Reallocation to stepping was associated with 5% lower 2-hour glucose, 7% lower fasting insulin, 13% lower 2-hour insulin and a 9% and 16% higher HOMA-IS and Matsuda-ISI, respectively. Reallocation of short sitting time to stepping was associated with 5% and 10% lower 2-hour glucose and 2-hour insulin and 12% higher Matsuda-ISI. Results were not modified by IGR status Continue reading >>

Clinical Recommendations In The Management Of The Patient With Type 1 Diabetes On Insulin Pump Therapy In The Perioperative Period: A Primer For The Anaesthetist

Clinical Recommendations In The Management Of The Patient With Type 1 Diabetes On Insulin Pump Therapy In The Perioperative Period: A Primer For The Anaesthetist

Clinical recommendations in the management of the patient with type 1 diabetes on insulin pump therapy in the perioperative period: a primer for the anaesthetist BJA: British Journal of Anaesthesia, Volume 116, Issue 1, 1 January 2016, Pages 1826, H. Partridge, B. Perkins, S. Mathieu, A. Nicholls, K. Adeniji; Clinical recommendations in the management of the patient with type 1 diabetes on insulin pump therapy in the perioperative period: a primer for the anaesthetist, BJA: British Journal of Anaesthesia, Volume 116, Issue 1, 1 January 2016, Pages 1826, Insulin pump therapy is increasingly common in patients with type 1 diabetes. Many of these patients will require surgery at some point in their lifetime. Few doctors will have experience of managing these patients, and little evidence exists to assist in the development of guidelines for patients with insulin pump therapy, undergoing surgery. It is clear that during emergency surgery insulin pump therapy is not appropriate and should be discontinued, but patients undergoing some elective surgery can and should continue insulin pump therapy, without any adverse effect on their blood sugar control, or on the outcome of their surgery. Individual hospitals need to formalize guidance on the management of patients receiving continuous subcutaneous insulin therapy, to allow patients the choice to continue their therapy during surgery. This expert opinion presents anaesthetists with a suggested clinical framework to help facilitate continued insulin pump therapy, during elective surgery and into the postoperative period. Since its introduction in the 1970s insulin pump therapy is being used increasingly in the management of type 1 diabetes, with current estimates of between 20 to 30% of people in North America with type 1 diab Continue reading >>

Insulin Resistance

Insulin Resistance

What medical conditions are associated with insulin resistance? While the metabolic syndrome links insulin resistance with abdominal obesity, elevated cholesterol, and high blood pressure; several other medical other conditions are specifically associated with insulin resistance. Insulin resistance may contribute to the following conditions: Type 2 Diabetes: Overt diabetes may be the first sign insulin resistance is present. Insulin resistance can be noted long before type 2 diabetes develops. Individuals reluctant or unable to see a health-care professional often seek medical attention when they have already developed type 2 diabetes and insulin resistance. Fatty liver: Fatty liver is strongly associated with insulin resistance. Accumulation of fat in the liver is a manifestation of the disordered control of lipids that occurs with insulin resistance. Fatty liver associated with insulin resistance may be mild or severe. Newer evidence suggests fatty liver may even lead to cirrhosis of the liver and, possibly, liver cancer. Arteriosclerosis: Arteriosclerosis (also known as atherosclerosis) is a process of progressive thickening and hardening of the walls of medium-sized and large arteries. Arteriosclerosis is responsible for: Other risk factors for arteriosclerosis include: High levels of "bad" (LDL) cholesterol Diabetes mellitus from any cause Family history of arteriosclerosis Skin Lesions: Skin lesions include increased skin tags and a condition called acanthosis nigerians (AN). Acanthosis nigricans is a darkening and thickening of the skin, especially in folds such as the neck, under the arms, and in the groin. This condition is directly related to the insulin resistance, though the exact mechanism is not clear. Acanthosis nigricans is a cosmetic condition strongly Continue reading >>

Changing Your Bolus Wizard Settings

Changing Your Bolus Wizard Settings

Did You Know: The Bolus Wizard is a feature that calculates an estimated bolus in order to cover any carbohydrates (carbs) you eat or drink or to correct a high blood glucose. Important: Work with your healthcare team to establish your personal settings, which includes your carb ratio, insulin sensitivity, blood glucose (BG) target, and active insulin time. Once these settings are entered, you only need your current BG and carb value (for a meal bolus) for the Bolus Wizard feature to calculate your bolus amount. Note: If you do not enter all the required settings, the MISSING INFO screen appears, listing any missing information. You must program all settings before you can use the Bolus Wizard feature. After you enter all your settings, review them for accuracy. 9404039-012 20110713 Continue reading >>

All You Need To Know About Insulin Sensitivity Factor

All You Need To Know About Insulin Sensitivity Factor

Insulin is a hormone that plays an important role in the body's metabolism by controlling blood sugar levels and other processes. It is produced by beta cells in the pancreas and released it into the bloodstream after we eat to enable some body cells, such as muscle, fat, and heart cells, to absorb the sugar from the food we eat. Insulin also helps store glucose in the liver as glycogen when it is not needed, so it can be released when blood sugar levels are low or when more energy is needed. Therefore, insulin is essential for regulating blood sugar, ensuring that levels remain within certain limits and do not climb too high or fall too low. What is insulin sensitivity factor? Insulin sensitivity factor, or correction factor, refers to the number of milligrams per deciliter (mg/dl) fall in blood sugar levels caused by taking 1 unit of insulin. Knowing this number can help people with type 1 diabetes lower their blood sugar levels when they are out of their target range. This is usually added to the premeal insulin dose and is based on how much higher the person's blood sugar level is compared to their target. Target blood sugar levels need to be determined in discussions with a doctor. According to the American Diabetes Association, they should be as close as possible to healthy non-diabetic levels of: Between 70 and 130 mg/dl before a meal No higher than 180 mg/dl up to 2 hours after a meal Insulin treatment plans vary, but most people with type 1 diabetes are now on a basal-bolus insulin routine. A basal-bolus insulin routine involves injecting a longer-acting form of insulin to keep blood sugar levels stable between meals and when sleeping and injections of faster-acting insulin to cover meals. For people on a pump, an amount of fast-acting insulin is delivered thro Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Overview Diabetes is a lifelong condition that causes a person's blood sugar level to become too high. The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood There are two main types of diabetes: type 1 – where the pancreas doesn't produce any insulin type 2 – where the pancreas doesn't produce enough insulin or the body's cells don't react to insulin These pages are about type 2 diabetes. Read more about type 1 diabetes. Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear after birth. Symptoms of diabetes The symptoms of diabetes occur because the lack of insulin means glucose stays in the blood and isn't used as fuel for energy. Your body tries to reduce blood glucose levels by getting rid of the excess glucose in your urine. Typical symptoms include: feeling very thirsty passing urine more often than usual, particularly at night feeling very tired weight loss and loss of muscle bulk See your GP if you think you may have diabetes. It's very important for it to be diagnosed as soon as possible as it will get progressively worse if left untreated. Causes of type 2 diabetes Type 2 diabetes occurs when the body doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. This means glucose stays in the blood and isn't used as fuel for energy. Type 2 diabetes is often associated with obesity and tends to be diagnosed in older people. It's far more common than type 1 diabetes. Treating type 2 diabetes As type 2 diabetes usually gets worse, you may eventually need medication – usually tablets – to keep your blood glucose at normal levels. Complications of type 2 diabetes Diabetes can cause serious long-term heal Continue reading >>

What’s Your Insulin Sensitivity Factor?

What’s Your Insulin Sensitivity Factor?

Whether you have type 1 or type 2 diabetes, if you’re taking insulin via pump, pen, or syringe, you need to know your “insulin sensitivity factor” or “correction factor.” Without knowing this number, you don’t know how much insulin you need to correct a high blood sugar and risk either going far too low after an injection or simply not going low enough to meet the goal of a healthy blood sugar level. What is an “Insulin Sensitivity Factor”? A ISF (insulin sensitivity factor) is the number of points in your blood sugar by which 1 unit of insulin will reduce your blood sugar. For instance, my ISF is 1:100, which means that if my blood sugar is 200 mg/dL and I want to take a correction dose to bring it down to 125 mg/dL, I would need to take .75 units of insulin. Depending on your level of activity, insulin sensitivity or insulin resistance, your age, your diet, the amount of carbohydrates you consume on a daily basis, and your bodyweight, your ISF could range anywhere from 2 to 200! Children are obviously far more sensitive to insulin than grown adults. Teenagers tend to have higher insulin needs than adults because of growth hormones, and those with type 2 diabetes are more likely to have greater insulin resistance (hence the type 2 diabetes diagnosis). I have worked both with adult type 2 diabetes who had ISF ratios of 1:3 (1 unit drops them 3 points in their blood sugar) and young children who had ISF ratios of 1:150 (1 unit drops them 150 points). How to Determine Your ISF: Gary Scheiner, MS. CDE. explains on page 163 of his book, “Think Like a Pancreas,” that you can actually get a close estimate of your ISF based on your total daily insulin usage in this chart on the right. But don’t stop there simply with the number you get from the chart on t Continue reading >>

Changes In Insulin Sensitivity In Response To Different Modalities Of Exercise: A Review Of The Evidence

Changes In Insulin Sensitivity In Response To Different Modalities Of Exercise: A Review Of The Evidence

Type 2 diabetes is an increasingly prevalent condition with complications including blindness and kidney failure. Evidence suggests that type 2 diabetes is associated with a sedentary lifestyle, with physical activity demonstrated to increase glucose uptake and improve glycaemic control. Proposed mechanisms for these effects include the maintenance and improvement of insulin sensitivity via increased glucose transporter type four production. The optimal mode, frequency, intensity and duration of exercise for the improvement of insulin sensitivity are however yet to be identified. We review the evidence from 34 published studies addressing the effects on glycaemic control and insulin sensitivity of aerobic exercise, resistance training and both combined. Effect sizes and confidence intervals are reported for each intervention and meta-analysis presented. The quality of the evidence is tentatively graded, and recommendations for best practice proposed. © 2013 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons, Ltd. Introduction Diabetes is responsible for over one million amputees worldwide each year, is a major cause of blindness and is the largest cause of kidney failure in the developed world [1]. The prevalence of type 2 diabetes (T2D) is alarming. In 2010, 285 million people worldwide were classified as suffering with the disease, a figure that is expected to rise to 438 million by 2030 [2]. Latest available figures indicate that 8.3% of the US population [3] and 5.1% of the UK population have the disease [4]. In 2010, the estimated cost of treatment in the UK was £3.5bn per year [5], with US costs estimated at $174bn in 2007 [3]. Type 2 diabetes is characterized by elevated glucose levels in circulating blood, caused by impairment Continue reading >>

Insulin Resistance And Weight Gain

Insulin Resistance And Weight Gain

Hormones are powerful and you should not take them lightly. Several hormones may either speed-up or impede your weight loss success. Insulin is one such hormone. Resistance to insulin causes diabetes and weight gain. Escaping insulin resistance can give you control over your blood sugar and your weight too! What is Insulin? But, what is insulin? What does it do? Insulin is a hormone released by your pancreas - an organ in your abdomen. When you eat, your body senses that and signals your pancreas to release insulin. Your body releases insulin in response to glucose, amino acids and fats in your meals (1-3). But, its secretion is highest when you eat sugary foods. What Does Insulin Do? After its release, insulin assists the entry of glucose from your food into your body cells. Think of insulin as a key that unlocks the door for glucose to enter into your body cells. When your system gets loaded with glucose, it causes a shift in your metabolism. It slows down the breakdown of fat. More importantly, it starts the synthesis of new fat. Insulin redirects excess glucose into fat cells and triggers ‘adipogenesis’- synthesis of fat (4-7). No wonder sugary stuff is so fattening! Insulin Sensitivity vs. Insulin Resistance Insulin sensitivity is the term for how your body responds to insulin. If your body is ‘sensitive’ to insulin, it means everything is on the right track. The key is turning the locks just fine and there is no need to worry. But, things become different when ‘resistance’ replaces ‘sensitivity’. When you become resistant to insulin, it means the key is not turning the locks the way it is supposed to. Glucose is not entering into the cells and fat synthesis is on the rise (8). Insulin Resistance - Cause or Consequence? The link between insulin resi Continue reading >>

What’s A Correction Factor? An Insulin Sensitivity? A Ratio?

What’s A Correction Factor? An Insulin Sensitivity? A Ratio?

Share: A Correction Factor (sometimes called insulin sensitivity), is how much 1 unit of rapid acting insulin will generally lower your blood glucose over 2 to 4 hours when you are in a fasting or pre-meal state. However, you should keep in mind: this is an estimate it may need to change as your baseline dose changes expect variations - sometimes 1 unit will lower it by more, and other times 1unit will lower it by less! calculating how much 1 unit of insulin will drop your blood sugar is a trial and error process, and sensitivity to insulin varies with the individual To get your total daily dose, add up all your usual meal time insulin and basal insulin. For example, Tom wants to calculate his correction factor: daily insulin dose: 8 units at breakfast, 6 units at lunch,10 at dinner and N/NPH 8 units at breakfast and 18 units at 10 pm Total Daily Dose (TDD) = 8 + 8 + 6+ 10 + 18 = 50 Correction Factor (CF) = 100/50 = 2 Therefore, one unit of rapid acting insulin would lower Tom’s blood sugar by 2 mmol/L over the next 2 to 4 hours. The average adult needs approximately 1 unit of insulin for every 2 mmol increase in blood sugar, but this can vary a lot between individuals: some people need 1 unit of insulin for every 1 mmol/L increase in blood sugar others need 1 unit of insulin for every 3 -5 mmol/L increase in blood sugar Using your CF before meal doses Before meal means there has been about 4 hours or more since you last ate or took an insulin dose for carbohydrate containing food or beverage. The correction factor or insulin sensitivity can be used to make a scale for pre meal insulin doses. BG Breakfast Lunch Dinner Bed Basal < 3.9 -2 -2 -2 Snack 4.0 - 5.9 Baseline Baseline Baseline Baseline Baseline 6.0 - 7.9 Baseline Baseline Baseline Baseline Baseline 8.0 – 9.9 Continue reading >>

Insulin Resistance, The Metabolic Syndrome, And Incident Cardiovascular Events In The Framingham Offspring Study

Insulin Resistance, The Metabolic Syndrome, And Incident Cardiovascular Events In The Framingham Offspring Study

The metabolic syndrome and insulin resistance have been related to incident cardiovascular disease (CVD), but it is uncertain if metabolic syndrome predicts CVD independent of insulin resistance. Our study sample included 2,898 people without diabetes or CVD at baseline. Metabolic syndrome was defined by the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) criteria. Insulin resistance was defined by the homeostasis model assessment (HOMA-IR) and by Gutt et al.’s insulin sensitivity index (ISI0,120). Age- and sex-adjusted proportional hazards regression models assessed the association of baseline metabolic syndrome and insulin resistance to 7-year CVD risk (186 events). Metabolic syndrome and both measures of insulin resistance were individually related to incident CVD (age- and sex-adjusted hazard ratio [HR] for metabolic syndrome [present versus absent]: 2.0 [95% CI 1.5–2.6], P = 0.0001; for HOMA-IR: 1.9 [1.2–2.9], P = 0.003; and for ISI0,120 [both highest versus lowest quartile]: 0.5 [0.3–0.7], P = 0.001). In models adjusted for age, sex, LDL cholesterol, and smoking status and including metabolic syndrome, ISI0,120 levels were independently related to incident CVD (0.5 [0.3–0.8], P = 0.004), whereas HOMA-IR levels were not (1.3 [0.8–2.1], P = 0.24); metabolic syndrome was associated with increased CVD risk in both models (HR 1.6, P ≤ 0.007 in both). In conclusion, metabolic syndrome and ISI0,120 but not HOMA-IR independently predicted incident CVD. Metabolic syndrome may not capture all the CVD risk associated with insulin resistance. The National Cholesterol Education Program (NCEP) definition of the metabolic syndrome was proposed as a pra Continue reading >>

Insulin Sensitivity Factor

Insulin Sensitivity Factor

The drop in blood glucose level, measured in milligrams per deciliter (mg/dl), caused by each unit of insulin taken. Knowing their insulin sensitivity factor can help people with Type 1 diabetes to determine the dose of short-acting or rapid-acting insulin to take. Health-care professionals use the “1500 rule” to calculate insulin sensitivity factor for people who use Regular (short-acting) insulin. The 1500 rule works as follows: Divide 1500 by the total daily dose of Regular insulin, in units. For example, if a person’s total daily dose is 30 units of Regular insulin, his insulin sensitivity factor would be 50 (1500 ÷ 30). So one unit of Regular insulin would be estimated to lower his blood glucose by 50 mg/dl. Health-care professionals use the “1800 rule” to calculate insulin sensitivity factor for people who use the rapid-acting insulin analogs lispro (brand name Humalog), aspart (NovoLog), and glulisine (Apidra). This is done by dividing 1800 by the total daily dose of rapid-acting insulin. If the total daily insulin dose is 40 units, the insulin sensitivity factor would be 1800 divided by 40, or 45. Insulin sensitivity factor can be calculated only for people with Type 1 diabetes. It cannot be calculated reliably for people with Type 2 diabetes, whose pancreases often still make some insulin and who have varying degrees of insulin resistance. Continue reading >>

Optimum Bolus Wizard Settings In Insulin Pumps In Children With Type 1 Diabetes.

Optimum Bolus Wizard Settings In Insulin Pumps In Children With Type 1 Diabetes.

Diabet Med. 2016 Oct;33(10):1360-5. doi: 10.1111/dme.13064. Epub 2016 Feb 5. Optimum bolus wizard settings in insulin pumps in children with Type 1 diabetes. Faculty of Health and Medical Sciences, University of Copenhagen, Herlev, Denmark. [email protected] Paediatric Department, Copenhagen University Hospital, Herlev, Denmark. Section of Biostatistics, Institute of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. To evaluate current insulin pump settings in an optimally regulated paediatric population using bolus wizard. We used a retrospective study design to analyse data from 124 children on insulin pump therapy who had optimum HbA1c levels [< 59 mmol/mol (< 7.5%)] and no history of severe hypoglycaemic events. Bolus wizard settings were used to calculate the insulin to carbohydrate factors and insulin sensitivity factors. Multiple regression analysis was used to analyse the variables associated with the calculation factors. Insulin to carbohydrate factor varied from 276 in the youngest group to 424 in the oldest group, and increased according to age. Insulin sensitivity factor was highest in the group aged 6 to < 12 years, with a value of 125. Age, amount of carbohydrates, number of boluses per day and insulin per kg were all significantly associated with both calculation factors. Furthermore, duration of insulin pump treatment was significantly associated with insulin sensitivity factor and percentage bolus/basal was significantly associated with insulin to carbohydrate factor. Gender, diabetes duration and BMI were not associated with any of the calculation factors. Optimum insulin pump settings at pump initiation depend on both insulin requirements and use of the pump. Settings need to be individualized Continue reading >>

Formula To Determine Bg Mmol/l Change Per Unit Of Insulin

Formula To Determine Bg Mmol/l Change Per Unit Of Insulin

Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Formula to determine BG mmol/l change per unit of insulin Discussion in ' Insulin ' started by andybraith , Jun 1, 2017 . Hi all, has anyone used a formula to work out BG change per unit of insulin for a T1D? I know the effect of a unit of insulin will, potentially, be different depending on many factors (age, time of diagnosis, current state of pancreas and any remains beta cells etc...). I have always been told that the general rule of thumb is 1 unit changes blood glucose by 3 mmol/l. However, the more I consider this the more I think this is, as described, a rule of thumb and we should calculate this, perhaps from TDD which takes into account our weight. Any thoughts on this would be appreciated! If the ratio between insulin and change in BG is incorrect then all meal carb counting and corrections will be causing BGs to fluctuate. One other thing I find confusing is that if we are more sensitive to insulin in the morning then why does the 1 unit:3mmol/l change apply all day?!? Hi @andybraith your questions are totally valid and absolutely right. The 1u:3mmol/l ISF value is a totally arbitrary number (based on the rule of 100 ) that is really a starting point. As you see on a pump, you have the ability to set different ISF and Insulin Carb Ratios for different periods of the day. This is why it's really important to understand whether your basal levels are correct by doing a basal test, then following that up with a Correction Factor (or Insulin Sensitivity Factor) test and an Insulin Carb Ratio test for different times of the day. So to sum up, yes, the start is really just that and you need to adjust for yourself around those numbers, and yes mos Continue reading >>

Fat And Protein Counting In Type 1 Diabetes

Fat And Protein Counting In Type 1 Diabetes

The prevalence of obesity in type 1 diabetes is increasing and may be exacerbated by the use of an intensive insulin therapy regimen which improves glycaemia but is associated with weight increase. There are a plethora of diets and weight loss programmes to choose from, but balancing the insulin doses to achieve good glycaemic control is challenging. Mealtime insulin doses are traditionally calculated to match the amount of carbohydrate in the meal but evidence, particularly from continuous glucose monitoring, suggests that protein and fat can also have an effect on postprandial glycaemia. This article looks at the effect of fat and protein on the glycaemic response of a meal, alternative algorithms to calculate the bolus doses, their timing and delivery, and considers their effectiveness in supporting weight loss in overweight or obese individuals with type 1 diabetes. Introduction There are 3.5 million people diagnosed with diabetes in the UK: 6.25% of the adult population. Ten percentof these have type 1 diabetes. In other words, there are over 300 000 adults and approximately 44 000 children under 19 years diagnosed with type 1 diabetes in the UK.1 The majority of these people are treated with intensive insulin therapy (IIT), either a multiple daily injection (MDI) regimen or continuous subcutaneous insulin infusion (CSII) therapy. Both therapies require the patient to use variable insulin dosing, usually calculated to match the carbohydrate component of the meal. The DCCT/EDIC study showed that this approach improved overall glycaemic control compared to conventional insulin therapy in patients with type 1 diabetes and reduced the risk of non-fatal myocardial infarction, stroke or cardiovascular death by 57%.2 However, the IIT group also gained an average of 4.6kg Continue reading >>

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