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Should Insulin Be Capitalized

Enhanced Glycemic Control With Combination Therapy For Type 2 Diabetes In Primary Care

Enhanced Glycemic Control With Combination Therapy For Type 2 Diabetes In Primary Care

Go to: Globally, the World Health Organization (WHO) reports that as many as 220 million individuals have diabetes.1 The Framingham Offspring Study database indicates that the incidence of type 2 diabetes mellitus (DM2) has doubled in the US from the 1970s through the 1990s.2 In the US, it was estimated in 2010 that nearly 26 million individuals had diabetes, of which 7.0 million (27%) were undiagnosed.3 Furthermore, the prevalence of diabetes (driven largely by DM2) is projected to reach 12.0% by 2050, affecting more than 48 million individuals.4 Disconcertingly, almost half of deaths in this population occur before the age of 70 years, and the WHO projects that the number of diabetes deaths will double between 2005 and 2030. Clinicians also increasingly recognize the additional burden of DM2 in children and adolescents.5 Most patients with DM2 are appropriately managed within the primary care sector, with the occasional need for consultation by diabetologists. Since DM2 is associated with increased mortality, increased risk of macrovascular disease (ie, stroke and myocardial infarction), and increased microvascular disease (ie, retinopathy, nephropathy, and neuropathy), there are numerous challenges worthy of intervention for risk reduction. Healthy diet, regular physical activity, maintaining a normal body weight, and avoiding tobacco use can prevent or delay the onset of diabetes. Good control of glucose (glycated hemoglobin A1c [HbA1c] >7%) in patients with DM2 has been shown to reduce microvascular disease and improve quality of life.6 Despite the salutary effects attributable to good glucose control, only about half of patients with diabetes are at the currently recognized treatment goal.7 In addition to glycemic control, comprehensive DM2 care requires attention Continue reading >>

Diabetologia Style Guide

Diabetologia Style Guide

This style guide is intended to be an evolving document to help make your copy-editing more efficient and to maintain consistency. If you come across an item that isn't covered or needs updating, please email us at [email protected] We recommend that you view this guide using Mozilla, as some formatting (e.g. small capitals) is not recognised in Internet Explorer. Download Mozilla free here This section gives a basic outline of what tasks are required for each article. More detailed information on each point is given elsewhere in the style guide. In this section: Timing Please acknowledge receipt of articles sent for copy-editing and let us know whether you can take them. We normally request that articles be returned within 3 working days. Please let us know if you need any significant extension to this. General The text should be edited for accuracy, clarity and consistency, following the style guide. In general, retain the author's style but make changes to assist readability. PerfectIt should be used as a pre- or post-editing tool. Let us know if you have any problems with this. Papers for copy-editing will have words or parts of words highlighted in pink to help you identify words or phrases that may need attention (see guide to pre-editing checks for details). Please complete an author query form for each article with a list of queries to be passed on to the author. Please also complete the copy-editor's checklist and note any queries for the attention of the Editorial Office. Data Please cross-check all data in the paper, where possible. In particular, check that results reported in the Abstract are consistent with the rest of the paper and are rounded correctly; similarly, cross-check data reported in the Results to the figures and tables, as appropria Continue reading >>

Insulin: A Primer

Insulin: A Primer

Authors Jay H. Shubrook, DO, FACOFP, FAAFP, Associate Professor of Family Medicine, Director, Diabetes Fellowship Program, The Diabetes Institute at Ohio University Nancy Mora Becerra, MD, Ohio State University, Columbus, OH Sarah E. Adkins, PharmD, BCACP, Faculty, The Ohio State University College of Pharmacy; Assistant Professor of Pharmacology, Ohio University Heritage College of Medicine, Athens, OH Aili Guo, MD, Assistant Professor of Specialty Medicine, Ohio University Heritage College of Osteopathic Medicine Peer Reviewer Jeff Unger, MD, ABFP, FACE, Director, Unger Primary Care Concierge Medical Group, Rancho Cucamonga, CA Executive Summary Patients starting on insulin in the ED should be started on a basal insulin 0.1-0.2 U/kg. Patients being treated for acute hyperglycemia (not previously on insulin) should receive 2 U for every 50 mg/dL elevation of glucose over 150 mg/dL. Patients who present acutely ill with an active insulin pump should have the pump turned off and supplemental insulin given IV. Patients who present with unexplained hypoglycemia should have a c-peptide and insulin level drawn. High insulin levels without equal elevation of c-peptide suggest exogenous insulin administration. Introduction Prior to the discovery of insulin, type 1 diabetes was a uniformly fatal disease. The first use of exogenous insulin in a dog by Banting and Macloed resulted in the Nobel Prize in Physiology or Medicine.1 In January 1922, they injected exogenous insulin in a 14-year-old boy who was dying at the Toronto General Hospital. After receiving the insulin he desperately needed, he improved and by the end of that month his glucosuria and ketonuria normalized.1 Initially, bovine and porcine insulins were purified from animal pancreatic tissues and were used to treat p Continue reading >>

Review Of Basal‐plus Insulin Regimen Options For Simpler Insulin Intensification In People With Type 2 Diabetes Mellitus

Review Of Basal‐plus Insulin Regimen Options For Simpler Insulin Intensification In People With Type 2 Diabetes Mellitus

Go to: Abstract To identify simple insulin regimens for people with Type 2 diabetes mellitus that can be accepted and implemented earlier in primary and specialist care, taking into consideration each individual's needs and capabilities. Methods Using randomized clinical trials identified by a search of the PubMed database, as well as systematic reviews, meta‐analyses and proof‐of‐concept studies, this review addresses topics of interest related to the progressive intensification of a basal insulin regimen to a basal‐plus regimen (one basal insulin injection plus stepwise addition of one to three preprandial short‐acting insulin injections/day) vs a basal‐bolus regimen (basal insulin plus three short‐acting insulin injections per day) in people with Type 2 diabetes. The review explores approaches that can be used to define the meal for first prandial injection with basal‐plus regimens, differences among insulin titration algorithms, and the importance of self‐motivation and autonomy in achieving optimum glycaemic control. A basal‐plus regimen can provide glycaemic control equivalent to that obtained with a full basal‐bolus regimen, with fewer injections of prandial insulin. The first critical step is to optimize basal insulin dosing to reach a fasting glucose concentration of ~6.7 mmol/l; this allows ~40% of patients with baseline HbA1c >75 mmol/mol (9%) to be controlled with only one basal insulin injection per day. Compared with a basal‐bolus regimen, a basal‐plus insulin regimen is as effective but more practical, and has the best chance of acceptance and success in the real world. Continue reading >>

Guidelines For Formatting Gene And Protein Names

Guidelines For Formatting Gene And Protein Names

Within articles describing genetic studies, it is often difficult for readers to determine whether the authors are referring to a gene or its corresponding protein. This can be problematic when readers are trying to understand the details of complex molecular systems and the methodology used by the authors to probe those systems. To reduce this potential source of confusion for both peer reviewers and the larger audience of your published article, it is important to use accepted formatting conventions for gene and protein symbols in a consistent manner throughout your manuscript. General formatting and writing guidelines When possible, to reduce the proliferation of duplicative gene names, always use standard gene names and symbols, which can be found in community databases that are specific to particular organisms (e.g., human: www.genenames.org; rat: rgd.mcw.edu; mouse: www.informatics.jax.org; zebrafish: zfin.org; flies: flybase.org; worms: www.wormbase.org). The use of standard gene names and symbols is often specifically required by scientific and medical journals. If a gene does not yet have an approved name or symbol, it may be possible to propose new name or symbol designations to the relevant database or its professional association. In general, symbols for genes are italicized (e.g., IGF1), whereas symbols for proteins are not italicized (e.g., IGF1). The formatting of symbols for RNA and complementary DNA (cDNA) usually follows the same conventions as those for gene symbols. If many genes are listed together in a table, it is usually up to the authors’ (or the journal’s) discretion as to whether they should be italicized. Gene names that are written out in full are not italicized (e.g., insulin-like growth factor 1). Genotype designations should be italic Continue reading >>

Pumper’svoice

Pumper’svoice

Lighten Your Lows Pump therapy can help you avoid hypoglycemia Hypoglycemia has been called the greatest limiting factor in intensive diabetes management. Were it not for the risk of hypoglycemia, we could simply load up on insulin and keep blood sugars from ever rising too high. Unfortunately, hypoglycemia does exist, and it creates a number of problems for those of us who take insulin: risk of accidents, seizures and loss of consciousness; rebound highs; impaired intellectual and physical performance; unwanted weight gain; and worsening of hypoglycemia unawareness. It is not realistic to achieve tight blood glucose control without any episodes of hypoglycemia. However, we should make every effort to minimize the frequency and severity of lows. To do this, we need to do everything possible to match the insulin we need with the insulin we take. After all, it is the simple act of taking too much insulin that is the root cause of hypoglycemia. One of the main advantages offered by insulin pump therapy is the ability to closely mimic the actions of a healthy pancreas. There are a number of reasons why pump users tend to experience fewer and less severe bouts of hypoglycemia compared to those on injections. First is the ability to carefully match basal insulin to the body’s needs. Long-acting insulin (NPH, Lantus, Levemir) cannot be adjusted and fine-tuned the way basal insulin delivered with a pump can. Most people need extra basal insulin at certain times of day and less at others. Injected long-acting insulin does not usually provide a drop-off in the insulin level when less basal insulin is needed, and thus sets a person up for low blood sugar. But the pump’s basal insulin delivery can be reduced at times of day when less insulin is needed. Pumps also allow for temp Continue reading >>

Future Prospect Of Insulin Inhalation For Diabetic Patients: The Case Of Afrezza Versus Exubera

Future Prospect Of Insulin Inhalation For Diabetic Patients: The Case Of Afrezza Versus Exubera

Abstract The current review was designed to compare between the insulin inhalation systems Exubera and Afrezza and to investigate the reasons why Exubera was unsuccessful, when Afrezza maker is expecting their product to be felicitous. In January 2006, Pfizer secured FDA and EC approval for the first of its kind, regular insulin through Exubera inhaler device for the management of type 1 and 2 diabetes mellitus (DM) in adults. The product was no longer available to the market after less than two years from its approval triggering a setback for competitive new inhalable insulins that were already in various clinical development phases. In contrary, Mannkind Corporation started developing its ultra-rapid-acting insulin Afrezza in a bold bid, probably by managing the issues in which Exubera were not successful. Afrezza has been marketed since February, 2015 by Sanofi after getting FDA approval in June 2014. The results from this systematic review indicate the effectiveness of insulin inhalation products, particularly for patients initiating insulin therapy. Pharmaceutical companies should capitalize on the information available from insulin inhalation to produce competitive products that are able to match the bioavailability of subcutaneous (SC) insulin injection and to deal with the single insulin unit increments and basal insulin requirements in some diabetic patients or extending the horizon to inhalable drug products with completely different drug entities for other indications. Copyright © 2015. Published by Elsevier B.V. Continue reading >>

Lecture 2: How To Write Drug Dosages

Lecture 2: How To Write Drug Dosages

In order to write and read drug orders or prescriptions, we need to know how they should be written. Because it is so important to minimize the chance that someone might misread a drug order, there are specific units of measure, abbreviations, and rules for writing orders that must be used. In this section, we will learn what these rules are and practice using them in example drug orders. The Metric System The most commonly used system of measurement in the medical profession is the metric system. It is the most modern system and is preferred because all units of measure come in powers of 10, making it easy to convert from one unit to another. Metric system units of measure : weight length volume grams g meters m liters L milligrams mg 1000 mg = 1 g micrograms mcg (μg) 1000 mcg = 1 mg Do NOT use μg for micrograms--use mcg instead! centimeters cm milliliters mL 1000 mL = 1 L cubic centimeters (cc) are milliliters (1 cc = 1 mL) Do NOT use cc for cubic centimeters--use mL instead! In the above table we can see the basic units of measurement for each category, along with the abbreviations for each unit. In this table we have included some older abbreviations for micrograms and milliliters (or cubic centimeters) that used to be common, but that should no longer be used. These outdated abbreviations are included because you may still encounter them on drug labels or syringes, and because it is important to be aware when reading drug orders that some doctors may use outdated abbreviations--if you see any of these abbreviations when reading a drug order, it is a good idea to question the drug order, just to be sure! Some other metric units: Most drug dosages are measured by weight in grams, milligrams or micrograms; however certain special drugs have other metric units that m Continue reading >>

Insulin: Its History And Future

Insulin: Its History And Future

Learn about the invention of the life-saving drug insulin, and what the future holds in store. We all know that without insulin, those of us with type 1 diabetes would slowly starve to death. Our bodies don't make insulin, so we can't process the food we eat properly and get energy and nutrients from it. In this article, I'll talk about the development of insulin, as well as how insulin is used right now in diabetes treatment. At the end, I'll talk a little about the future of insulin and type 1 diabetes. History of Insulin and Diabetes Before insulin became available, children routinely were fed a cup of cooking oil a day because that was thought to help them process food. The results were as you imagine. The archives of Joslin Diabetes Center, where Elliott P. Joslin, MD, was one of the first Americans to use insulin, are replete with before and after pictures of children who looked at death’s door one month, and months later appeared to be healthy normal children. Insulin was greeted as a cure for diabetes; however, today we know that it can only control the disease, and with extended life comes a long list of long-term complications. Diabetes was first described and named by Aratacus of Cappadocia in Asia Minor in the first century AD. The name came from the analogy that diabetics' urine was like water coming through a siphon. The sweet smell of the urine of diabetics was first noted in the 17th century by the Oxford physician, Thomas Willis, but ancient Indians in the 4th century are said to have noted ants congregating at the urine of diabetics. Attempts at treatment began when no more was known about diabetes than the polyuria. John Rollo, Surgeon-General to the Royal Artillery treated a patient by dietary restriction in 1706. The great figure in the story of d Continue reading >>

Lantus Patient Information Including Side Effects

Lantus Patient Information Including Side Effects

Brand Names: Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen Generic Name: insulin glargine (Pronunciation: IN su lin AS part, IN su lin AS part PRO ta meen) What is the most important information I should know about insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? What should I discuss with my healthcare provider before using insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? What is insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Insulin glargine is a man-made form of a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. Insulin glargine is a long-acting form of insulin that is slightly different from other forms of insulin that are not man-made. Insulin glargine is used to treat type 1 or type 2 diabetes. Insulin glargine may also be used for purposes not listed in this medication guide. What are the possible side effects of insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Get emergency medical help if you have any of these signs of insulin allergy: itching skin rash over the entire body, wheezing, trouble breathing, fast heart rate, sweating, or feeling like you might pass out. Hypoglycemia, or low blood sugar, is the most common side effect of insulin glargine. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar. Tell your doctor if you have itching, swelling, redness, or thickening of the skin where you inject insulin glargine. This is not a complete list of side effects and others may occur. Call Continue reading >>

Biodel Primed To Capitalize On Next Generation Treatments In The $10b Diabetes Market

Biodel Primed To Capitalize On Next Generation Treatments In The $10b Diabetes Market

Glucose is one of the most important chemical structures because it is essential in providing the body with energy. It is integral in the chemical process called aerobic respiration, which generates a usable form of energy. Glycolysis is the beginning of this process, which oxidizes glucose to form CO2, H20, and adenosine triphosphate (ATP). ATP is a chemical structure that stores energy and transfers it throughout the body. When our bodies have trouble regulating the uptake of glucose into the blood stream, not enough energy is created and distributed to important organs, especially the brain. Since glucose is a necessary chemical in our bodies, problems with the uptake of this chemical can cause major issues. Diabetes is a disease that causes the body to have problems regulating the uptake of glucose in the bloodstream. The uptake of glucose through the blood stream is controlled by a balance between glucose and a peptide hormone released by the pancreas called insulin. The amount of glucose in the blood stream is important because too much glucose can lead to hyperglycemia, but too little can lead to hypoglycemia. Hyperglycemia can lead to blindness, loss of kidney function, and nerve damage while hypoglycemia can result in dizziness, fainting, confusion, and increased heart rate. Since diabetes has become such a prevalent disease, several biotech companies have created therapies to help patients regulate insulin and glucose in the blood stream. Biodel (NASDAQ: BIOD) is one such biotech company that is developing specialized therapies for diabetes. Biodel's lead drug candidate BIOD-123 is a therapy for patients with Type 1 and Type 2 diabetes. Although still in clinical trials, BIOD-123 has the potential to be a better therapy than those currently on the market. The Continue reading >>

How Would You Use Insulin In A Sentence?

How Would You Use Insulin In A Sentence?

The word usage examples above have been gathered from various sources to reflect current and historical usage. They do not represent the opinions of YourDictionary.com. Continue reading >>

As Consumerism Grows, Payers Must Capitalize On Open Enrollment

As Consumerism Grows, Payers Must Capitalize On Open Enrollment

Most Americans have health insurance today, either through an employer, Medicare, Medicaid or the state and federal exchanges, but according to new research from Xerox, only three out of 10 are very confident that their current health plan is the best fit for their family. Understandably so. Enrolling in a health plan in today’s ever-changing healthcare landscape is anything but simple. From deductibles, to copays, to in-network and out-of-network providers, the enrollment process can be frustrating and confusing. In addition, new technology has changed the way people enroll in a health plan altogether, enabling them to shop online for health insurance the same way they would shop for new shoes or books on Amazon. However, the shopping experience is nowhere near as user friendly as what consumers experience with their favorite online retailer. One-click checkout, anyone? In fact, Xerox’s survey, which received more than 2,000 responses from U.S. adults, found that among those who have health insurance (1,937), more than half have experienced one or more challenges with the open enrollment process including frustration with the enrollment process, not understanding their healthcare options and being asked the same information more than once. Why this presents an opportunity for payers As the cost of care continues to rise and provider networks and drug benefits change and evolve, consumers need help understanding their benefit choices and the financial implications that may apply. This is an opportunity for payers to start a dialogue and enhance the member experience—even potentially gain new customers. Though many Americans today are more involved and knowledgeable than ever before about healthcare and are even leveraging technology to make more self-informed deci Continue reading >>

Incorrect Diabetes Terms

Incorrect Diabetes Terms

I am just back from a health conference where I heard too many incorrect terms to wait any longer to make this effort to correct the rest of the world. Several of these terms are “politically incorrect.” One that I have been careful to avoid for years is to label someone who has diabetes as a diabetic. Now, diabetic medications and diabetic foods are fine. But many people who have diabetes actively resist being labeled as a diabetic, as if we were an illness. A correspondent writes, “What I give as an example to doctors and other technical people is: If a person has hemorrhoids, does that make that person one?” Here, I absolutely agree with the American Diabetes Association, which vigorously resists this label, insisting that we are “people with diabetes.” By using the term people with diabetes we follow the general example of “people-first language.” Another term that may or may not be politically incorrect but is certainly objectionable to many people with diabetes is noncompliant. For most of us, to be labeled noncompliant is a worse slander than being called a diabetic. This is particularly true when health care people criticize us for not doing things that they haven’t clearly explained or where we think they are wrong. An endocrinologist friend wisely says, “The ‘noncompliant’ label always grated on me — it’s assuming a model of health care delivery that assumes the doc to be the captain of the ship and the patients to be chained to the oars…” Control is another important issue. People frequently perceive good control as a value judgement. We should replace it with non-emotional terms like “tight control” or “intensive control” or “stringent control” or “aggressive control.” Likewise, poor control is a terribly perjo Continue reading >>

Pramlintide

Pramlintide

Pramlintide Pramlintide is a synthetic soluble form of the naturally occurring hormone, amylin, which is co-secreted with insulin from the β cell. The pharmacologic effects of amylin are complementary to insulin in that they inhibit the inappropriate release of postprandial glucagon and slow gastric emptying. The primary consequence is reduction in postprandial glucose, with modest reductions in overall glycemia (A1c ∼0.33%).64 Pramlintide also induces modest weight loss through control of appetite centers in the brain. As with GLP-1, the counterregulatory hormone response to hypoglycemia is unaltered, and in the absence of other therapies, pramlintide does not cause hypoglycemia. That being said, early clinical trials that did not make anticipatory reductions in insulin dosage demonstrated severe hypoglycemia in some patients with type 1 diabetes. Pramlintide is currently only approved for use in conjunction with basal-bolus insulin regimens in patients with type 1 or type 2 diabetes who are not meeting glycemic targets. Pramlintide is available in a multiuse pen with several dose increments that facilitate titration. For type 2 diabetes, the starting dose is 60 mcg (10 units) subcutaneously before major meals (those exceeding 30 g of carbohydrates), increasing to 120 mcg (20 units) as tolerated. The major side effect is nausea, which can be minimized with slow titration. It is advisable that the prandial insulin dose be decreased by 50% at the initiation of pramlintide, although ultimately, most patients need a smaller decrement. The timing of the prandial insulin dose may also require adjustment, since postprandial glucose levels generally peak later and at a smaller amplitude following pramlintide administration. The drug is contraindicated in patients with gastr Continue reading >>

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