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What Is An Mdi Diabetes?

Type 2 Diabetes Patients On Mdi Insulin Therapy Can Benefit From Cgm Use, Study Shows

Type 2 Diabetes Patients On Mdi Insulin Therapy Can Benefit From Cgm Use, Study Shows

DexCom, Inc., announced today the publication of a new study that shows people with Type 2 diabetes on a multiple daily injection (MDI) insulin therapy benefit from the use of continuous glucose monitoring (CGM). Participants in the study achieved significant A1C reduction and spent more time in range, regardless of age, education or math ability. The findings are the result of the DIaMonD study (Multiple Daily Injections and Continuous Glucose Monitoring in Diabetes), which assessed the impact of CGM on glycemic control in individuals with Type 2 diabetes on MDI insulin therapy. Results from a parallel arm of the study using participants with Type 1 diabetes were published in January 2017. "This study represents a significant step forward for the diabetes community," said Roy Beck, MD, lead study investigator from the Jaeb Center for Health Research. "The results allow us to confidently tell people with Type 2 diabetes using insulin they can use CGM to take control of their disease and make better treatment decisions." Published today in the Annals of Internal Medicine, the study showed: After 24 weeks participants with Type 2 diabetes using CGM while on MDI insulin therapy averaged a 0.8 percent A1C reduction compared to baseline (changes in A1C are measured as absolute percent changes; in this case, a reduction from an average baseline A1C of 8.5% to 7.7%) A subset of this group with an A1C of 9.0 percent or higher saw an average 1.4 percent reduction from baseline at week 24 The CGM group also decreased time in hyperglycemia and increased time spent in the target range compared to the control group (use of only a standard meter to test glucose) The CGM group increased time in range by 1.3 hours compared to baseline, and 0.6 hours compared to the control group The A1 Continue reading >>

Multilple Daily Injections | Medtronic Hcp Portal

Multilple Daily Injections | Medtronic Hcp Portal

THE PAIN AND ANXIETY ASSOCIATED WITH MULTIPLE DAILY INJECTIONS MDI - MULTIPLE DAILY INJECTIONS FOR DIABETES PATIENTS Multiple Daily Injections (MDI) is the first line of diabetes treatment in Europe. It is defined as: the administration of 3/more insulin injections/day. This includes one injection of long-acting insulin (24h hours active) in the evening and an injection of rapid or short-acting insulin before each meal. On this regimen, the physiologic replacement of mealtime insulin secretion is administered three times a day using rapid or short-acting insulin. These injections are given before meals and are typically adjusted to match food intake using an insulin-to-carbohydrate ratio. When compared to regular insulin, rapid-acting insulin is typically preferred because it provides better physiologic insulin coverage for meals and more closely matches the glucose level rise that occurs in response to meals. The peak action time of rapid-acting insulin occurs at approximately 1-1.5 hours after administration. This correlates well with the digestion of most meals. Continuous Glucose Monitoring IPro2 device - Providing more accurate data Using the blood glucose (BG) method only, you may miss your patients hypoglycaemia or hyperglycaemia events as BG onlyprovidesa momentary reading . By using iPro2 - the only available professional Continuous Glucose Monitoring (CGM) device designed for the masked collection of glucose level data - you will benefit from more precise insights into your patients glycaemic profile. ALTERNATIVES TO MULTIPLE DAILY INJECTIONS (MDI) DIABETES TREATMENT: INSULIN PUMP THERAPY This therapy mimics the functions of a normal pancreas more closely and replaces the need for frequent insulin injections by delivering precise doses of rapid-acting insulin Continue reading >>

To Pump Or Not To Pump

To Pump Or Not To Pump

First fully described in 1983, intensive insulin therapy attempts to match the levels of insulin in the blood with the physiologic needs of the diabetic patient (1). The results of the Diabetes Control and Complications Trial solidified the importance of this approach to the prevention of microvascular complications of diabetes (2). There are two primary approaches to intensive insulin therapy: 1) multiple daily injections (MDI), and 2) continuous subcutaneous insulin infusion utilizing an external insulin infusion pump (CSII). For the last 10 years, a scientific (and often emotional) debate has existed concerning which approach is superior. The answer is important, as it affects the lifestyle, financial reserves, safety, and glucose control of the diabetic patient. Subcutaneous insulin does not reproduce the physiological delivery of insulin to the liver and systemic circulation. In humans, insulin is secreted directly into the hepatic portal vein such that the liver is exposed to higher concentrations of insulin compared with the systemic circulation. The liver subsequently removes ∼50% of this insulin, thereby lowering the exposure of the peripheral tissues to insulin. This differential insulin exposure has physiological ramifications, resulting in very fine control of intermediary metabolism. In contrast, both CSII and MDI deliver insulin subcutaneously, bypassing the liver and entering the systemic circulation. However, an insulin pump has one unique advantage over insulin injections: the ability to program changes in basal insulin dosage to meet an anticipated increase or decrease in need. This feature can be advantageous in controlling the normal rise in blood glucose concentration before breakfast (i.e., the dawn phenomenon) or preventing anticipated hypoglyce Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections

Continuous subcutaneous insulin infusion versus multiple daily injections 1Diabetes Centre, 2nd Propaedeutic Department of Internal Medicine, Aristotle University, Hippokratio General Hospital, Thessaloniki, Greece 22nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippokratio Hospital, Thessaloniki, Greece 3Organ Transplantation Unit, Hippokratio General Hospital, Thessaloniki, Greece Karagianni P, 19, G. Palama street, Thessaloniki, 54622, Tel:2310271108, 6973029192, [email protected] Copyright 2009, Hippokratio General Hospital of Thessaloniki This article has been cited by other articles in PMC. Background and aim: Continuous Subcutaneous Insulin Infusion (CSII) and Multiple Daily insulin Injections (MDI) are both strategies aiming to achieve a tight glycemic and metabolic control. However, the choice between them remains controversial. The aim of the present study was to compare the efficacy of MDI (three or more injections daily) with CSII on glycemic control in patients with Type 1 Diabetes Mellitus and assess satisfaction from treatment in the CSII group. Material and Methods: Seventeen patients with Type 1 Diabetes Mellitus on CSII (previously on MDI) and 17 patients on MDI, matched for age, gender, BMI and duration of diabetes, were retrospectively studied. Glucosylated Hemoglobin A1c (HbA1c), frequency of hypoglycaemias (assessed as self reported episodes), BMI and total units of insulin per day were evaluated at baseline and after 6 months in both groups. CSII group completed a questionnaire concerning motive for treatment selection, advantages, deficiencies and inconvenience at the end of the study. Satisfaction from treatment was assessed with a scale from 0 to10. Results: CSII group had more hypoglycaemic episodes at baseline tha Continue reading >>

Insulin Use - Type 2

Insulin Use - Type 2

Overview Most people with type 2 diabetes will eventually require insulin replacement therapy There are barriers to insulin treatment with multiple daily injections (MDI) Insulin pumps are effective in people with type 2 diabetes, but due to complexity use is limited To overcome insulin delivery barriers, new simple insulin infusion devices have been developed Type 2 diabetes is a progressive disease of insulin resistance and B-cell failure (cells that store and produce insulin) resulting in a continued and progressive need to intensify diabetes therapies to maintain glycemic (blood sugar) control. Eventually most people with type 2 diabetes require insulin replacement therapy. This is generally initiated with basal (background) insulin and, if needed, bolus (mealtime) insulin is introduced to address the high blood sugar after a meal.1 This "basal-bolus" insulin therapy is most frequently administered by multiple daily injections (MDI) with an insulin syringe or pen device. Unfortunately MDI therapy can be challenging and patient compliance and persistence with MDI therapy is frequently inadequate.2 Potential barriers to MDI, which can result in suboptimal glycemic control, include; having to take multiple injections, interference of injections with daily activities, injection pain and embarrassement.2 As a result many people using MDI therapy do not achieve target glycemic control.3 Continuous subcutaneous insulin infusion (CSII) therapy using an insulin pumps addresses many of the barriers associated with MDI therapy and could result in enhanced adherence. In type 1 diabetes, CSII therapy has shown benefits over MDI therapy including improved glycemic control, reduced glycemic variability, higher quality of life and has become standard of care.4,5,6 Several studies h Continue reading >>

Csii Vs Mdi: The Evidence

Csii Vs Mdi: The Evidence

Insulin regimens are traditionally known as conventional, with two injections of mixed insulin, or intensive, in which the basal [background] and bolus [meal] insulin doses are given separately. Intensive insulin therapy has been shown to reduce risk of complications. It can be delivered as multiple daily dose insulin injections (MDI) including long acting basal insulin with boluses of rapid acting insulin given pre-meal, or using continuous subcutaneous insulin infusion [CSII] via an insulin pump. CSII delivers the basal component of the insulin regime via a slow infusion, and the patient can deliver boluses as and when required in addition to this. While both CSII and MDI are effective methods of intensive insulin therapy, they each have advantages and disadvantages. This review evaluates the evidence for both these regimens, highlighting the limitations of the evidence as it currently stands. In MDI, we separate out the basal and bolus components of insulin delivery. Basal insulin, delivered using long acting insulin [NPH, Determir, Glargine, Degludec] provides background insulin and ideally the dose is titrated to keep blood glucose stable if no carbohydrate is consumed. Fast acting insulin [Soluble insulin, Lispro, Aspart, Glulisine] is given pre-meal to cover the carbohydrate content of the meal and correct any readings that may be out of range. The DCCT study from the late 1980s showed that MDI provides tighter glucose control than conventional insulin given with twice daily mixed insulin, with a significant reduction in risk of complications of diabetes [1] . In this study, there was however a penalty to pay in the form of three-fold higher rates of severe hypoglycaemia requiring third party assistance. However, when MDI is used after structured education in fl Continue reading >>

5 Reasons People Ditch The Pump

5 Reasons People Ditch The Pump

We hear a lot about the pros of insulin pump therapy. A diabetes educator shares some of the cons. Integrated Diabetes Services (IDS) provides detailed advice and coaching on diabetes management from certified diabetes educators and dieticians. Insulin Nation hosts a regular Q&A column from IDS that answers questions submitted from the Type 1 diabetes community. Q – I see studies show that people with Type 1 do better on insulin pump therapy, but I sometimes hear of people stopping pump therapy to return to multiple daily injections. Can you tell me why it might be better for some people to stop using a pump? A – There are many more choices for insulin pumps than in the past, and many of these new pumps come with new and powerful technological options to help you with blood sugar management. Many clinicians promote pump use as the best way to achieve optimal control. But is it really the end-all-be-all of diabetes management? As with everything in life, it comes down to personal choice and what works for you. It’s best to do your homework to evaluate if a pump is best for your lifestyle and blood sugar management needs. There are plenty of articles discussing the pros of pump therapy, but few that discuss the cons. To offer some balance, here are some downsides to pump use that have caused people to switch back to multiple daily injections: 1) Mechanical Failure Insulin pens and syringes don’t have mechanical parts – they will not malfunction or have errors. The more technology that is used to deliver insulin, the higher the chance that something can go wrong in a mechanical sense. It doesn’t happen often, but it does happen. I have had several pump failures in 15 years of pump use; all were detected by the pump. Pump problems can include internal errors in Continue reading >>

Counterpoint: Are Insulin Pumps Underutilized In Type 1 Diabetes? No

Counterpoint: Are Insulin Pumps Underutilized In Type 1 Diabetes? No

One of the major goals in the treatment of diabetes is to achieve an HbA1c (A1C) <6.5 or 7.0% (depending on which organization’s guidelines are used) without an unacceptable incidence of hypoglycemia. This goal has not been achieved in many patients with diabetes. The reasons are diverse and often complex. It is appropriate to ask whether placing more patients with type 1 diabetes on insulin pumps (continuous subcutaneous insulin infusion [CSII]) would achieve this goal and be the best use of limited medical resources. Alternatively, resources could be utilized to purchase insulin analogs, to train additional diabetes educators, to transport patients to diabetes centers, or to purchase improved insulin-delivery devices. Some clinicians believe that increasing the number of type 1 diabetic patients on pumps is the best solution (1,2). It has been estimated that at least 160,000 patients in the U.S. were already utilizing insulin pumps in 2001 and >200,000 worldwide (3). This article will address one specific question, i.e., whether a major effort should be made to increase the number of patients on insulin pumps in order to achieve the above-stated A1C goal. Determinants of plasma glucose concentration There are several factors that determine plasma glucose concentration. These include 1) the carbohydrate composition of food, 2) the rate of gastric emptying, 3) the rate of glucose absorption, 4) the concurrent magnitude of endogenous glucose production, 5) the concurrent rate of glucose disposal, 6) the diurnal change in insulin sensitivity, 7) the activity of counterregulatory hormones, 8) the change in the magnitude and type of exercise, and 9) the ambient insulin concentration. It is important to note that most of these factors are not directly under the patient’s Continue reading >>

Comparison Of A Multiple Daily Insulin Injection Regimen (basal Once-daily Glargine Plus Mealtime Lispro) And Continuous Subcutaneous Insulin Infusion (lispro) In Type 1 Diabetes

Comparison Of A Multiple Daily Insulin Injection Regimen (basal Once-daily Glargine Plus Mealtime Lispro) And Continuous Subcutaneous Insulin Infusion (lispro) In Type 1 Diabetes

OBJECTIVE Insulin pump therapy (continuous subcutaneous insulin infusion [CSII]) and multiple daily injections (MDIs) with insulin glargine as basal insulin and mealtime insulin lispro have not been prospectively compared in people naïve to either regimen in a multicenter study. We aimed to help close that deficiency. RESEARCH DESIGN AND METHODS People with type 1 diabetes on NPH-based insulin therapy were randomized to CSII or glargine-based MDI (both otherwise using lispro) and followed for 24 weeks in an equivalence design. Fifty people were correctly randomized, and 43 completed the study. RESULTS Total insulin requirement (mean ± SD) at end point was 36.2 ± 11.5 units/day on CSII and 42.6 ± 15.5 units/day on MDI. Mean A1C fell similarly in the two groups (CSII −0.7 ± 0.7%; MDI −0.6 ± 0.8%) with a baseline-adjusted difference of −0.1% (95% CI −0.5 to 0.3). Similarly, fasting blood glucose and other preprandial, postprandial, and nighttime self-monitored plasma glucose levels did not differ between the regimens, nor did measures of plasma glucose variability. On CSII, 1,152 hypoglycemia events were recorded by 23 of 28 participants (82%) and 1,022 in the MDI group by 27 of 29 patients (93%) (all hypoglycemia differences were nonsignificant). Treatment satisfaction score increased more with CSII; however, the change in score was similar for the groups. Costs were ∼3.9 times higher for CSII. CONCLUSIONS In unselected people with type 1 diabetes naïve to CSII or insulin glargine, glycemic control is no better with the more expensive CSII therapy compared with glargine-based MDI therapy. Insulin substitution in type 1 diabetes is based on mealtime rapid-acting and basal insulin, using multiple daily injections (MDIs) or continuous subcutaneous insulin in Continue reading >>

Insulin Pump Vs Mdi | Diabetic Connect

Insulin Pump Vs Mdi | Diabetic Connect

So my endocrinologist "officially" diagnosed me as type 1 (I think I'm 1.5, but who am I? Lol) Anyways she said I'm a good candidate for an insulin pump and asked if I wanted her to get the paperwork together to send to my insurance company. I sat there and pondered a bit and told her I needed some time to decide. I've been doing research and I know pumps are expensive. I know insurance companies vary but typically how much would someone with insurance have to pay out of pocket? My schedule is pretty crazy, I have to be at work at 5am so I usually take my Lantus at 4:30am, so on my days off I have to wake myself up at 4:30am just to inject myself. (I spread out my the dose for a few days and there was no changes to my numbers) I know insulin pumps give the basal dose at a steady rate throughout the day. So that's a plus in my eyes. But being connected to something all the time doesn't sit right with me. My doctor said my numbers are looking much better and that my a1c is going down (from 9.2 to 7.8) and that the MDI may work for me. So who prefers MDI over Insulin pumps or vice versa? How much more money is it monthly to use an insulin pump? Please do share! I have been using a Medtronic insulin pump for 5 years and have to say I LOVE IT. You can disconnect it for up to 2 hrs to shower or swim and can suspend operation whenever you need to. My Medical Mutual insurance paid 100% of the cost of the pump and it is replaced every 4 years. Medtronic has a 4 yr warranty with excellent customer service. If you ever have a problem with it they overnight you a replacement. My meter also wirelessly sends my BG reading to my pump and then I just bolus what is needed or let it do it for me. My meter also downloads all my numbers to my computer or my doctors so no need to write all Continue reading >>

What Does The Diabetes Term Mdi Mean?

What Does The Diabetes Term Mdi Mean?

Virtually all type 1 diabetics (people with type 1 diabetes) and some type 2 diabetics (people with type 2 diabetes) take both basal and fast-acting insulin. This is called MDI (for multiple daily injection) or Basal/Bolus therapy. Bolus is a medical and patient slang term for an injection of fast-acting insulin taken with a meal. Continue reading >>

Multiple Daily Insulin (mdi)

Multiple Daily Insulin (mdi)

Multiple daily insulin (MDI), also called a basal/bolus routine,is a proactive approach. Most people with type 1 diabetes should use this approach. It requires careful attention to meals and exercise planning, but allows a more flexible schedule. Its like flying a jumbo jet compared to a one-engine plane. It may be more complex but there is also more potential. The benefits of MDI are that people can change their activities more, and dont have to eat meals at the same time every day because they are taking insulin before every meal.MDI aims to provide a steady stream of insulin throughout the day, similar to the way the pancreas does. This is done with 4 or 5 daily injections, or an insulin infusion pump and extra insulin at mealtime. A bolus dose of rapid-acting or short-acting insulin is usually taken with all meals (breakfast, lunch, and dinner) and sometimes with an afternoon or evening snack. Long-acting (basal) insulin is taken once a day, usually at supper or at bedtime. The dose of the rapid-acting insulin is based on 3 things: the amount of carbohydrate about to be eaten the activity planned over the next 2 to 3 hours When the blood sugar goes higher than the target before a given meal, there is a chance to give some extra short-acting or rapid-acting insulin right then, to bring the blood sugar back into the target range. Likewise, if the blood sugar level is under 4 mmol/L (70 mg/dL) just before a meal, or if a lot of exercise is planned in the next few hours, the insulin dose can be reduced immediately. The use of MDI allows for more intensive management of diabetes. The use of MDI to intensify diabetes management was central to the ground-breaking Diabetes Control and Complications Trial (DCCT). This was a U.S. government-funded study that looked at the ef Continue reading >>

Multiple Dose Insulin Therapy - Multiple Daily Injections

Multiple Dose Insulin Therapy - Multiple Daily Injections

Tweet Multiple dose injection (MDI) therapy, also known as multiple daily injections, is an alternative term for the basal/bolus regime of injecting insulin. The therapy involves injecting a long acting insulin once or twice daily as a background (basal) dose and having further injections of rapid acting insulin at each meal time. Multiple daily injection therapy will usually involve at least four injections a day. What is a non-MDI regime? Before analogue insulins, insulin injections would commonly be given twice daily. The injections would often include a mixture of short acting and intermediate acting insulins. Injections would usually be administered once in the morning, before breakfast, and once before the evening meal; therefore dividing the day into two periods of roughly 12 hours. This meant that once you’d injected a dose, the balance of carbohydrates and activity you take over the next 12 hours would need to correspond to the last dose you injected. What are the benefits of multiple dose insulin therapy? On multiple daily injections, there is more freedom as you don’t need to plan so far in advance or be so restricted by injections delivered a number of hours ago. Because MDI involves rapid acting insulin, it has allowed people to wait less time before eating after injecting. Depending on the overall GI content of a meal, some people may be able to inject during or after a meal, without their blood sugar ‘spiking’ too much. Generally speaking, rapid acting insulin helps to reduce the effect of high blood sugar levels 1-2 hours after eating. Furthermore a multiple dose regime allows more flexibility as to when meals can be taken. Speed of action and correction doses The speed of action of rapid acting insulin also allows people to make correction doses Continue reading >>

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Inpregnant Women With Type 1 Diabetes.

Continuous Subcutaneous Insulin Infusion Versus Multiple Daily Injections Inpregnant Women With Type 1 Diabetes.

1. Diabetes Technol Ther. 2010 Apr;12(4):263-9. doi: 10.1089/dia.2009.0140. Continuous subcutaneous insulin infusion versus multiple daily injections inpregnant women with type 1 diabetes. Gonzlez-Romero S(1), Gonzlez-Molero I, Fernndez-Abelln M, Domnguez-Lpez ME,Ruiz-de-Adana S, Olveira G, Soriguer F. (1)Endocrinology and Nutrition, Hospital Regional Universitario Carlos Haya, Avenida del Dr. Glvez Ginachero S/N, Malaga, Spain. [email protected] BACKGROUND: Continuous subcutaneous insulin infusion (CSII) may be an alternativeto multiple daily injections (MDI) in pre-gestational diabetes during pregnancy. However, no clear improvement in obstetric and perinatal outcome has so far been established for CSII treatment.METHODS: In a case-control study, 35 pregnancies treated with CSII and 64pregnancies treated with MDI treatment were evaluated. Metabolic control andobstetric and perinatal outcome were compared.RESULTS: Women in the CSII group improved their metabolic control (hemoglobin A1cbefore CSII, 7.83 +/- 0.97%; 3-6 months after, 6.77 +/- 0.61%; P < 0.05).Hemoglobin A1c before pregnancy was lower in the CSII group (6.62 +/- 0.60%) thanin the MDI group (7.59 +/- 1.61%) (P < 0.05). No other significant differences,either in metabolic control of diabetes or in obstetric and perinatal outcome,were found.CONCLUSIONS: CSII treatment is safe in pregnancy, but it has not yet beenassociated with any improved pregnancy outcome. Continue reading >>

A Day In The Life: Mdi Vs. Insulin Pump Therapy With Cgm

A Day In The Life: Mdi Vs. Insulin Pump Therapy With Cgm

As someone who has lived with diabetes for over 11 years, I have experienced life with multiple daily injections (MDI), as well as an insulin pump therapy and continuous glucose monitor (CGM). Either way, I am still living with diabetes, but these two lifestyles are fairly different in the way I manage my disease, and also my day. Let’s go through my typical day, from waking up to going to sleep, on MDI versus an integrated insulin pump with CGM. Morning My first alarm goes off, typically followed by a few snooze buttons. MDI: Wake up, check blood glucose (BG) to see how well my basal insulin worked overnight. Pump: Wake up, view my sensor glucose (SG) on my pump, and check my BG to see how well my basal settings on my pump worked overnight. Meals and Snacks MDI: Check BG, count the carbs I’m about to eat, do the math to determine how much insulin is needed, draw up a syringe of insulin (or the proper amount in an insulin pen), and take the shot. Pump: Check BG, count the carbs I’m about to eat, input my BG and grams of carbs into the Bolus Wizard, and press ACT. Throughout the day, I’ll often pull my insulin pump out of my pocket to glance at my SG levels. I look for trends on the graphs provided by the CGM to determine if I need to wait a little longer to eat or if I need to take a BG and have some sugar sooner rather than later. Post Meal/Snack BG Tests MDI: Take a BG. If I’m high, I draw up a syringe of insulin, and take the shot. Pump: Check my sensor glucose (SG) on my pump, and if I’m high, check my BG. If my BG is high, I put my BG into my Bolus Wizard, review the Bolus Wizard recommendation, and press ACT. Mid-Day MDI: Do nothing until I start to feel my BG levels dropping, so I test my BG and am low, so I have a snack. Pump: The Predictive Low aler Continue reading >>

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