1,283 results on '"Insulin infusion"'
Search Results
52. Glucose Control: Patient Dynamics
- Author
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Thoma, M., editor, Morari, M., editor, Chee, Frederick, and Fernando, Tyrone
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- 2007
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- View/download PDF
53. Longevity of the novel <scp>ConvaTec</scp> infusion set with Lantern technology
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Rayhan A. Lal, Matthias Heschel, Liana Hsu, Jian Zhang, Pernelle K. Schøndorff, and Bruce A. Buckingham
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Adult ,Blood Glucose ,Technology ,Infusion set ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Extended wear ,Pilot Projects ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,Insulin infusion ,Insulin Infusion Systems ,0302 clinical medicine ,Endocrinology ,Internal Medicine ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Type 1 diabetes ,business.industry ,Blood Glucose Self-Monitoring ,medicine.disease ,Diabetes Mellitus, Type 1 ,Anesthesia ,business - Abstract
Current insulin infusion sets are approved for only 2-3 days. The novel ConvaTec infusion set with Lantern technology is designed to extend infusion set wear time. The goal of this pilot study was to evaluate the duration of wear for this set. This was a pilot safety study in adults with type 1 diabetes using tethered insulin pumps. Participants inserted the set and wore it for 10 days or until failure. Among 24 participants, two were excluded. Forty-five per cent of the sets lasted 10 days. Median wear time was 9.1 (7.1, 10.0) days. Among 12 premature failures, six (50%) involved adhesive failures, four (33%) hyperglycaemia unresponsive to correction, one (8%) hyperglycaemia with ketones and one (8%) infection. Average CGM glucose per day of infusion set wear showed a statistically significant increase over time, while total daily insulin over the same period did not change. In this pilot study, the duration of wear for the novel infusion set exceeded previously reported commercial sets (P < .001). This extended wear technology may eventually allow for a combined glucose sensor and infusion set.
- Published
- 2021
54. Management of Hypertriglyceridemia-Induced Acute Pancreatitis in a Nondiabetic Patient
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Conor G. Loftus, Navine Nasser-Ghodsi, Jamie M. Reed, and Breann M. Hogan
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Medicine (General) ,lcsh:R5-920 ,Triglyceride ,business.industry ,Hypertriglyceridemia ,Case Report ,Hypoglycemic episodes ,030204 cardiovascular system & hematology ,Hypoglycemia ,medicine.disease ,03 medical and health sciences ,Insulin infusion ,chemistry.chemical_compound ,R5-920 ,0302 clinical medicine ,chemistry ,Anesthesia ,Female patient ,medicine ,Acute pancreatitis ,030212 general & internal medicine ,Dosing ,lcsh:Medicine (General) ,business - Abstract
Treatment strategies for hypertriglyceridemia-induced acute pancreatitis are not well defined in the current literature or guidelines. One therapeutic option is an insulin infusion accompanied by a dextrose infusion to avoid hypoglycemia. The purpose of this case report is to highlight dosing considerations for dextrose infusions in nondiabetic patients. We describe a case of hypertriglyceridemia-induced acute pancreatitis in a 34-year-old nondiabetic woman treated with a reduced-dose insulin infusion that was complicated by hypoglycemic episodes requiring dextrose infusion titrations. Empirical initiation of a higher dextrose concentration infusion with glucose level titrations should be considered to avoid hypoglycemia for nondiabetic patients treated with an insulin infusion to lower triglyceride levels. In this case, clinical pharmacy assistance was imperative for successful treatment with a reduced-dose insulin infusion and titrated dextrose infusion in the management of hypertriglyceridemia-induced acute pancreatitis.
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- 2021
55. Effect of Permissive Underfeeding with Intensive Insulin Therapy on MCP-1, sICAM-1, and TF in Critically Ill Patients
- Author
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Ahmad Aljada, Ghada Fahad AlGwaiz, Demah AlAyadhi, Emad Masuadi, Mahmoud Zahra, Shahad H. Al-Matar, Ahmad Al-Bawab, Waleed Tamimi, Dunia Jawdat, Abdulaziz Al-Dawood, Maram H. Sakkijha, Musharaf Sadat, and Yaseen M. Arabi
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permissive underfeeding ,insulin infusion ,caloric intake ,inflammation ,MCP-1 ,sICAM-1 and tissue factor ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Purpose: This study examined the effect of permissive underfeeding compared to target feeding and intensive insulin therapy (IIT) compared to conventional insulin therapy (CIT) on the inflammatory mediators monocyte chemoattractant protein 1 (MCP-1), soluble intercellular adhesion molecule 1 (sICAM-1), and tissue factor (TF) in critically ill patients. Methodology: This was a substudy of a 2 × 2 factorial design randomized controlled trial in which intensive care unit (ICU) patients were randomized into permissive underfeeding compared to target feeding groups and into IIT compared to CIT groups (ISRCTN96294863). In this substudy, we included 91 patients with almost equal numbers across randomization groups. Blood samples were collected at baseline and at days 3, 5, and 7 of an ICU stay. Linear mixed models were used to assess the differences in MCP-1, sICAM-1, and TF across randomization groups over time. Results: Baseline characteristics were balanced across randomization groups. Daily caloric intake was significantly higher in the target feeding than in the permissive underfeeding groups (P-value < 0.01), and the daily insulin dose was significantly higher in the IIT than in the CIT groups (P-value < 0.01). MCP-1, sICAM-1, and TF did not show any significant difference between the randomization groups, while there was a time effect for MCP-1. Baseline sequential organ failure assessment (SOFA) score and platelets had a significant effect on sICAM-1 (P-value < 0.01). For TF, there was a significant association with age (P-value < 0.01). Conclusions: Although it has been previously demonstrated that insulin inhibits MCP-1, sICAM-1 in critically ill patients, and TF in non-critically ill patients, our study demonstrated that IIT in critically ill patients did not affect these inflammatory mediators. Similarly, caloric intake had a negligible effect on the inflammatory mediators studied.
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- 2019
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56. Open- and Closed-Loop Insulin Delivery Systems and Glucose Sensors
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Pickup, John C., Conn, P. Michael, editor, and Sperling, Mark A., editor
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- 2003
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57. Introduction to Diabetes : Principles of Care in the Surgical Patient with Diabetes
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Sheehan, Peter, Veves, Aristidis, editor, Giurini, John M., editor, and LoGerfo, Frank W., editor
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- 2002
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58. Efficacy and safety of a new insulin infusion protocol adapted for the target glycemic range of 140–180 mg/dl in adult critical care units: a tertiary care centre experience
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Sumera Batool, Sabiha Banu, Muhammad Qamar Masood, and Erfan Hussain
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business.industry ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Hypoglycemia ,medicine.disease ,Tertiary care ,Insulin dose ,Care setting ,03 medical and health sciences ,Insulin infusion ,0302 clinical medicine ,Diabetes mellitus ,Anesthesia ,Internal Medicine ,Medicine ,Very low risk ,030212 general & internal medicine ,business ,Glycemic - Abstract
In critical care setting, insulin infusion rather than subcutaneous insulin is recommended to maintain the blood glucose (BG) level in the target range. We have devised an insulin infusion protocol which requires monitoring of blood glucose and insulin dose adjustment one hourly. In this study, we have studied the efficacy of our insulin infusion protocol (IIP) in terms of bringing and maintaining blood glucose to target range, and its safety in terms of preventing hypoglycemia. It is a retrospective review of all patients who received insulin infusion from the 1st of July 2017 to the 30th of June 2018. A total of 231 were included and data pertaining to demographic details and related to insulin infusion was documented in a predefined questionnaire. Insulin infusion was continued for a mean duration of 26.3 ± 13.7 h taking 5.7 ± 3.1 h to reach the target BG level 180 mg/dl) but the mean BG remains 168.95 ± 45.52 within the desired target range. Our insulin infusion protocol not only achieved and maintained the blood glucose in the target range, it is safe with a very low risk of hypoglycemia.
- Published
- 2021
59. Automatic Regulation of Basal Insulin Infusion in a Personalized Insulin Therapy System
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Evgeniia L. Litinskaia, Kirill V. Pozhar, and Elizaveta A. Polyakova
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medicine.medical_specialty ,business.industry ,Settling time ,Insulin ,medicine.medical_treatment ,Basal insulin ,0206 medical engineering ,Biomedical Engineering ,Insulin delivery ,Medicine (miscellaneous) ,02 engineering and technology ,Target range ,020601 biomedical engineering ,Medical Laboratory Technology ,Insulin infusion ,Constant rate ,Endocrinology ,Internal medicine ,medicine ,business - Abstract
A method and a system for automatic regulation of the basal insulin administration rate for maintenance of glycemia in the target range are proposed. The method is based on proportional regulation of the infusion rate using feedback. It suspends the insulin delivery when the glucose level falls below a threshold value. According to the modeling results, the proposed method can be used to compensate hyperglycemia of different etiologies with reduction of the settling time in comparison with constant rate insulin infusion.
- Published
- 2021
60. Glucose Response to Fast- and Long-Acting Insulin in People with Type 2 Diabetes
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Sarah Ellinor Engell, John Bagterp Jørgensen, Magnus Ekelund, Tinna Björk Aradóttir, and Henrik Bengtsson
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medicine.medical_specialty ,Standard of care ,business.industry ,Long acting insulin ,Insulin ,medicine.medical_treatment ,Insulin naive ,Type 2 diabetes ,medicine.disease ,Insulin dose ,Artificial pancreas ,Insulin infusion ,Endocrinology ,Control and Systems Engineering ,Internal medicine ,Medicine ,business - Abstract
In type 2 diabetes (T2D), injections with long-acting insulin can become necessary to regulate blood glucose and avoid long-term complications. However, finding a safe and effective insulin dose, a process known as titration, is both challenging and time demanding. In this paper, we propose a new method for safe and rapid identification of a personalized insulin dose with long-acting insulin through short-term use of fast-acting insulin in an artificial pancreas (AP). To illustrate this novel concept, we simulate our method by modelling the glucose response to fast-and long-acting insulin in people with T2D. We apply a simple control-algorithm for the AP to adjust the insulin infusion rate during fasting periods. In this case-study, we simulate an insulin naive T2D patient on AP treatment for one week, gradually adjusting the insulin infusion rate. After one week, we convert the insulin infusion rate, unit-to-unit, to a daily injection of long-acting insulin. We compare our method to titration with the standard of care 2-0-2 algorithm. Our simulations indicate that we can reduce the titration period from five weeks to a single week, whilst easing the burden on the patient.
- Published
- 2021
61. Metaheuristic Optimization of Insulin Infusion Protocols Using Historical Data with Validation Using a Patient Simulator
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Lynne Chepulis, Hongyu Wang, Ryan G. Paul, and Michael Mayo
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Computer science ,Metaheuristic optimization ,metaheuristic search ,Machine learning ,computer.software_genre ,lcsh:QA75.5-76.95 ,03 medical and health sciences ,Insulin infusion ,0302 clinical medicine ,simulated validation ,Search algorithm ,Intravenous insulin ,medicine ,030212 general & internal medicine ,Patient simulation ,Metaheuristic ,Type 1 diabetes ,lcsh:T58.5-58.64 ,lcsh:Information technology ,business.industry ,030503 health policy & services ,medicine.disease ,insulin infusion protocol ,lcsh:Electronic computers. Computer science ,Artificial intelligence ,0305 other medical science ,business ,continuous optimisation ,computer - Abstract
Metaheuristic search algorithms are used to develop new protocols for optimal intravenous insulin infusion rate recommendations in scenarios involving hospital in-patients with Type 1 Diabetes. Two metaheuristic search algorithms are used, namely, Particle Swarm Optimization and Covariance Matrix Adaption Evolution Strategy. The Glucose Regulation for Intensive Care Patients (GRIP) serves as the starting point of the optimization process. We base our experiments on a methodology in the literature to evaluate the favorability of insulin protocols, with a dataset of blood glucose level/insulin infusion rate time series records from 16 patients obtained from the Waikato District Health Board. New and significantly better insulin infusion strategies than GRIP are discovered from the data through metaheuristic search. The newly discovered strategies are further validated and show good performance against various competitive benchmarks using a virtual patient simulator.
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- 2020
62. Diabetic Ketoacidosis, Hyperosmolar Nonketotic States, and Stress-Induced Hyperglycemia
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Marik, Paul Ellis and Marik, Paul Ellis
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- 2001
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63. A unified Hyperglycemia and Diabetic ketoacidosis (DKA) insulin infusion protocol based on an Excel algorithm and implemented via Electronic Medical Record (EMR) in Intensive Care Units.
- Author
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Gupta, Deepashree, Kirn, Meredith, Jamkhana, Zafar A., Lee, Richard, Albert, Stewart G., and Rollins, Kimberly M.
- Abstract
Background To assess the efficacy of a unified hyperglycemia and diabetic ketoacidosis (DKA) insulin infusion protocol (IIP), based on an Excel algorithm and implemented as an electronic order set, in achieving glycemic targets and minimizing hypoglycemia. Methods An IIP was instituted in medical and surgical intensive care units for post-cardiac surgery (PCS) and other stress hyperglycemia (SH), diabetes hyperglycemia (DH), and DKA. The IIP initiated therapeutic insulin rates at elevated blood glucose (BG), and decreased insulin when target range was achieved. A convenience sample (n = 62) was studied; 20 PCS, 15 with DH, 9 with SH, 8 with diabetes on vasopressors, 7 with diabetes on glucocorticoids and 3 with DKA were assessed. Results The protocol maintained BG at 144 ± 24.7 mg/dL for PCS and 167 ± 36 mg/dL for patients with diabetes mellitus. It maintained acceptable target range (ATR) (100 mg/dL–180 mg/dL) 89% of the time for PCS and 67% of the time for patients with diabetes mellitus. There were no measurements of BG < 70 mg/dL. The protocol lowered the BG at a similar rate and time period in those with diabetes, DKA and those with or without vasopressors or glucocorticoids. To determine long-term efficacy, a retrospective review of Point of Care (POC) RALS (Remote Automated Data System) BG data 2 years post implementation demonstrated fewer episodes of hypoglycemia < 70 mg/dL and hyperglycemia > 240 mg/dL and more BG values within ATR. Conclusions This IIP maintained ATR without hypoglycemia for patients in the ICU setting without requiring complex nursing calculations. [ABSTRACT FROM AUTHOR]
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- 2017
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64. Acute phase response in lactating dairy cows during hyperinsulinemic hypoglycaemic and hyperinsulinemic euglycaemic clamps and after intramammary LPS challenge.
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De Matteis, L., Bertoni, G., Lombardelli, R., Wellnitz, O., Van Dorland, H. A., Vernay, M. C. M. B., Bruckmaier, R. M., and Trevisi, E.
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HYPERINSULINISM , *LACTATION in cattle , *LIPOPOLYSACCHARIDES , *TUMOR necrosis factors , *HAPTOGLOBINS - Abstract
The link between energy availability, turnover of energy substrates and the onset of inflammation in dairy cows is complex and poorly investigated. To clarify this, plasma inflammatory variables were measured in mid-lactating dairy cows allocated to three groups: hyperinsulinemic hypoglycaemic clamp, induced by insulin infusion (HypoG, n = 5); hyperinsulinemic euglycaemic clamp, induced by insulin and glucose infusion (EuG; n = 6); control, receiving a saline solution infusion (NaCl; n = 6). At 48 h after the start of i.v. infusions, two udder quarters per cow were challenged with 200 μg of E. coli lipopolysaccharide ( LPS). Individual blood samples were taken before clamps, before LPS challenge (i.e. 48 h after clamps) and 6.5 h after. At 48 h, positive acute phase proteins (pos APP) did not differ among groups, whereas albumin and cholesterol (index of lipoproteins), negative APP (neg APP), were lower (p < 0.05) in EuG compared to NaCl and HypoG. The concentration of IL-6 was greater in EuG (p < 0.05) but only vs. HypoG. At 6.5 h following LPS challenge, IL-6 increased in the NaCl and EuG clamps (p < 0.05), while TNF- α increased (p < 0.05) in the EuG only. Among the pos APP, haptoglobin markedly increased in EuG (p < 0.05), but not in NaCl (p = 0.76) and in HypoG; ceruloplasmin tended to decline during LPS challenge, the reduction was significant when all animals were considered (p < 0.05). Conversely, all the neg APP showed a marked reduction 6.5 h after LPS challenge in the three groups. In conclusion, EuG caused an inflammatory status after 48-h infusion (i.e. decrease of neg APP) and induced a quicker acute phase response (e.g. marked rise of TNF- α, IL-6) after the intramammary LPS challenge. These data suggest that the simultaneous high availability of glucose and insulin at the tissue-level makes dairy cows more susceptible to inflammatory events. In contrast, HypoG seems to attenuate the inflammatory response. [ABSTRACT FROM AUTHOR]
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- 2017
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65. Computerised insulin dosing calculators for the management of continuous insulin infusions after cardiac surgery: A systematic review and meta-analysis.
- Author
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Higgs, Megan H. and Fernandez, Ritin S.
- Abstract
Objectives: To investigate the effectiveness of computerised insulin dosing calculators for the management of continuous insulin infusions in adult patients who underwent cardiac surgery. Method: A systematic review was conducted. The CINAHL, MEDLINE and Cochrane databases were searched for primary studies that compared a computerised insulin dosing calculator to a paper protocol. The main outcome measures were mean Blood Glucose Level (BGL), time to achieve BGL target range, time spent within BGL target range, the incidence of hyperglycaemia and the incidence of hypoglycaemia. Results: Five studies were included in the final review. Pooled data demonstrated significant improvements in mean BGL (MD -14.24, 95% CI -26.93 to -1.55), p = 0.03 and significantly lower rates of hypoglycaemia (OR 0.038, 95% CI: 0.16-0.90), p = 0.03 amongst the computer calculator groups in comparison to the paper protocol groups. No significant difference in the incidence of severe hypoglycaemia was demonstrated (OR 0.21, 95% CI 0.02-1.79), p = 0.15. No difference was found in time (hours) to reach target blood glucose range (MD -1.47, 95% CI -3.75 to 0.81), p = 0.21. Conclusion: There is some evidence to support the use of computerised insulin dosing calculators for insulin infusion management within critical care environments. [ABSTRACT FROM AUTHOR]
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- 2017
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66. Adaptive continuous-time model predictive controller for implantable insulin delivery system in Type I diabetic patient.
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Patra, Akshaya Kumar and Rout, Pravat Kumar
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TYPE 1 diabetes ,GLUCOSE ,PREDICTIVE control systems ,H2 control ,SIMULATION methods & models ,PATIENTS - Abstract
This paper presents a physiological model of glucose-insulin (GI) interaction and design of a Continuous-time Model Predictive Controller (CMPC) to regulate the blood glucose (BG) level in Type I diabetes mellitus (TIDM) patients. For the designing of the CMPC, a nonlinear physiological model of TIDM patient is linearized as a ninth-order state-space model with an implanted insulin delivery device. A novel control approach based on Continuous-time Model Predictive technique is proposed for the BG regulation with rejection of periodic or random meal and exercise disturbances in the process. To justify its efficacy a comparative analysis with Linear Quadratic Gaussian (LQG) control, and recently published control techniques like Proportional-Integral-Derivative (PID), Linear Quadratic Regulator with Loop Transfer Recovery (LQR/LTR) and H-infinity has been established. The efficiency of the controller with respect to accuracy and robustness has been verified via simulation. The proposed controller performances are assessed in terms of ability to track a normoglycaemic set point of 81 mg/dl (4.5 mmol/l) in the presence of Gaussian and stochastic noise. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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67. Chronic insulin infusion induces reversible glucose intolerance in lean rats yet ameliorates glucose intolerance in obese rats.
- Author
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Hamza, Shereen M., Sung, Miranda M., Gao, Fei, Soltys, Carrie-Lynn M., Smith, Nancy P., MacDonald, Patrick E., Light, Peter E., and Dyck, Jason R.B.
- Subjects
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PROINSULIN , *METABOLIC disorders , *INSULIN resistance , *TYPE 2 diabetes , *GLUCOSE intolerance - Abstract
Background Although insulin resistance (IR) is a key factor in the pathogenesis of type 2 diabetes (T2D), the precise role of insulin in the development of IR remains unclear. Therefore, we investigated whether chronic basal insulin infusion is causative in the development of glucose intolerance. Methods Normoglycemic lean rats surgically instrumented with i.v. catheters were infused with insulin (3 mU/kg/min) or physiological saline for 6 weeks. At infusion-end, plasma insulin levels along with glucose tolerance were assessed. Results Six weeks of insulin infusion induced glucose intolerance and impaired insulin response in healthy rats. Interestingly, the effects of chronic insulin infusion were completely normalized following 24 h withdrawal of exogenous insulin and plasma insulin response to glucose challenge was enhanced, suggesting improved insulin secretory capacity. As a result of this finding, we assessed whether the effects of insulin therapy followed by a washout could ameliorate established glucose intolerance in obese rats. Obese rats were similarly instrumented and infused with insulin or physiological saline for 7 days followed by 24 h washout. Seven day-insulin therapy in obese rats significantly improved glucose tolerance, which was attributed to improved insulin secretory capacity and improved insulin signaling in liver and skeletal muscle. Conclusion Moderate infusion of insulin alone is sufficient to cause glucose intolerance and impair endogenous insulin secretory capacity, whereas short-term, intensive insulin therapy followed by insulin removal effectively improves glucose tolerance, insulin response and peripheral insulin sensitivity in obese rats. General significance New insight into the link between insulin and glucose intolerance may optimize T2D management. [ABSTRACT FROM AUTHOR]
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- 2017
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68. A Retrospective Cohort Analysis of Two Computerized Insulin Infusion Protocols.
- Author
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Lalani B, Gosselin K, Penno R, Puryear B, Rilo H, and Lalani A
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- Humans, Retrospective Studies, Hypoglycemic Agents, Insulin, Cohort Studies, COVID-19, Hypoglycemia drug therapy
- Abstract
Objective: The primary objective of this analysis was to compare the safety and efficacy of a novel computerized insulin infusion protocol (CIIP), the Lalani Insulin Infusion Protocol (LIIP), with an established CIIP, Glucommander., Methods: We conducted a 10-month retrospective analysis of 778 patients in whom LIIP was used (August 18, 2020 to June 25, 2021) at six HonorHealth Hospitals in the Phoenix metropolitan area. These data were compared with Glucommander that was used at those same hospitals from January 1, 2018 to August 17, 2020, n = 4700. Primary end points of the project included average time to euglycemia and average time in hyperglycemia (>180 mg/dL) and hypoglycemia (<70 mg/dL). Additional subgroup analysis was done to evaluate CIIP performance in patients in whom maintenance of euglycemia was more challenging., Results: The LIIP had a faster time to euglycemia (191 vs 222 minutes, P < .001) and similar time in hypoglycemia (2.79 vs 2.76 minutes, P = .50) for all patients, when compared with Glucommander. Similar observations were made for the following subgroups: diabetic ketoacidosis/hyperosmolar hyperglycemic state (DKA/HHS) patients, COVID-19 patients, patients on steroids, patients with ≥60 glomerular filtration rate (GFR), patients with renal insufficiency, and patients with sepsis., Conclusions: The LIIP is a safe and effective CIIP in managing intravenous insulin infusion rates. Utilization of LIIP resulted in reduced time to euglycemia, P < .001, when compared with Glucommander and did not cause increased hypoglycemia during the project period. Contributing factors to the success of LIIP may include improved clinical workflow, learnability and ease of use, compatibility with the Epic electronic health record (EHR), and its unique, dynamic and adaptive algorithm.
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- 2023
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69. External and implantable insulin pumps: current place in the treatment of diabetes
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Selam, J.-L. and Cochat, Pierre, editor
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- 2000
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70. Carbohydrate and insulin activity in critically ill patients
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Wolfe, R. R., Gullo, Antonino, editor, Guarnieri, G., editor, and Iscra, F., editor
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- 1999
- Full Text
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71. Aspectos clínicos del tratamiento de la hiperglucemia no complicada en la unidad de cuidados intensivos
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Andrea Juliana Pinto-Arias, Rafael Castellanos-Bueno, Adriana Milena Arias-Amaya, and Diego Alejandro Rangel-Rivera
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medicine.medical_specialty ,business.industry ,Mesh term ,Critically ill ,Insulin ,medicine.medical_treatment ,030208 emergency & critical care medicine ,Intensive care unit ,law.invention ,03 medical and health sciences ,Insulin infusion ,0302 clinical medicine ,law ,Critical illness ,General Earth and Planetary Sciences ,Medicine ,030212 general & internal medicine ,business ,Intensive care medicine ,General Environmental Science ,Glycemic - Abstract
ntroducción: la glucosa es una variable dinámica en el paciente crítico. La hiperglucemia (mayor a 140 mg/dL) es frecuente en este grupo de pacientes, existiendo distintos enfoques terapéuticos para el control adecuado de la misma. Objetivo: revisar los aspectos clínicos de la glucemia y la importancia del control glucémico en el paciente crítico adulto. Metodología de búsqueda: en base de datos Pubmed, utilizando los términos MeSH: “critical illness”, “insulin infusion”, “insulin protocol”, “hyperglycemia”. Se incluyeron artículos de revisión y originales, en inglés y español. Conclusiones: el manejo de la hiperglucemia en el paciente crítico es un objetivo primordial en el enfoque integral del paciente de la unidad de cuidados intensivos, dada su asociación con mortalidad, morbilidad y estancia hospitalaria. MÉD.UIS.2020;33(2): 49-54
- Published
- 2020
72. Efficiency of Computerized Insulin Infusion Glucose Control in Critically Ill Patients
- Author
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Keesang Yoo, Chi-Min Park, Hee Jung Lim, Eunmi Gil, Kyoung Jin Choi, and Sang-Man Jin
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Insulin infusion ,Glucose control ,business.industry ,Critically ill ,Anesthesia ,Insulin ,medicine.medical_treatment ,medicine ,Hypoglycemia ,medicine.disease ,business - Published
- 2020
73. Optimal Designs for Model‐Based Assessment of Insulin Sensitivity and Glucose Effectiveness
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Moustafa M. A. Ibrahim, Erik Redestad, and Maria C. Kjellsson
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Optimal design ,medicine.medical_treatment ,Sample (statistics) ,Hypoglycemia ,Models, Biological ,030226 pharmacology & pharmacy ,Drug Administration Schedule ,Pharmaceutical Sciences ,03 medical and health sciences ,Insulin infusion ,0302 clinical medicine ,medicine ,Humans ,Insulin ,insulin sensitivity ,nonlinear mixed effects ,Pharmacology (medical) ,optimal design ,Mathematics ,Pharmacology ,Sampling (statistics) ,Insulin sensitivity ,Replicate ,Glucose Tolerance Test ,Farmaceutiska vetenskaper ,medicine.disease ,minimal model ,Reliability engineering ,Glucose ,glucose effectiveness ,030220 oncology & carcinogenesis ,Insulin Resistance - Abstract
The integrated minimal model allows assessment of clinical diagnosis indices, for example, insulin sensitivity (SI ) and glucose effectiveness (SG ), from data of the insulin-modified intravenous glucose tolerance test (IVGTT), which is laborious with an intense sampling schedule, up to 32 samples. The aim of this study was to propose a more informative, although less laborious, IVGTT design to be used for model-based assessment of SI and SG . The IVGTT design was optimized simultaneously for all design variables: glucose and insulin infusion doses, time of glucose dose and start of insulin infusion, insulin infusion duration, sampling times, and number of samples. Design efficiency was used to compare among different designs. The simultaneously optimized designs showed a profound higher efficiency than both standard rich (32 samples) and sparse (10 samples) designs. The optimized designs, after removing replicate sample times, were 1.9 and 7.1 times more efficient than the standard rich and sparse designs, respectively. After including practical aspects of the designs, for example, sufficient duration between samples and avoidance of prolonged hypoglycemia, we propose 2 practical designs with fewer sampling times and lower input of glucose and insulin than standard designs, constrained to prevent hypoglycemia. The optimized practical rich design is equally efficient in assessing SI and SG as the rich standard design, but with half the number of the samples, while the optimized practical sparse design has 1 less sample and requires 4.6 times fewer individuals for equal certainty when assessing SI and SG than the sparse standard design.
- Published
- 2020
74. Neonatal hyperglycemia in a preterm infant managed with a subcutaneous insulin pump
- Author
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Dacotah Yokom, Brenda Thurlow, Luis Casas, Mohamed W Mohamed, and Julia D. Muzzy Williamson
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Insulin pump ,030209 endocrinology & metabolism ,Hypoglycemia ,03 medical and health sciences ,Insulin infusion ,Insulin Infusion Systems ,Subcutaneous Tissue ,0302 clinical medicine ,Pregnancy ,030225 pediatrics ,Humans ,Medicine ,Pharmacology ,business.industry ,Health Policy ,Infant, Newborn ,Disease Management ,Infant ,Gestational age ,Infusion Pumps, Implantable ,medicine.disease ,Subcutaneous insulin ,Discontinuation ,Hyperglycemia ,Infant, Extremely Premature ,Anesthesia ,Regular insulin ,Female ,business ,Neonatal Hyperglycemia - Abstract
Purpose Successful use of a subcutaneous insulin pump to administer regular insulin to a preterm infant with neonatal hyperglycemia is described. Summary A 520-g female infant born at 23 weeks’ gestational age via caesarian section was noted to have elevated blood glucose concentrations ranging up to 180 mg/dL (in SI units, 10 mmol/L) on day of life (DOL) 3 and peaking on DOL 9 at 250 mg/dL (13.9 mmol/L) despite conservative glucose infusion rates. Continuous infusion of regular insulin was begun on DOL 8 and continued through DOL 44, with an average insulin infusion rate of 0.08 units/kg/h. The patient experienced blood glucose concentration lability due to multiple factors, resulting in the need for frequent and routine blood glucose concentration monitoring to minimize hypoglycemia events. On DOL 44, a subcutaneous insulin pump was placed and used to provide diluted regular insulin (25 units/mL). After 1 week, the patient’s blood glucose concentration normalized, which led to a reduction in the frequency of glucose monitoring. After 3 weeks, insulin pump use was discontinued. The patient remained euglycemic thereafter. Conclusion The use of an insulin pump resulted in decreased blood glucose checks, discontinuation of central line access, and overall better patient care.
- Published
- 2020
75. Anti‐lipid therapy and risk factor management for triglyceridaemia‐induced acute pancreatitis
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Peter J. Yuide, Renee Tabone, Justin Gundara, Deepak L Vardesh, Matthew J. Burstow, and Terence C. Chua
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Triglyceride level ,Type 2 diabetes ,03 medical and health sciences ,Insulin infusion ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Risk factor management ,Hypertriglyceridemia ,business.industry ,General Medicine ,Heparin ,medicine.disease ,Diabetes Mellitus, Type 2 ,Pancreatitis ,030220 oncology & carcinogenesis ,Acute Disease ,Acute pancreatitis ,030211 gastroenterology & hepatology ,Surgery ,Plasmapheresis ,business ,medicine.drug - Abstract
Background: Pancreatitis secondary to hypertriglyceridaemia is rare, accounting for less than 5% of pancreatitis presentations. We reviewed our institutional experience with triglyceridaemia induced acute pancreatitis to report the clinical presentation, patient demographics and clinical management. Methods: The Acute Surgical Unit database at a high-volume general surgical referral centre was queried to identify cases of acute pancreatitis secondary to hypertriglyceridaemia between 2016 and 2019. Patient demographics, clinical manifestations, biochemical derangements and treatment regimens were analysed. Current related literature was reviewed. Results: There were 496 presentations for acute pancreatitis of which 14 presentations (2.8%), amongst 12 patients were due to hypertriglyceridaemia. The mean triglyceride level at presentation was 92.46 (standard deviation 46.9) mmol/L. Ten patients (83%) had poorly controlled type 2 diabetes. All patients were managed using conservative therapy combined with a restricted fat diet and commenced on long-term anti-lipid therapy to manage associated risk factors. In addition, 10 patients received an insulin infusion and one patient received insulin infusion, plasmapheresis and heparin infusion in combination. The median length of hospital stay was 5.5 (range 3–13) days. Two patients (16%) developed a recurrent episode related to non-compliance to medical therapy. Conclusion: Hypertriglyceridaemia is a rare cause of acute pancreatitis. Successful management involves the treatment of acute pancreatitis in conjunction with long-term anti-lipid therapy and optimisation of associated risk factors.
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- 2020
76. A Pilot Study of Flat and Circadian Insulin Infusion Rates in Continuous Subcutaneous Insulin Infusion (CSII) in Adults with Type 1 Diabetes (FIRST1D)
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Monika Reddy, Siân Rilstone, and Nick Oliver
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Adult ,medicine.medical_specialty ,Continuous infusion ,Injections, Subcutaneous ,Endocrinology, Diabetes and Metabolism ,Biomedical Engineering ,Pilot Projects ,030209 endocrinology & metabolism ,Bioengineering ,03 medical and health sciences ,Insulin infusion ,Insulin Infusion Systems ,0302 clinical medicine ,Internal medicine ,Internal Medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,030212 general & internal medicine ,Circadian rhythm ,Glycated Hemoglobin ,Type 1 diabetes ,business.industry ,Basal insulin ,Original Articles ,medicine.disease ,Circadian Rhythm ,Subcutaneous insulin ,Regimen ,Diabetes Mellitus, Type 1 ,Endocrinology ,business - Abstract
Background: Initiation of continuous subcutaneous insulin therapy (CSII) in type 1 diabetes requires conversion of a basal insulin dose into a continuous infusion regimen. There are limited data to guide the optimal insulin profile to rapidly achieve target glucose and minimize healthcare professional input. The aim of this pilot study was to compare circadian and flat insulin infusion rates in CSII naïve adults with type 1 diabetes. Methods: Adults with type 1 diabetes commencing CSII were recruited. Participants were randomized to circadian or flat basal profile calculated from the total daily dose. Basal rate testing was undertaken on days 7, 14 and 28 and basal rates were adjusted. The primary outcome was the between-group difference in absolute change in insulin basal rate over 24 hours following three rounds of basal testing. Secondary outcomes included the number of basal rate changes and the time blocks. Results: Seventeen participants (mean age 33.3 (SD 8.6) years) were recruited. There was no significant difference in absolute change in insulin basal rates between groups ( P = .85). The circadian group experienced significant variation in the number of changes made with the most changes in the morning and evening ( P = .005). The circadian group received a greater reduction in total insulin (−14.1 (interquartile range (IQR) −22.5-12.95) units) than the flat group (−7.48 (IQR −11.90-1.23) units) ( P = .021). Conclusion: The initial insulin profile does not impact on the magnitude of basal rate changes during optimization. The circadian profile requires changes at specific time points. Further development of the circadian profile may be the optimal strategy.
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- 2020
77. The Effects of Insulin Infusion Protocol on the Glycemic Level of the Intensive Care Patients
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Jihan Zukhi, Normy Norfiza Abdul Razak, Mohd Zulfakar Mazlan, Mastura Mohd Sopian, Fatanah M. Suhaimi, and Ummu Kulthum Jamaludin
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Protocol (science) ,0209 industrial biotechnology ,medicine.medical_specialty ,Scale (ratio) ,business.industry ,020208 electrical & electronic engineering ,02 engineering and technology ,Guideline ,Intensive care unit ,law.invention ,Insulin infusion ,020901 industrial engineering & automation ,Control and Systems Engineering ,law ,Intensive care ,Emergency medicine ,0202 electrical engineering, electronic engineering, information engineering ,Standard protocol ,Medicine ,business ,Glycemic - Abstract
Insulin infusion protocol is the standard protocol that has been practiced in Malaysia’s intensive care unit (ICU) for controlling the hyperglycemia. Multiple sliding scale method of the insulin infusion protocol may drive conflict in selecting an appropriate scale to be applied to the patient. The objective of this paper is to analyse the blood glucose outcome of eight sliding scales insulin infusion protocol adopted in the Universiti Sains Malaysia Hospital (HUSM). A retrospective data of 78 ICU patients of HUSM were fitted using a validated glucose-insulin system to identify insulin sensitivity profiles of the patients. Then, these SI profiles were simulated on various scale protocols. The results obtained from this study showed that among eight scales, Scale 4 had the highest percentage of BG within the HUSM’s target of 6.0–10.0 mmol/L. Scale 1 had the highest percentage of BG for the BG measurement more than 10.0 mmol/L while Scale 8 had the highest percentage of BG measurement of less than 6.0 mmol/L. However, none of the scale shown better performance than the current clinical practice. Furthermore, all of the eight scales had a more substantial number of BG measurement compared to the clinical. This study shows that Scale 2 and Scale 3 result in a similar outcome. Similarly, Scale 5 is almost the same as Scale 6. Thus, at least two sets of scale can be combined to reduce the number of scales. The reduction of scales consequently avoid confusion and helps the clinician in selecting the appropriate scale to be applied to the patients. From this study, it can be concluded that the HUSM protocol is a combination of scales. The scales may be shifted from one to another scale depending on patient condition and clinician judgement. A proper guideline for the scale shifting seems necessary to allow optimum glycemic management in the ICU.
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- 2020
78. Development of a Single-Site Device for Conjoined Glucose Sensing and Insulin Delivery in Type-1 Diabetes Patients
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Mathias Tschaikner, Martin Ellmerer, Martin Fritz, Thomas R. Pieber, Amra Simic, Miro Jungklaus, and Werner Regittnig
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Blood Glucose ,Pancreas, Artificial ,Insulin pump ,Computer science ,medicine.medical_treatment ,0206 medical engineering ,Biomedical Engineering ,Insulin delivery ,Glucose sensing ,02 engineering and technology ,Diabetes treatment ,Insulin infusion ,Insulin Infusion Systems ,Single site ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Glucose sensors ,Type 1 diabetes ,Glucose sensitivity ,Blood Glucose Self-Monitoring ,Equipment Design ,medicine.disease ,020601 biomedical engineering ,Cannula ,Diabetes Mellitus, Type 1 ,Biomedical engineering - Abstract
Objective: Diabetes patients are increasingly using a continuous glucose sensor to monitor blood glucose and an insulin pump connected to an infusion cannula to administer insulin. Applying these devices requires two separate insertion sites, one for the sensor and one for the cannula. Integrating sensor with cannula to perform glucose sensing and insulin infusion through a single insertion site would significantly simplify and improve diabetes treatment by reducing the overall system size and the number of necessary needle pricks. Presently, several research groups are pursuing the development of combined glucose sensing and insulin infusion devices, termed single-port devices, by integrating sensing and infusion technologies created from scratch. Methods: Instead of creating the device from scratch, we utilized already existing technologies and introduced three design concepts of integrating commercial glucose sensors and infusion cannulas. We prototyped and evaluated each concept according to design simplicity, ease of insertion, and sensing accuracy. Results: We found that the best single-port device is the one in which a Dexcom sensor is housed inside a Medtronic cannula so that its glucose sensitive part protrudes from the cannula tip. The low degree of component modification required to arrive at this configuration allowed us to test the efficiency and safety of the device in humans. Conclusion: Results from these studies indicate the feasibility of combining commercial glucose sensing and insulin delivery technologies to realize a functional single-port device. Significance: Our development approach may be generally useful to provide patients with innovative medical devices faster and at reduced costs.
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- 2020
79. Smart Artificial Pancreas with Diet Recommender System for Elderly Diabetes
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Munnevver Mine Ozyetkin, Jothydev Kesavadev, Seshadhri Srinivasan, B. Subathra, Korkut Bekirogulu, Geethu Sanal, T. Padmapritha, and Gopika Krishnan
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0209 industrial biotechnology ,Type 1 diabetes ,business.industry ,Insulin ,medicine.medical_treatment ,020208 electrical & electronic engineering ,Predictive controller ,02 engineering and technology ,Recommender system ,Machine learning ,computer.software_genre ,medicine.disease ,Artificial pancreas ,Insulin infusion ,020901 industrial engineering & automation ,Control and Systems Engineering ,Research centre ,Diabetes mellitus ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Artificial intelligence ,business ,computer - Abstract
This investigation presents a smart artificial pancreas (AP) for treating Type 1 Diabetes Mellitus (T1DM) in elderly which simultaneously automates the insulin administration but also diet recommender system using implicit carbohydrate (CHO) measurements. Three main components of the AP are: (i) long-term model of physiological dynamics, (ii) model predictive controller and (iii) a diet recommender algorithm which uses implicit CHO measurements. We first show that long-term dynamics are important for capturing the food influences on blood glucose levels and to maintain within admissive bands. The diet recommender algorithm fuses the insulin infusion information of the MPC, long-term model, average CHO and its variations to recommend diet and its pattern. The proposed artificial pancreas with diet recommender system is illustrated using studies conducted on elderly patients with T1DM based on clinical trials conducted at Jothydev’s Diabetes Research Centre, Trivandrum, India. Our studies shows that the proposed AP not only automates the insulin infusion but also provides a recommender system for diet.
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- 2020
80. Diabetic Ketoacidosis
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Harrison, Jacqueline, Millikan, Keith W., editor, and Saclarides, Theodore J., editor
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- 1998
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81. Automation and interoperability of a nurse-managed insulin infusion protocol as a model to improve safety and efficiency in the delivery of high-alert medications
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Zoe Demko, Mark Romig, Adam Sapirstein, Steven M Griffiths, Alan Ravitz, Cindy Dwyer, Michael A. Rosen, Aaron S. Dietz, Peter J. Pronovost, and Noah Barasch
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Protocol (science) ,medicine.medical_specialty ,business.industry ,Interoperability ,Medication administration ,medicine.disease ,Automation ,Insulin infusion ,Diabetes mellitus ,Emergency medicine ,Infusion pump ,Medicine ,sense organs ,business - Abstract
The administration of high-alert medications requires the use of enhanced systems to prevent errors. One commonly used system relies on independent verification of dose changes by a second clinicia...
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- 2019
82. Cost-Effectiveness of Sensor-Augmented Insulin Pump Therapy Versus Continuous Insulin Infusion in Patients with Type 1 Diabetes in Turkey
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Stéphane Roze, Tuğba Akgül, A Zeynep Özdemir Saltik, Jayne Smith-Palmer, Oğuzhan Deyneli, and Simona de Portu
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Adult ,Blood Glucose ,Male ,Insulin pump ,Adolescent ,Turkey ,genetic structures ,Cost effectiveness ,Cost-Benefit Analysis ,Endocrinology, Diabetes and Metabolism ,Young Adult ,Insulin infusion ,Insulin Infusion Systems ,Endocrinology ,Diabetes mellitus ,Humans ,Hypoglycemic Agents ,Insulin ,Medicine ,In patient ,Child ,Glycated Hemoglobin ,Type 1 diabetes ,business.industry ,Continuous glucose monitoring ,Blood Glucose Self-Monitoring ,medicine.disease ,eye diseases ,Subcutaneous insulin ,Medical Laboratory Technology ,Diabetes Mellitus, Type 1 ,Anesthesia ,Female ,Quality-Adjusted Life Years ,business - Abstract
Background and Aims: Sensor-augmented pump therapy (SAP) combines continuous glucose monitoring with continuous subcutaneous insulin infusion (CSII). SAP is costlier than CSII but provides...
- Published
- 2019
83. Insulin Distribution in Human Adipose Tissue via a Novel Insulin Infusion Catheter
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Pernelle K. Schøndorff, Frank Sinner, Matthias Heschel, Thomas Birngruber, Thomas Altendorfer-Kroath, and Simon Schwingenschuh
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Adult ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Adipose tissue ,Insulin infusion ,Insulin Infusion Systems ,Endocrinology ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,Distribution (pharmacology) ,Tissue Distribution ,business.industry ,Middle Aged ,medicine.disease ,Subcutaneous insulin ,Medical Laboratory Technology ,Catheter ,Adipose Tissue ,Female ,business - Abstract
Continuous subcutaneous insulin infusion (CSII) is a widely used treatment for diabetes patients. Insulin infusion sets (CSII-catheters) are continuously optimized regarding size, handling and safety, but recurring dysfunction (kinking or occlusion), due to different user situations, behavior or chain of events, demand new ways to improve the functionality and safety in patients experiencing these issues. A novel CSII-catheter design (Lantern) features additional lateral perforations, which guarantee functionality even in case of kinking or occlusion. This study aimed to compare functionality, insulin distribution, and failure rate of Lantern and standard catheters using excised human adipose tissue samples. Novel Lantern CSII-catheters (open and artificially occluded) and commercially available standard CSII-catheters were inserted into adipose tissue samples. A mixture of insulin and contrast agent was infused as single bolus (7 IU) with an insulin infusion pump at highest flow rate (1 IU/s). Microtomography images and surface-to-volume ratios were used to assess insulin distribution and depot volume indicating the functionality of CSII-catheters. Failure rate was measured by flow-stop alerts of the pump. We found no difference in the volume of insulin depots compared with the nominal volume of 70 μL. Surface-to-volume ratios showed no significant difference among CSII-catheters. None of the catheters triggered any flow-stop alarm. The novel Lantern CSII-catheter design achieved similar insulin distribution as commercially available CSII-catheters. Moreover, functionality of Lantern CSII-catheters was guaranteed during occlusion, which is an improvement compared with standard CSII-catheters. We conclude that the novel CSII-catheter design has the potential to provide a valuable contribution to patient well-being and safety.
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- 2019
84. Insulin and Blood Pressure
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Gans, Rijk O. B., Donker, Ab J. M., and Mogensen, Carl Erik, editor
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- 1997
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85. Adaptive Glycaemia Control Using Neural Networks
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Bafunno, R., Coltelli, C., Ciaccia, P., Takahashi, Y., and Ghista, Dhanjoo N., editor
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- 1996
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86. Control Algorithms for a Wearable Artificial Pancreas
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Fabietti, P. G., Tega, L., Allegrezza, S., and Ghista, Dhanjoo N., editor
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- 1996
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87. Recent Developments and Open Problems in Feedback Control of the Glucose System in Diabetes
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Sarti, E., Cobelli, C., and Ghista, Dhanjoo N., editor
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- 1996
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88. Insulin and the Regulation of the Cardiovascular System: Role of the l-arginine Nitric Oxide Pathway and the Sympathetic Nervous System
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Scherrer, U. and Lüscher, Thomas F., editor
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- 1995
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89. The Course of Incipient and Overt Diabetic Nephropathy: The Perspective of More Optimal Insulin Treatment
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Feldt-Rasmussen, Bo and Mogensen, Carl Erik, editor
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- 1994
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90. Insulin and Blood Pressure
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Gans, Rijk O. B., Donker, A. B. J. M., and Mogensen, Carl Erik, editor
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- 1994
- Full Text
- View/download PDF
91. EP.TU.200Improving variable rate insulin infusion compliance in general surgery
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Samuel Jackson, Jayan George, Rohan Ardley, and Andrew Orsi
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Compliance (physiology) ,Insulin infusion ,business.industry ,Anesthesia ,Medicine ,Surgery ,business - Abstract
Aims 1. Audit the current variable rate insulin infusion (VRII) practice per local guidelines. 2. Understand barriers to good VRII practice to create an intervention. 3. Re-Audit the VRII practice following intervention. Methods Junior doctors were surveyed using Likert scales (1 to 5: not at all confident to very confident) as well as closed and open questions. Chain action reaction (CAR) theory was used. Six domains were identified against a local proforma. Initial audit and questionnaire were collected from November 2019 to January 2020 and analysed using Microsoft Excel. Intervention consisted of a condensed one-page algorithm with group teaching. Re-audit data was collected between June 2020 to August 2020 for comparison. Results Questionnaire – 53.6% (15/28) of juniors responded. Challenges included conversion oral hypoglycaemics and complexity of the guidance. Group teaching and a condensed portable format were the most popular modalities for delivery of further education. Initial Audit – 12 VRII charts were audited. 33.3% (4/12) were completed correctly. Areas of significant need for improvement were as follows: ensuring long-acting insulin is prescribed, transferring from a VRII back to oral medications and appropriate fluid prescribing. Re-Audit – 18 charts were audited following intervention. Of these, 66.7% (12/18) were completed correctly. There was a significant improvement in appropriate fluid prescribing and long-acting insulin prescriptions. Conclusions Understanding the factors involved throughout the chain of how VRIIs are prescribed has helped to implement a positive intervention in our department. The improvement has been significant (100% better) however there is still further work required to improve compliance.
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- 2021
92. Dietary Changes During COVID-19 Lockdown in Adults With Type 1 Diabetes on a Hybrid Artificial Pancreas
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Raffaele De Angelis, Silvia Di Rienzo, Mariasofia Pagliuca, Claudia Vetrani, Giovanni Annuzzi, Gabriele Riccardi, Lutgarda Bozzetto, Ilaria Calabrese, Angela A. Rivellese, Annamaria Rivieccio, Vetrani, C., Calabrese, I., Di Rienzo, S., Pagliuca, M., Rivieccio, A., De Angelis, R., Riccardi, G., Rivellese, A. A., Annuzzi, G., and Bozzetto, L.
- Subjects
Adult ,Blood Glucose ,Male ,Pancreas, Artificial ,Glucose control ,Coronavirus disease 2019 (COVID-19) ,type 1 diabetes ,Artificial pancreas ,lockdown ,Insulin infusion ,Animal science ,Blood Glucose Self-Monitoring ,medicine ,Humans ,Eating habits ,Original Research ,Retrospective Studies ,glucose control ,hybrid artificial pancrea ,Type 1 diabetes ,Meal ,business.industry ,hybrid artificial pancreas ,SARS-CoV-2 ,diet composition ,Public Health, Environmental and Occupational Health ,COVID-19 ,eating habit ,eating habits ,Middle Aged ,medicine.disease ,Diabetes Mellitus, Type 1 ,Communicable Disease Control ,Female ,Public Health ,Public aspects of medicine ,RA1-1270 ,business ,diet - Abstract
In this retrospective analysis, we examine the impact of the lockdown of the coronavirus pandemic (COVID-19) on eating habits in individuals with type 1 diabetes (T1D) on a hybrid artificial pancreas (HAP). Dietary composition before and during lockdown was assessed by 7-day food records of 12 participants with T1D on HAP (three men and nine women, ages 38 ± 13 years, HbA1c 6.8 ± 0.3%, M ± SD). Continuous glucose monitoring (CGM) metrics and lifestyle changes (online questionnaire) were also assessed. Compared to prelockdown, reported body weight tended to increase during lockdown with no changes in total energy intake. Participants significantly decreased animal protein intake (−2.1 ± 3.7% of total energy intake, p = 0.048), but tended to increase carbohydrate intake (+17 ± 28 g/day, p = 0.052). These changes were induced by modifications of eating habits at breakfast and lunch during weekdays. Patients consumed more cereals (+21 ± 33 g/day, p = 0.038), whole grain (+22 ± 32 g/day, p = 0.044), and sweets (+13 ± 17 g/day, p = 0.021), and less animal protein sources (−42 ± 67 g/day, p = 0.054). Participants showed a more regular meal timing and decreased physical activity. Blood glucose control remained optimal (time-in-range 76 ± 8 vs. 75 ± 7% before lockdown), and daily total insulin infusion increased (42 ± 10 vs. 39 ± 12 I.U., p = 0.045). During the lockdown, patients with T1D on HAP modified dietary habits by decreasing animal protein and increasing carbohydrate intake. This increase, mainly concerning whole grain and low-glycemic-index products, did not influence blood glucose control.
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- 2021
93. Dynamic Insulin Basal Needs Estimation and Parameters Adjustment in Type 1 Diabetes
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Alfredo Gardel-Vicente, Mercedes Rigla, Ignacio Bravo, José Luis Lázaro-Galilea, Jesús Berián, and Universidad de Alcalá. Departamento de Electrónica
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Adult ,Blood Glucose ,Pancreas, Artificial ,Adolescent ,Computer science ,Medicina ,medicine.medical_treatment ,030209 endocrinology & metabolism ,02 engineering and technology ,TP1-1185 ,Biochemistry ,Artificial pancreas ,Article ,Analytical Chemistry ,03 medical and health sciences ,Insulin infusion ,Insulin Infusion Systems ,0302 clinical medicine ,Control theory ,Diabetes mellitus ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Hypoglycemic Agents ,Insulin ,insulin control ,Electrical and Electronic Engineering ,Child ,Instrumentation ,Glycemic ,Type 1 diabetes ,closed-loop ,diabetes ,Blood Glucose Self-Monitoring ,Chemical technology ,artificial pancreas ,Insulin sensitivity ,medicine.disease ,Atomic and Molecular Physics, and Optics ,Diabetes Mellitus, Type 1 ,Basal (medicine) ,basal needs ,Medicine ,020201 artificial intelligence & image processing ,Electrónica ,Electronics ,Algorithms - Abstract
Technology advances have made possible improvements such as Continuous Glucose Monitors, giving the patient a glucose reading every few minutes, or insulin pumps, allowing more personalized therapies. With the increasing number of available closed-loop systems, new challenges appear regarding algorithms and functionalities. Several of the analysed systems in this paper try to adapt to changes in some patients’ conditions and, in several of these systems, other variables such as basal needs are considered fixed from day to day to simplify the control problem. Therefore, these systems require a correct adjustment of the basal needs profile which becomes crucial to obtain good results. In this paper a novel approach tries to dynamically determine the insulin basal needs of the patient and use this information within a closed-loop algorithm, allowing the system to dynamically adjust in situations of illness, exercise, high-fat-content meals or even partially blocked infusion sites and avoiding the need for setting a basal profile that approximately matches the basal needs of the patient. The insulin sensitivity factor and the glycemic target are also dynamically modified according to the situation of the patient. Basal insulin needs are dynamically determined through linear regression via the decomposition of previously dosed insulin and its effect on the patient’s glycemia. Using the obtained value as basal insulin needs and other mechanisms such as basal needs modification through its trend, ISF and glycemic targets modification and low-glucose-suspend threshold, the safety of the algorithm is improved. The dynamic basal insulin needs determination was successfully included in a closed-loop control algorithm and was simulated on 30 virtual patients (10 adults, 10 adolescent and 10 children) using an open-source python implementation of the FDA-approved (Food and Drug Administration) UVa (University of Virginia)/Padova Simulator. Simulations showed that the proposed system dynamically determines the basal needs and can adapt to a partial blockage of the insulin infusion, obtaining similar results in terms of time in range to the case in which no blockage was simulated. The proposed algorithm can be incorporated to other current closed-loop control algorithms to directly estimate the patient’s basal insulin needs or as a monitoring channel to detect situations in which basal needs may differ from the expected ones.
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- 2021
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94. Adaptive Model Predictive Control with Particle Filter for Artificial Pancreas
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Weijie Wang, Yixuan Geng, Shaoping Wang, and Xingjian Wang
- Subjects
State variable ,Model predictive control ,Insulin infusion ,Control theory ,Computer science ,Uncertain systems ,Particle filter ,Clinical treatment ,Artificial pancreas - Abstract
Controller takes an important role for artificial pancreas (AP) to regulate insulin infusion rate according variable requirements of diabetic patients. In this research, an adaptive model predictive control (MPC) algorithm is proposed to overcome the parameter uncertainty induce by inter and intra variability. Firstly, a glucose-insulin dynamic model is established to describe the integrated metabolism of glucose and insulin, in which the time-varying parameters can be extended to observable state variables. Then, particle filtering technology is introduced to track and adjust the parameters. Meanwhile, the glucose and insulin concentration in plasma (PGC and PIC) are also estimated. Finally, imbedding the dynamic model with personalized parameters, an adaptive MPC algorithm is proposed based on the estimated PIC and PGC. For validation, the in-silico experiments are carried out on the 30 virtual patients of the UVa/Padova simulator. The proposed algorithm shows promising performances. It shows that the proposed method has the potential for artificial pancreas in clinical treatment.
- Published
- 2021
95. Evaluation of Computer-Based Insulin Infusion Algorithm Compared With a Paper-Based Protocol in the Treatment of Diabetic Ketoacidosis.
- Author
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Martinez HM, Elwood K, Werth C, and Sarangarm P
- Abstract
Background: Development of computer-based software, termed electronic glucose management system (eGMS), offers an alternative strategy to manage diabetic ketoacidosis (DKA) compared with institution-specific paper protocols by integrating glucose and insulin titration into the electronic medical record. Objective: To evaluate the safety and efficacy of eGMS versus a paper-based DKA protocol in an urban academic medical center. Methods: Single-center, retrospective analysis of patients admitted for DKA. The primary objective of this study was the time to transition from intravenous to subcutaneous insulin after resolution of DKA pre- and post-eGMS implementation. Secondary outcomes included incidence of hypoglycemia while on an insulin infusion, intensive care unit (ICU) length of stay, and total hospital length of stay. Results: Time to DKA resolution was similar in both groups with a median time of 8.6 versus 8.8 hours in the paper-based (n = 133) and eGMS groups (n = 84), respectively ( P = 0.43). Hypoglycemia occurred more frequently in the paper-based group compared with eGMS during insulin infusion (14 vs 3 patients, P = 0.06). The median ICU (36.5 vs 41.4 hours; P = 0.05) and hospital length of stay (67.9 vs 77.8 hours; P = 0.05) were shorter in the paper-based group compared with the eGMS group. Conclusion and Relevance : Similar rates of DKA resolution were seen for patients managed with a paper-based protocol compared with eGMS. Patients in the paper-based protocol had a shorter ICU and hospital length of stay; however, eGMS had improved clinically relevant safety outcomes., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
- Published
- 2023
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96. On Insulin Action in Vivo: The Single Gateway Hypothesis
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Bergman, Richard N., Bradley, David C., Ader, Marilyn, Östenson, Claes Göran, editor, Efendić, Suad, editor, and Vranic, Mladen, editor
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- 1993
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97. Indirect Effects of Insulin in Regulating Glucose Fluxes
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Shi, Z. Q., Giacca, A., Fisher, S. J., Lekas, M., Bilinski, D., Van Delangeryt, M., Lickley, H. L. A., Vranic, M., Östenson, Claes Göran, editor, Efendić, Suad, editor, and Vranic, Mladen, editor
- Published
- 1993
- Full Text
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98. Blood Glucose Regulation by the Pancreas and the Kidney
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Ypey, Dirk L., Verveen, Alettus A., van Duijn, Bert, Luker, Paul A., editor, Schmidt, Bernd, editor, van Wijk van Brievingh, Rogier P., editor, and Möller, Dietmar P. F., editor
- Published
- 1993
- Full Text
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99. Hypoglycemia, Gluconeogenesis and the Brain
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Cherrington, A. D., Frizzell, R. T., Biggers, D. W., Connolly, C. C., Vranic, Mladen, editor, Efendic, Suad, editor, and Hollenberg, Charles H., editor
- Published
- 1991
- Full Text
- View/download PDF
100. Search for the Hypoglycemia Receptor Using the Local Irrigation Approach
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Donovan, Casey M., Cane, Patricia, Bergman, Richard N., Vranic, Mladen, editor, Efendic, Suad, editor, and Hollenberg, Charles H., editor
- Published
- 1991
- Full Text
- View/download PDF
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