scholarly journals Relationship between Optimum Mini-doses of Glucagon and Insulin Levels when Treating Mild Hypoglycaemia in Patients with Type 1 Diabetes - A Simulation Study

2017 ◽  
Vol 122 (3) ◽  
pp. 322-330 ◽  
Author(s):  
Ajenthen Ranjan ◽  
Sabrina L. Wendt ◽  
Signe Schmidt ◽  
Sten Madsbad ◽  
Jens J. Holst ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Simulation Study ◽  
Insulin Levels ◽  
Mild Hypoglycaemia ◽  
Glucagon And Insulin

scholarly journals Lower plasma insulin levels during overnight closed-loop in school children with type 1 diabetes: Potential advantage? A randomized cross-over trial

PLoS ONE ◽  
2019 ◽  
Vol 14 (3) ◽  
pp. e0212013 ◽  
Author(s):  
Ulrike Schierloh ◽  
Malgorzata E. Wilinska ◽  
Ineke M. Pit-ten Cate ◽  
Petra Baumann ◽  
Roman Hovorka ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
School Children ◽  
Plasma Insulin ◽  
Closed Loop ◽  
Lower Plasma ◽  
Insulin Levels ◽  
Plasma Insulin Levels

scholarly journals A Simulation Study of an Inverse Controller for Closed- and Semiclosed-Loop Control in Type 1 Diabetes

2010 ◽  
Vol 12 (2) ◽  
pp. 95-104 ◽  
Author(s):  
Agustín Rodríguez-Herrero ◽  
Carmen Pérez-Gandía ◽  
Mercedes Rigla ◽  
Alberto de Leiva ◽  
Enrique J. Gómez ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Simulation Study ◽  
Loop Control

Effect of Exercise Intensity on Exogenous Glucose Requirements to Maintain Stable Glycemia At High Insulin Levels in Type 1 Diabetes

2020 ◽  
Vol 106 (1) ◽  
pp. e83-e93
Author(s):  
Vinutha B Shetty ◽  
Paul A Fournier ◽  
Nirubasini Paramalingam ◽  
Wayne Soon ◽  
Heather C Roby ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Exercise Intensity ◽  
High Intensity ◽  
High Intensity Exercise ◽  
Moderate Intensity ◽  
Insulin Levels ◽  
Glucose Levels ◽  
Exogenous Glucose ◽  
High Insulin

Abstract Context Under basal insulin levels, there is an inverted U relationship between exercise intensity and exogenous glucose requirements to maintain stable blood glucose levels in type 1 diabetes (T1D), with no glucose required for intense exercise (80% V̇O2 peak), implying that high-intensity exercise is not conducive to hypoglycemia. Objective This work aimed to test the hypothesis that a similar inverted U relationship exists under hyperinsulinemic conditions, with high-intensity aerobic exercise not being conducive to hypoglycemia. Methods Nine young adults with T1D (mean ± SD age, 22.6 ± 4.7 years; glycated hemoglobin, 61 ± 14 mmol/mol; body mass index, 24.0 ± 3.3 kg/m2, V̇O2 peak, 36.6 ± 8.0 mL·kg–1 min–1) underwent a hyperinsulinemic-euglycemic clamp to maintain stable glycemia (5-6 mmol·L−1), and exercised for 40 minutes at 4 intensities (35%, 50%, 65%, and 80% V̇O2peak) on separate days following a randomized counterbalanced study design. Main Outcome Measures Glucose infusion rates (GIR) and glucoregulatory hormones levels were measured. Results The GIR (± SEM) to maintain euglycemia was 4.4 ± 0.4 mg·kg–1 min–1 prior to exercise, and increased significantly by 1.8 ± 0.4, 3.0 ± 0.4, 4.2 ± 0.7, and 3.5 ± 0.7 mg·kg–1 min–1 during exercise at 35%, 50%, 65%, and 80% V̇O2 peak, respectively, with no significant differences between the 2 highest exercise intensities (P > .05), despite differences in catecholamine levels (P < .05). During the 2-hour period after exercise at 65% and 80% V̇O2 peak, GIRs did not differ from those during exercise (P > .05). Conclusions Under hyperinsulinemic conditions, the exogenous glucose requirements to maintain stable glycemia during and after exercise increase with exercise intensity then plateau with exercise performed at above moderate intensity ( > 65% V̇O2 peak). High-intensity exercise confers no protection against hypoglycemia.

scholarly journals SAT-671 Glycogenic Hepatopathy. A Rare and Dramatic Manifestation of Poorly Controlled Type 1 Diabetes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Cassie Maciel ◽  
Rebecca Salvo ◽  
Mark D Wilson
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Type 1 Diabetes Mellitus ◽  
Quadrant Pain ◽  
Insulin Levels ◽  
Insulin Requirements ◽  
High Insulin ◽  
Glycogen Deposition

Abstract Background: Glycogenic hepatopathy (GH) is a well described, yet underdiagnosed disorder in type 1 diabetes. Erratic blood glucose values and high insulin levels promote the excessive deposition of glucose storage in the liver as glycogen, resulting in hepatomegaly, right upper quadrant pain and abnormal liver function. GH was first described with the introduction of insulin as a therapy to treat type 1 diabetes in the early 20th century. As our ability to effectively treat type 1 diabetes mellitus has improved, GH is seen much less commonly. Today, GH generally effects adolescent or young adult patients with poorly controlled type 1 diabetes mellitus and DKA. It is reversible with successful treatment of hyperglycemia. Clinical Case: An 18 year old woman with a history of poorly controlled type 1 diabetes mellitus and frequent admissions for DKA was admitted for DKA and pyelonephritis. On admission, the patient complained of significant right upper quadrant pain and was found to have elevated transaminase values of: AST 1199 U/L (<37 U/L), ALT 371 U/L (56 U/L), an elevated alkaline-phosphatase of 319 IU/L (<135 IL/L) and normal indices of biosynthetic function (INR/PT). After inpatient treatment of DKA and pyelonephritis, the right upper quadrant pain persisted and required pharmacologic analgesia. Radiographic evaluation demonstrated severe hepatomegaly (24 cm in maximum length) without focal lesions. Laboratory evaluation for viral hepatitis, autoimmune hepatitis, Celiac Disease, Wilson’s Disease and hemochromatosis were unremarkable. Given the patient’s persistent symptoms and severity of hepatomegaly, hepatic biopsy was performed.Biopsy findings were consistent with glycogenic hepatopathy demonstrating steatosis and glycogen deposition with nucleic glycogenation and mega mitochondria.Our patient had higher than usual insulin requirements for type 1 diabetes (~1 unit/kg/day). Abdominal pain, hepatomegaly and elevated LFTs resolved over a 2 month duration with improvement in her blood glucose control. Conclusions: GH is an established yet rare complication of poorly controlled type 1 diabetes. Glycogen deposition in the liver leads to painful hepatomegaly due to stretching of the liver capsule. GH has a female predominance (77%) and is characterized by elevated AST >>ALT with preserved liver biosynthetic function.It is postulated that GH is a result of elevated blood glucose levels and elevated insulin levels. The patient we describe has long standing poorly controlled type 1 diabetes mellitus, frequent admissions for DKA and high insulin requirements. To our knowledge, insulin requirements have not been investigated or previously reported as a potential risk factor for this condition.

scholarly journals Comparing two treatment approaches for patients with type 1 diabetes during aerobic exercise: a randomised, crossover study

2020 ◽  
Author(s):  
Varun Vartak ◽  
Lynne Chepulis ◽  
Matt Driller ◽  
Ryan Paul
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Aerobic Exercise ◽  
Blood Lactate ◽  
Perceived Exertion ◽  
Trial Registration ◽  
Glucose Levels ◽  
Significant Difference ◽  
Mild Hypoglycaemia

Abstract In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age: 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate/kg of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-minute treadmill-walk at 7.24 km.h-1 and a six-minute walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, blood ketone and blood lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL⋅kg−1⋅min−1) were also calculated for the 6MWT. Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluating in other groups, including women, children and those with sub-optimal glycaemic control. Trial registration: ACTRN12619001397101p. Registered 09 September 2019, http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378264

Reversal of New-Onset Type 1 Diabetes in Mice and Induction of FoxP3+ Regulatory T Cells by Syngeneic Bone Marrow Transplantation.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4857-4857
Author(s):  
Jian Ouyang ◽  
Yanting Wen ◽  
Junhao Chen ◽  
Yong Liu ◽  
De Pei Wu
Keyword(s):  
Bone Marrow ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Bone Marrow Transplantation ◽  
Glucose Tolerance ◽  
Marrow Transplantation ◽  
Diabetic Mice ◽  
Insulin Levels ◽  
New Onset

Abstract Objective: Autologous bone marrow transplantation (ABMT) was introduced as a novel strategy to treat new-onset type 1 diabetes (T1D). Induction of CD4+CD25+ FoxP3+T regulatory lymphocytes (Tregs) helps maintain self-tolerance in autoimmune diabetes. Here, we were tying to investigate the effects of syngeneic bone marrow transplantation (syn-BMT) in T1D mice models and to investigate the role of Tregs in this context. Research design and methods: Syn-BMT was used to mimic the ABMT to T1D patients in human. Fraternal inbred multiple low doses of streptozotocin (mld-SZ) induced diabetic mice were used as both donors (n = 7) and recipients (n = 20). And normal fraternal inbred mice were also used as donors (n=13). After total body irritation to recipient mice, syn-BMT was given either on day 10 or on day 40 of T1D. Blood and urine glucose was observed. On day120 after syn-BMT, glucose tolerance was tested and then mice were killed. Insulin levels in sera were tested by ELISA and pancreata histological and morphometry were analyzed by HE staining. Tregs in spleens were tested by Flow cytometry analysis, FoxP3 protein was tested by western blot, and FoxP3 mRNA was tested by real time PCR. Results: Syn-BMT, if applied when T1D is new-onset (10 d), can reverse blood glucose to close to normoglycemia without farther relapse, maintain blood insulin levels, improve glucose tolerance and ameliorate pancreata destruction. Syn-BMT leading to recovery of T1D results in the induction of Tregs, increased Foxp3 protein and mRNA expression in both the groups of diabetic mice receiving syn-BMT with either diabetic or normal donors. However, if given on a later disease stage (40 d), although syn-BMT helped reduce blood glucose for about 66 d and improved pancreata histological and morphometry, it showed relapse of diabetes further and decrement of insulin levels. Interestingly, this group did not show the increment of Tregs, Foxp3 protein or mRNA expression. Conclusions: This study provided a rationale to treat human new-onset T1D with autologous HSC. Syn-BMT, if given when T1D is new-onset, is safe and is able to reverse the diabetic status. The induction of Tregs and Foxp3 in both mRNA and protein levels as the results of syn-BMT, may contribute to the immune tolerance after syn-BMT, and the observed improvement of new-onset T1D.

scholarly journals Comparing Two Treatment Approaches for Patients with Type 1 Diabetes During Aerobic Exercise: a Randomised, Crossover Study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Varun Vartak ◽  
Lynne Chepulis ◽  
Matthew Driller ◽  
Ryan G. Paul
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Aerobic Exercise ◽  
Perceived Exertion ◽  
Trial Registration ◽  
Clinical Trial Registry ◽  
Glucose Levels ◽  
Significant Difference ◽  
Mild Hypoglycaemia

Abstract Background In a randomised, counterbalanced, crossover design, eight men with type 1 diabetes (T1D; mean ± SD age, 27.6 ± 11.4 years) reduced insulin (INS) by 50% of their normal dose or consumed carbohydrates equivalent to 1 g of carbohydrate per kilogramme of their body weight without the usual insulin bolus (CARBS) over two sessions, held a week apart. Each session included standardised meals, a 45-min treadmill walk at 7.24 km h−1 and a 6-min walk test (6MWT). Rate of perceived exertion (RPE), blood glucose, ketone and lactate measures were taken before, during and immediately after the aerobic exercise. The distance covered in metres and the predicted VO2 max (mL kg−1 min−1) were also calculated for the 6MWT. Results Participants completing the INS intervention spent more time in normoglycaemia (242 ± 135 min vs 88 ± 132 min; P < 0.01) and less time in hyperglycaemia (41 ± 95 min vs 154 ± 125 min; P = 0.01) as compared to the CARBS intervention. Mild hypoglycaemia occurred in two participants during INS and no participants during CARBS. Furthermore, there was no significant difference for blood lactate, ketone, RPE, distance covered and predicted VO2 max between interventions. Conclusion Based on this pilot study, INS intervention appears to be the best approach for maintaining blood glucose levels in those with T1D during aerobic exercise, though this does need evaluation in other groups, including women, children and those with suboptimal glycaemic control. Trial Registration Australian New Zealand Clinical Trial Registry, ACTRN12619001397101p. Registered 09 September 2019.

Effects of subcutaneous, low-dose glucagon on insulin-induced mild hypoglycaemia in patients with insulin pump treated type 1 diabetes

2016 ◽  
Vol 18 (4) ◽  
pp. 410-418 ◽  
Author(s):  
A. Ranjan ◽  
S. Schmidt ◽  
S. Madsbad ◽  
J. J. Holst ◽  
K. Nørgaard
Keyword(s):  
Type 1 Diabetes ◽  
Low Dose ◽  
Insulin Pump ◽  
Mild Hypoglycaemia
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