scholarly journals A novel approach to basal-bolus insulin initiation in adults with newly diagnosed type 1 diabetes: an observational cohort study of a service redesign

2018 ◽  
Vol 18 (2) ◽  
pp. 71-75
Author(s):  
Helen E Hopkinson ◽  
Anna D White ◽  
Peter Nightingale ◽  
Parth Narendran
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Basal Insulin ◽  
Dose Adjustment ◽  
Newly Diagnosed ◽  
Insulin Initiation ◽  
Carbohydrate Counting ◽  
Bolus Insulin ◽  
Basal Bolus

Aims: The National Institute for Health and Care Excellence (NICE) recommendation for insulin in newly diagnosed type 1 diabetes is a ‘basal-bolus’ regimen of prandial insulin with twice-daily basal insulin initiated at diagnosis. We developed an insulin initiation programme that embraces the contribution of endogenous insulin to glycaemic control in adults newly diagnosed with type 1 diabetes. Our aim was to embed carbohydrate counting skills and dose adjustment very early on to mitigate against the decline in glycaemic control that is commonly seen post honeymoon.Methods: We designed a novel insulin initiation programme that focused initially on prandial insulin replacement using the lowest possible dose of basal insulin. The approach also facilitates carbohydrate counting and bolus insulin dose adjustment behaviours from diagnosis.Results: Prior to implementing the new programme, the mean HbA1c at 12 months was 64 mmol/mol (8.0%) (95% CI 60 to 69 (7.6% to 8.4%)). This reduced to 55 mmol/mol (7.1%) (95% CI 51 to 58 (6.9% to 7.4%)), p<0.001 with the new programme. The improved HbA1c persisted to 3 years of follow-up (p<0.001). There were no episodes of diabetic ketoacidosis or severe hypoglycaemia associated with this novel approach.Conclusions: We suggest that using minimal basal insulin and focusing on prandial bolus insulin replacement in adults newly diagnosed with type 1 diabetes is safe, more physiological and may be better able to achieve lasting glycaemic control than the currently proposed national guidelines. This approach will need to be tested formally in an adequately designed randomised controlled clinical trial.

scholarly journals Switching from Twice-Daily Basal Insulin Injections to Once-Daily Insulin Degludec Injection for Basal-Bolus Insulin Regimen in Japanese Patients with Type 1 Diabetes: A Pilot Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Yuka Tosaka ◽  
Akio Kanazawa ◽  
Fuki Ikeda ◽  
Mayu Iida ◽  
Junko Sato ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Basal Insulin ◽  
Japanese Patients ◽  
Insulin Degludec ◽  
Insulin Regimen ◽  
Once Daily ◽  
Daily Insulin ◽  
Bolus Insulin ◽  
Basal Bolus

The aim of this study was to investigate the efficacy of insulin degludec used for basal-bolus insulin regimen after switching from twice-daily basal insulin in Japanese patients with type 1 diabetes mellitus. The subjects were 22 type 1 diabetes patients treated with basal-bolus insulin regimen with twice-daily basal insulin. Basal insulin was switched to once-daily injection of insulin degludec with 10% dose reduction. HbA1c and fasting plasma glucose (FPG) were measured before and 12 weeks after switching. The frequency of hypoglycemic episodes, standard deviation (SD) of blood glucose, and mean of daily difference (MODD) were evaluated by continuous glucose monitoring (CGM) before and 4 weeks after switching. HbA1c and FPG before and 12 weeks after switching were comparable (HbA1c 8.5 ± 1.4 versus 8.7 ± 1.6%,P=0.28; FPG 203.2 ± 81.2 versus 206.5 ± 122.4 mg/dL,P=0.91). The frequency of hypoglycemia during nighttime was not significantly different at 4 weeks after switching (14.4 ± 17.0 versus 11.1 ± 15.0%,P=0.45). In addition, SD and MODD before and 4 weeks after switching were also comparable. In conclusion, glycemic control under once-daily insulin degludec injection was almost comparable to that under twice-daily basal insulin injections in Japanese type 1 diabetes patients. This study was registered with ID:UMIN000010474.

scholarly journals Circulating Levels of MicroRNA from Children with Newly Diagnosed Type 1 Diabetes and Healthy Controls: Evidence That miR-25 Associates to Residual Beta-Cell Function and Glycaemic Control during Disease Progression

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Lotte B. Nielsen ◽  
Cheng Wang ◽  
Kaspar Sørensen ◽  
Claus H. Bang-Berthelsen ◽  
Lars Hansen ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Beta Cell ◽  
Beta Cell Function ◽  
Cell Function ◽  
Control Group ◽  
Healthy Controls ◽  
Newly Diagnosed ◽  
New Onset

This study aims to identify key miRNAs in circulation, which predict ongoing beta-cell destruction and regeneration in children with newly diagnosed Type 1 Diabetes (T1D). We compared expression level of sera miRNAs from new onset T1D children and age-matched healthy controls and related the miRNAs expression levels to beta-cell function and glycaemic control. Global miRNA sequencing analyses were performed on sera pools from two T1D cohorts (n= 275 and 129, resp.) and one control group (n= 151). We identified twelve upregulated human miRNAs in T1D patients (miR-152, miR-30a-5p, miR-181a, miR-24, miR-148a, miR-210, miR-27a, miR-29a, miR-26a, miR-27b, miR-25, miR-200a); several of these miRNAs were linked to apoptosis and beta-cell networks. Furthermore, we identified miR-25 as negatively associated with residual beta-cell function (est.: −0.12,P= 0.0037), and positively associated with glycaemic control (HbA1c) (est.: 0.11,P= 0.0035) 3 months after onset. In conclusion this study demonstrates that miR-25 might be a “tissue-specific” miRNA for glycaemic control 3 months after diagnosis in new onset T1D children and therefore supports the role of circulating miRNAs as predictive biomarkers for tissue physiopathology and potential intervention targets.

scholarly journals MON-671 Embarrassed to Eat: Two Cases of Gustatory Hyperhidrosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Omer H Tarar ◽  
Andres J Munoz
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Medical History ◽  
Early Identification ◽  
Hemoglobin A1c ◽  
Past Medical History ◽  
History Of ◽  
Bolus Insulin ◽  
Basal Bolus

Abstract Introduction Diabetic Gustatory Hyperhidrosis is characterized by profuse sweating with eating and may be a manifestation of Diabetic autonomic dysfunction. Most patients have evidence of other microvascular complications including nephropathy, retinopathy, peripheral neuropathy and other signs of autonomic neuropathy. We present 2 cases of gustatory hyperhidrosis associated with longstanding poorly controlled type 1 diabetes. Case 1: 49 year old Male with past medical history of longstanding type 1 diabetes with poor control, complicated with diabetic retinopathy, polyneuropathy, albuminuria presented to endocrine clinic for management of diabetes. His hemoglobin A1c was 10.8%. He was on basal-bolus Insulin at home. However, he admitted to missing most doses of prandial Insulin. On further questioning, he mentioned having episodes of profuse head and neck sweating while eating any type of food. He attributed these episodes to “low blood sugars” without checking and therefore tried to avoid Insulin. However, he continued having these episodes. He was diagnosed with Diabetic gustatory hyperhidrosis and started on topical Aluminum hexahydrate. Case 2: 34 year old Female with past medical history of long-standing DM type 1 complicated with poly- neuropathy, autonomic dysfunction, nephropathy, Retinopathy, chronic kidney disease stage III presented for follow up of her diabetes. Her hemoglobin A1c was 9.8%. She was on basal-bolus Insulin at home and reported good compliance. Given her extensive polyneuropathy, she was questioned about hyperhidrosis. She reported having profuse facial and neck sweating with eating all types of food which led to increased embarrassment while eating in public. She was diagnosed with diabetic gustatory hyperhidrosis and started on topical aluminum hexahydrate, with plans for Botox if symptoms persisted. Discussion Diabetic Gustatory Hyperhidrosis is an under- recognized condition and may be misdiagnosed as hypoglycemia, anxiety, gastroparesis or other conditions. This gustatory sweating is a source of severe distress and embarrassment for patients and can have serious emotional, social and professional implications. Associated symptoms may also be mistaken for hypoglycemia and in turn lead to nonadherence with Insulin and other diabetic medications causing suboptimal glycemic control. Topical anti-perspirants like Aluminum Chloride hexahydrate are often used as first line therapy. Second line treatment options include glycopyrrolate, Oxybutynin and Botulinum toxin. Conclusion Most patients are reluctant to mention these symptoms to health care providers and diligent history taking with specific questions in high risk patients may help in early identification and management of this condition. Early identification and management can also help promote overall confidence, quality of life and better glycemic control.

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