Preferable Conversion Rate from Intravenous to Subcutaneous Insulin in Hyperglycemic Emergencies in Diabetic Patients

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 2286-PUB
Author(s):  
HIKARU TAKAMINE ◽  
YULIA NAMIKI ◽  
HIROKO HIIRAGI ◽  
TAKU YAMADA ◽  
YUYA TAKANO ◽  
...  
Keyword(s):  
Conversion Rate ◽  
Diabetic Patients ◽  
Subcutaneous Insulin

scholarly journals Mortality and Conversion Rate to Below Knee or Above Knee Amputation Following Transmetatarsal Amputation

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0011
Author(s):  
D. Anthony Barcel ◽  
Susan M. Odum ◽  
Taylor Rowe ◽  
Jefferson B. Sabatini ◽  
Samuel E. Ford ◽  
...  
Keyword(s):  
Risk Factors ◽  
Conversion Rate ◽  
Significant Risk ◽  
High Rate ◽  
Administrative Database ◽  
Categorical Variables ◽  
Diabetic Patients ◽  
Knee Amputation ◽  
History Of ◽  
Transmetatarsal Amputation

Category: Midfoot/Forefoot; Diabetes; Other Introduction/Purpose: Non-traumatic lower extremity amputations (LEA), especially those performed in dysvascular and diabetic patients, are known to have poor long-term prognosis. Perioperative mortality has been reported at between 4 and 10%, and the 1 and 5 year mortality rates range between 22-33% and 39-69%, respectively. While poor outcomes in these patients have been described, there is no consensus as to the predictors of mortality. The purpose of the study is to determine the percentage of patients who had a complication following transmetatarsal amputation (TMA) and identify associated risk factors for complications and mortality. Methods: We queried our institution’s administrative database to identify 247 TMA procedures performed in 229 patients between January, 2002 and December, 2016. Electronic health records were reviewed to document complications defined as reoperation, amputation and mortality. Mortality was also verified using the National Death Index. Additionally, we recorded risk factors including diabetes, A1c level, end stage renal disease (ESRD), cardiovascular disease (CVD), peripheral vascular disease (PVD), history of revascularization, contralateral amputation, and neuropathy. The majority of the study patients were males (157, 69%) and the average age was 57 years (range 24-91). The median BMI was 28 (range 16-58) and 29% of the study patients were obese with a BMI ≥ 30. Fishers Exact tests were used to compare categorical variables. Kruskal-Wallis and Independent T-tests were used to compare numeric data. All data were analyzed using SAS/STAT software version 9.4 (Carey, NC) and a 0.05 level of significance was defined apriori. Results: The conversion rate to below (BKA) or above knee amputation (AKA) was 26% (64 of 247). Males (p=.0274), diabetics (p=.0139), patients in ESRD (p=.019), and patients with a history of CVD (p=.0247) or perioperative revascularization (p=.022) were more likely to undergo further amputation following an index TMA. BMI was significantly higher in patients requiring BKA/AKA (p=.0305). There were no significant differences in age (p=.2723) or A1c levels (p=.4219). The overall mortality rate was 35% (84 of 229). Diabetes (p=.0272), ESRD (p=.0031), history of CVD (p<.0001) or PVD (p=.0179) were all significantly associated with mortality. Patients who died were significantly older (p=.0006) and had significantly higher A1c levels (p=.0373). BMI was not significantly associated with mortality. Twenty-two patients who had 23 further amputations subsequently died. Conclusion: In our series of patients undergoing TMA, 26% underwent further amputation and 35% of patients died. Conversion rate to BKA or AKA occurred at a high rate regardless of preoperative revascularization or the use of tendo-achilles or gastrocnemius lengthening procedures. Male sex, diabetes, ESRD, history of CVD or revascularization are significant risk factors for further amputation. ESRD, diabetes, history of CVD or PVD, older age and higher A1c levels are significant risk factors for mortality. These data provide useful insight into risk factors to be emphasized when counseling patients and their families to establish realistic postoperative expectations.

Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on Capd: Is There a Synergistic Effect with Insulin?

1995 ◽  
Vol 15 (6_suppl) ◽  
pp. 231-235 ◽  
Author(s):  
Maria Jose Fernandez-Reyes ◽  
Rafael Selgas ◽  
Maria Auxiliadora Bajo ◽  
Carlos Jimenez ◽  
Gloria Del Peso ◽  
...  
Keyword(s):  
Resistance Index ◽  
Diabetic Patients ◽  
Type I ◽  
Subcutaneous Insulin ◽  
Serum Parathyroid Hormone ◽  
Insulin Dependent ◽  
Independent Association ◽  
Pth Resistance ◽  
Serum Erythropoietin ◽  
Baseline Hemoglobin

Objective To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel. Patients Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. Conclusions According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.

Increased Response to Subcutaneous Erythropoietin on Type I Diabetic Patients on CAPD: Is There a Synergistic Effect with Insulin?

1995 ◽  
Vol 15 (3) ◽  
pp. 231-235 ◽  
Author(s):  
Maria Jose Fernandez-Reyes ◽  
Rafael Selgas ◽  
Maria Auxiliadora Bajo ◽  
Carlos Jimenez ◽  
Gloria Del Peso ◽  
...  
Keyword(s):  
Resistance Index ◽  
Diabetic Patients ◽  
Type I ◽  
Subcutaneous Insulin ◽  
Serum Parathyroid Hormone ◽  
Insulin Dependent ◽  
Independent Association ◽  
Pth Resistance ◽  
Serum Erythropoietin ◽  
Baseline Hemoglobin

Objective To evaluate the effect of subcutaneous erythropoietin (SC EPO) on the treatment of anemia in diabetic and nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Design A resistance index was designed for measuring the relative EPO response, dividing EPO dose (U/kg/ week) by the hemoglobin (Hb) increment with respect to the basallevel. Patients Eleven nonselected type I diabetic patients using subcutaneous insulin compared with 16 nondiabetic controls, all on CAPD therapy. Results The two groups showed similar mean baseline hemoglobin levels (7.4 D- l and 7.7 non-D, g/dL). There was a statistically significant lower resistance index for diabetics (13.8±9.7 U/kg/g Hb increment) compared to nondiabetic (55.8±128, p < 0.001). Multivariate analysis confirmed an independent association between diabetes and resistance index. The response to EPO was slightly better among those diabetic patients with lower levels of serum parathyroid hormone (iPTH) (PTH-resistance index, correlation coefficient, r = 0.7, p < 0.05). No other differences, apart from the use of subcutaneous insulin, were found between diabetics and controls. Although diabetic patients had an increased response to EPO, they had no more frequent side effects than nondiabetics. Conclusions According to our results, we suggest that factors related to insulin-dependent diabetes seem to be involved in a favorable response to SC EPO. Hyperinsulinemia derived from subcutaneous use of insulin might act as a comitogen with the induced increments of serum erythropoietin.

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