32-LB: Interstitial Glucose Levels during Exercise in Persons with and without Type 1 Diabetes

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 32-LB
Author(s):  
MICHAEL RIDDELL ◽  
ZHAOMIAN LI ◽  
NINOSCHKA DSOUZA ◽  
CHRISTOPHER YEUNG ◽  
DURMALOUK KESIBI ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Levels ◽  
Interstitial Glucose

scholarly journals Insulin degludec overdose in an adolescent with type 1 diabetes: proactive management including monitoring using the Freestyle Libre flash glucose monitoring system

2018 ◽  
Vol 2018 ◽  
Author(s):  
Harmony Thompson ◽  
Helen Lunt ◽  
Cate Fleckney ◽  
Steven Soule
Keyword(s):  
Type 1 Diabetes ◽  
Inpatient Treatment ◽  
Glucose Monitoring ◽  
Insulin Degludec ◽  
Glucose Levels ◽  
Proactive Management ◽  
Freestyle Libre ◽  
Interstitial Glucose ◽  
Insulin Overdose

Summary An adolescent with type 1 diabetes and a history of self-harm, which included intentional overdoses and insulin omission, presented with an insulin degludec overdose. She had been commenced on the ultra-long-acting insulin, degludec, with the aim of reducing ketoacidosis episodes in response to intermittent refusal to take insulin. Insulin degludec was administered under supervision as an outpatient. Because it was anticipated that she would attempt a degludec overdose at some stage, the attending clinicians implemented a proactive management plan for this (and related) scenarios. This included long-term monitoring of interstitial glucose using the Abbott Freestyle Libre flash glucose monitor. The patient took a witnessed overdose of 242 units of degludec (usual daily dose, 32 units). She was hospitalised an hour later. Inpatient treatment was guided primarily by interstitial glucose results, with capillary and venous glucose tests used as secondary measures to assess the accuracy of interstitial glucose values. Four days of inpatient treatment was required. The patient was managed with high glycaemic loads of food and also intermittent intravenous dextrose. No hypoglycaemia was documented during the admission. In summary, while a degludec overdose may require several days of inpatient management, in situations where proactive management is an option and the dose administered is relatively modest, it may be possible to avoid significant hypoglycaemia. In addition, this case demonstrates that inpatient interstitial glucose monitoring may have a role in managing insulin overdose, especially in situations where the effect of the insulin overdose on glucose levels is likely to be prolonged. Learning points: Degludec overdoses have a prolonged effect on blood glucose levels, but if the clinical situation allows for early detection and management, treatment may prove easier than that which is typically needed following overdoses of a similar dose of shorter acting insulins. Inpatient real-time interstitial monitoring helped guide management, which in this context included the prescription of high dietary carbohydrate intake (patient led) and intravenous 10% dextrose (nurse led). Use of inpatient interstitial glucose monitoring to guide therapy might be considered ‘off label’ use, thus, both staff and also patients should be aware of the limitations, as well as the benefits, of interstitial monitoring systems. The Libre flash glucose monitor provided nurses with low cost, easy-to-use interstitial glucose results, but it is nevertheless advisable to check these results against conventional glucose tests, for example, capillary ‘finger-stick’ or venous glucose tests.

776-P: Characteristics of Overnight Blood Glucose Levels Are Related to Sleep Quality in People with Type 1 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 776-P
Author(s):  
RACHEL BRANDT ◽  
MINSUN PARK ◽  
LAURIE T. QUINN ◽  
MINSEUNG CHU ◽  
YOUNGKWAN SONG ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Sleep Quality ◽  
Glucose Levels ◽  
Blood Glucose Levels

Effects of glycemic control on target organ responses to epinephrine in type 1 diabetes

2005 ◽  
Vol 289 (2) ◽  
pp. E258-E265 ◽  
Author(s):  
Deanna Aftab Guy ◽  
Darleen Sandoval ◽  
M. A. Richardson ◽  
Donna Tate ◽  
Stephen N. Davis
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Blood Pressure Response ◽  
Severe Hypoglycemia ◽  
Glucose Production ◽  
Endogenous Glucose Production ◽  
Target Organ ◽  
Epinephrine Infusion ◽  
Glucose Levels

Severe hypoglycemia occurs in intensively treated patients with type 1 diabetes mellitus (T1DM) due in part to deficient epinephrine counterregulatory responses. Previously, we have found that T1DM patients demonstrated a spectrum of altered responses to epinephrine at a variety of target organs compared with nondiabetic healthy subjects. What is not known is whether intensive glycemic control further modifies target organ responses in individuals with T1DM. Therefore, the aim of this study is to assess whether there is tissue specific (liver, muscle, adipose tissue, pancreas and cardiovascular) resistance to epinephrine in intensively controlled (IC) T1DM compared with those with conventional control (CC). Eight IC patients (age 33 ± 4 yr, BMI 24 ± 2 kg/m2, Hb A1C6.7 ± 0.1%), and 11 CC patients (age 35 ± 3 yr, BMI 25 ± 1 kg/m2, Hb A1C9.6 ± 0.1%) underwent two separate randomized, single-blind, 2-h hyperinsulinemic euglycemic clamp studies with (EPI) and without (NO EPI) epinephrine infusion. Epinephrine levels during EPI were similar in all groups (5,197 ± 344 pmol/l). Glucose (5.3 ± 0.1 mmol/l) and insulin levels (515 ± 44 pmol/l) were similar in all groups during the glucose clamps. Endogenous glucose production (EGP) and glucose uptake (Rd) were determined using [3-H3]glucose. Muscle biopsy was performed at the end of each study. IC had a significantly reduced EGP and Rdresponses to EPI compared with CC. Glucagon responses to EPI were similarly blunted in both IC and CC. Free fatty acid and glycerol response to EPI was greater in CC compared with IC. There was a significantly greater systolic blood pressure response to EPI in CC. We conclude that, despite similar epinephrine, insulin, and glucose levels, intensively treated T1DM patients had reduced cardiovascular, skeletal muscle, hepatic, and adipose target organ responses to EPI compared with conventionally treated T1DM patients.

Type I Diabetes Mellitus

2019 ◽  
Author(s):  
Joseph I. Wolfsdorf ◽  
Katharine Garvey
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Ketoacidosis ◽  
Autoimmune Diabetes ◽  
Type I ◽  
Insulin Deficiency ◽  
Glucose Levels

Type 1 diabetes mellitus is characterized by severe insulin deficiency, making patients dependent on exogenous insulin replacement for survival. These patients can experience life-threatening events when their glucose levels are significantly abnormal. Type 1 diabetes accounts for 5 to 10% of all diabetes cases, with type 2 accounting for most of the remainder. This review details the pathophysiology, stabilization and assessment, diagnosis and treatment, disposition and outcomes of patients with Type 1 diabetes mellitus. Figures show the opposing actions of insulin and glucagon on substrate flow and plasma levels; plasma glucose, insulin and C-peptide levels throughout the day; the structure of human proinsulin; current view of the pathogenesis of Type 1 autoimmune diabetes mellitus; pathways that lead from insulin deficiency to the major clinical manifestations of Type 1 diabetes mellitus; relationship between hemoglobin A1c values at the end of a 3-month period and calculated average glucose levels during the 3-month period; different combinations of various insulin preparations used to establish glycemic control; and basal-bolus and insulin pump regimens. Tables list the etiologic classification of Type 1 diabetes mellitus, typical laboratory findings and monitoring in diabetic ketoacidosis, criteria for the diagnosis of Type 1 diabetes, clinical goals of Type 1 diabetes treatment, and insulin preparations. This review contains 10 figures, 9 tables, and 40 references. Keywords: Type 1 diabetes mellitus, optimal glycemic control, hypoglycemia, hyperglycemia, polyuria, polydipsia, polyphagia, HbA1c, medical nutrition therapy, Diabetic Ketoacidosis

T1D Hypoglycemia Prediction Algorithms: A Systematic Review (Preprint)

2021 ◽  
Author(s):  
Stella Tsichlaki ◽  
Lefteris Koumakis ◽  
Manolis Tsiknakis
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Digital Libraries ◽  
Predictive Models ◽  
Real Life ◽  
Blood Glucose Monitoring ◽  
Detection Techniques ◽  
Glucose Levels ◽  
Wide Range

BACKGROUND Diabetes is a chronic condition that necessitates regular monitoring and self-management of the patient's blood glucose levels. People with type 1 diabetes (T1D) can live a productive life if they receive proper diabetes care. Nonetheless, a loose glycemic control might increase the risk of developing hypoglycemia. This incident can occur due to a variety of causes, such as taking additional doses of insulin, skipping meals, or over-exercising. Mainly, the symptoms of hypoglycemia range from mild dysphoria to more severe conditions, if not detected in a timely manner. OBJECTIVE In this review, we report on innovative detection techniques and tactics for identifying and preventing hypoglycemic episodes, focusing on type 1 diabetes. METHODS A systematic literature search following the PRISMA guidelines was performed focusing on the “PUBMED”, “Google Scholar”, “IEEE Xplore” and “ACM” digital libraries to find articles about technologies related to hypoglycemia detection in type 1 diabetes patients. RESULTS The presented approaches have been utilized or devised to enhance blood glucose monitoring and boost its efficacy to forecast future glucose levels, which could aid the prediction of future episodes of hypoglycemia. We detected nineteen predictive models for hypoglycemia, specifically on type 1 diabetes, utilizing a wide range of algorithmic methodologies, spanning from statistics (10%) to machine learning (52%) and deep learning (38%). The algorithms employed most are the kalman filtering and classification models (SVM, KNN, random forests). The performance of the predictive models was found overall to be satisfactory, reaching accuracies between 70% and 99% which proves that such technologies are capable to facilitate the prediction of T1D hypoglycemia. CONCLUSIONS It is evident that CGM can improve the glucose control in diabetes but predictive models for hypo- and hyper- glycemia using only mainstream noninvasive sensors such as wristbands and smartwatches are foreseen to be the next step for mHealth in T1D. Prospective studies are required to demonstrate the value of such models in real-life mHealth interventions.

Abstract 5826: MicroSPECT-CT Imaging Demonstrates Impairment of Matrix Metalloproteinases Activation in Ischemic Peripheral Angiogenesis in Type-1 Diabetes Associated with Glycation

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lawrence W Dobrucki ◽  
Donna Dione ◽  
Leszek Kalinowski ◽  
Albert J Sinusas
Keyword(s):  
Type 1 Diabetes ◽  
Matrix Metalloproteinases ◽  
Advanced Glycation Endproducts ◽  
Fold Increase ◽  
Ct Imaging ◽  
Invasive Approach ◽  
Glycation Endproducts ◽  
Glucose Levels ◽  
Fasting Glycemia

We previously demonstrated an impairment of ischemic peripheral angiogenesis (IPA) in a murine model of hindlimb ischemia using a radiolabeled RGD peptide targeted at alpha-v integrin in type-1 diabetes mellitus (DM) in association with advanced glycation endproducts (AGE). Glycation of the extracellular matrix (ECM) in DM inhibits ECM degradation by matrix metalloproteinases (MMPs), and impairs IPA. We hypothesized that targeted microSPECT-CT imaging of MMP activation with 99m Tc-labeled peptidomimetic (RP805; Lantheus, USA) would demonstrate impaired MMP activation during IPA in DM in association with AGE accumulation. Right femoral artery was surgically ligated on C57BL/6 male non-DM mice (n= 12) and DM mice (n= 17) 4–6 wks after STZ treatment (40 mg/kg i.p. for 5 days). DM mice demonstrated glycosuria and fasting glycemia (>200 mg/dL). RP805 (1.6± 0.5mCi) was injected and microSPECT-CT imaging performed 60 min later in mice 1 week (non-DM: n= 5; DM: n= 9) and 2 weeks (non-DM: n= 7; DM: n= 8) post-ligation. Blood was collected in additional non-DM (n= 4) and DM (n= 4) mice for measurement of HbA1c, an index of AGE accumulation. MicroSPECT-CT images were analyzed for RP805 activity within hindlimb distal to ligation, and ischemic-to-nonischemic (I/N) activity ratios calculated. DM mice demonstrated ~3-fold increase in glucose levels, and ~2.7-fold increase in AGE. Quantitative RP805 imaging demonstrated an impairment of MMP activation (~47%, P< 0.05) in DM at 1 week post-ligation, which normalized at 2 weeks. RP805 microSPECT-CT imaging provides a novel non-invasive approach for evaluation of impaired MMP activation during IPA in DM, and was associated with AGE accumulation.

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