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Intensive Insulin Treatment (intensive + insulin_treatment)

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Medical Sciences100%

Selected Abstracts

Intensive insulin treatment in coronary and intensive care

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2007
Dr C Jones MRCP, MB ChB Specialist Registrar
Abstract Hyperglycaemia in the setting of acute illness carries a poor prognosis. The first Diabetes and Insulin-Glucose infusion in Acute Myocardial Infarction (DIGAMI) study demonstrated a reduction in total mortality with intravenous insulin to reduce hyperglycaemia followed by multi-dose subcutaneous insulin in diabetic patients following myocardial infarction. Unfortunately, there were several problems with the follow-up DIGAMI-2 study, so that it is not clear if maximum benefit was obtained by intravenous insulin, subcutaneous insulin, or a combination of both. In the surgical intensive care unit (ICU) setting, intensive insulin to restore normoglycaemia reduced total mortality in patients admitted to a surgical ICU who developed hyperglycaemia. In a follow-up study in medical ICU patients the results were disappointing, and there was no overall reduction in mortality. There is a need for a study which would combine these two complementary approaches, examining the possible benefits of using very intensive insulin treatment to achieve normoglycaemia following myocardial infarction in patients with diabetes. Copyright © 2007 John Wiley & Sons. [source]

C-Peptide Deficiency: An Important Pathogenetic Factor In Type 1 Diabetic Neuropathy

JOURNAL OF THE PERIPHERAL NERVOUS SYSTEM, Issue 3 2000
Aaf Sima
Background: C-peptide has insulin-like effects and ameliorates the acute nerve conduction defect (NCD) in experimental and human type 1 diabetic neuropathy (DN). Methods: In this study, diabetic BB/Wor-rats were treated with rat C-peptide (75 ng/kg) from onset of diabetes for 8 months (prevention-group, PG). In a separate experiment, 5-mo untreated diabetic BB/Wor-rats were started on the same C-peptide treatment continued to 8 mo of diabetes (intervention group, IG). Results: In the PG, the NCD was significantly decreased (p < 0.001) compared to untreated BB/Wor-rats and was similar to that of normo-C-peptidemic and isohyperglycemic type 2 BBZ rats. This effect was associated with significant preventions of nodal changes (p < 0.001) including axo-glial dysjunction (p < 0.001), which was not different from non-diabetic control rats. Axonal atrophy and Wallerian degeneration were significantly prevented (both p < 0.05). In the IG, the NCD decreased significantly (p < 0.01) during the 3 mo treatment period. Associated with the functional improvement, nodal changes improved significantly (p < 0.001) as did axonal degenerative changes (p < 0.01). C-peptide treatment in the IG resulted in a significant increase in the frequency of regenerating fibers (p < 0.001) compared with untreated 5 mo diabetic rats. Conclusion: These studies demonstrate that C-peptide replacement in type 1 diabetes prevents the chronic NCD and structural changes. Furthermore, C-peptide treatment significantly improves the already established functional and structural abnormalities of DN. This is the first demonstration of a therapeutic improvement of established neuropathy in experimental diabetes. We conclude that C-peptide deficiency in type 1 diabetes is an important pathogenetic component of DN and that its replacement may provide a valuable adjunct to intensive insulin treatment. [source]

Intensive insulin treatment in coronary and intensive care

PRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 1 2007
Dr C Jones MRCP, MB ChB Specialist Registrar
Abstract Hyperglycaemia in the setting of acute illness carries a poor prognosis. The first Diabetes and Insulin-Glucose infusion in Acute Myocardial Infarction (DIGAMI) study demonstrated a reduction in total mortality with intravenous insulin to reduce hyperglycaemia followed by multi-dose subcutaneous insulin in diabetic patients following myocardial infarction. Unfortunately, there were several problems with the follow-up DIGAMI-2 study, so that it is not clear if maximum benefit was obtained by intravenous insulin, subcutaneous insulin, or a combination of both. In the surgical intensive care unit (ICU) setting, intensive insulin to restore normoglycaemia reduced total mortality in patients admitted to a surgical ICU who developed hyperglycaemia. In a follow-up study in medical ICU patients the results were disappointing, and there was no overall reduction in mortality. There is a need for a study which would combine these two complementary approaches, examining the possible benefits of using very intensive insulin treatment to achieve normoglycaemia following myocardial infarction in patients with diabetes. Copyright © 2007 John Wiley & Sons. [source]

Combined Pancreatic Islet,Lung Transplantation: A Novel Approach to the Treatment of End-Stage Cystic Fibrosis

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 7 2010
L. Kessler
Patients with end-stage cystic fibrosis (CF) and severe CF-related diabetes (CFRD) may benefit from combined lung-pancreatic islet transplantation. In the present study, we report the long-term follow-up of four end-stage CF patients treated with combined bilateral lung and pancreatic islet transplantation from the same donor. All patients were C-peptide negative (<0.5 ,g/L) and inadequately controlled despite intensive insulin treatment. One patient was transplanted with 4 019 ± 490 islet equivalent/kg injected into the transverse colic vein using a surgical approach. In the remaining three patients, islets were cultured for 3,6 days and transplanted by percutaneous transhepatic catheterization of the portal vein. In all patients, islet allograft recovery was recognized by elevation in the plasma level of C-peptide (>0.5 ,g/L). At 6 months after transplantation, one patient showed multiple episodes of acute lung transplant rejection and a progressive decline in pancreatic islet cell function. Three out of four patients experienced an improved control of glucose levels with a HbA1c of 5.2%, 7% and 6% respectively at 1.5, 2 and 15 years follow-up. Compared with the pretransplant period, there was a 50% reduction in mean daily insulin needs. Pulmonary function remained satisfactory in all patients. In conclusion, our cases series shows that combined bilateral lung and pancreatic islet transplantation may be a viable therapeutic option for patients with end-stage CF and CFRD. [source]