Response:
Dr. Perkins,
To respond to your request to determine if switching from Lantus to Levemir or Tresiba would alleviate nocturnal hypoglycemia and weight gain we provide the following information:
Answer:
• The literature suggests that the use of insulin degludec is recommended over the use of long-insulin glargine and insulin detemir to reduce the rate of nocturnal hypoglycemia.
• The literature is inconclusive regarding switching from Lantus to Levemir or Tresiba and the alleviation of weight.
Background:
Long-acting insulins are used to control blood glucose levels in patients with diabetes. Although long-acting insulins control blood glucose levels they have been associated with nocturnal hypoglycemia and weight gain. These long-acting insulins provide blood-glucose maintenance for a 24-hour period per injection. Insulin degludec is an ultra-long basal insulin that provides blood-glucose maintenance for a 42-hour period. Due to the mechanism of action of these insulins, hypoglycemia and weight gain are frequently associated with their use.
Evidence:
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One study compared insulin degludec with insulin glargine. With a confidence interval of CI (.70 - .85) a p<0.001 when a 95% CI (0.31-0.73) was used.2 The last study utilized to answer this question also examined the safety and efficacy of insulin degludec vs. insulin glargine.3 In this study, there was a significantly lower rate of nocturnal hypoglycemia in insulin degludic (0.25 episodes per patient year of exposure) vs. insulin glargine (0.39 episodes per patient year of exposure); 95% confidence interval and p-value =
3: Briscoe VJ, Davis SN (2006) Hypoglycaemia in Type 1 and 2 Diabetes: Physiology, pathophysiology and management. Clinical Diabetes, 24 (3), 115-121
Spikoff, Martin. Controversy Continues to Surround Generic Insulin. 16 April 2008. 9 October 2009 .
Thyroid and metabolism hormones play a large role in the daily lives of all living species. Thyroid hormones regulate the metabolism and the metabolism is responsible for maintaining a specific range for the biochemical reactions that occur in the body (Martini 2014). The most important hormone for metabolic maintenance is thyroxine (T4). This hormone also plays a large role in body heat regulation. It is produced by the pituitary gland and secreted by the thyroid gland. The thyroid releasing hormone (TRH) must trigger the thyroid stimulating hormones (TSH) to release thyroid hormones to the thyroid gland. These hormones are under control of the hypothalamus, or main neural control center. Propylthiouracil (PTU) is a medication used to treat
As the solution pH can influence the stability of NaClO-NH3 blend and the elimination of SO2, NOx, the impact of the pH of NaClO-NH3 blend solution on the instantaneous removal as well as the duration time was investigated, and the final pH after reaction was also detected and shown in Fig. 5. It can be seen that the variation of solution pH has a negligible effect on the desulfurization, but the elevated pH has a great promotion on the NOx removal, the efficiencies are significantly increased from 36% to 99% for NO2 in the pH range of 5–12 and from 19% to 65% for NO when the pH is between 5 and 10, after where, both of them are constant. Hence, the optimal pH of the NaClO-NH3 solution for the
II. The American Diabetes association, containing health care professionals and staff members from all over the world, wrote an article published in September 14, 2014 describing two conditions when the body’s respond to insulin is crucial.
For this evaluation of a clinical practice guideline I chose to evaluate a guideline that was published in 2012 and that addressed the use of oral medication in the treatment of Type 2 Diabetes (Appendix B). People who have received a diagnosis of Type 2 Diabetes Mellitus (T2DM) are facing a long term treatment plan. Diabetes mellitus is a chronic metabolic disorder that results from a problem with insulin in the body. T2DM is growing in prevalence and is a cause for concern. There are several co-morbidities that can be linked to poorly controlled blood sugar levels such as cardiovascular disease, peripheral vascular disease, renal failure, and a decrease in eyesight. If blood sugar levels can be maintained at a normal to near normal limits the patient has a decreased risk of experiencing these comorbidities. Because of this it is important for the healthcare practitioner to evaluate all treatment methods available and the evidence that supports the efficacy of recommending this treatment to our patients. I used the AGREE II tool in evaluation of this guideline (Appendix A).
Orlistat is a lipase-inhibitor drug designed to help obese individuals lose and maintain their body weight. The drug in combination with a healthy low-fat diet and exercise can help in the treatment of obesity. Reducing fat intake is critical when attempting to reduce body fat. Orlistat reduces body fat by increasing the amount of fat passed through the body. The drug has already been approved in Europe and is expected to be approved by the FDA in the US in 1999.There have been scientific studies which support the effectiveness and low risks of Orlistat. Diet and exercise should be stressed in all attempts at weight loss, yet it seems Orlistat may be a helpful addition to the weight loss program for obese patients.
Insulin is a hormone produced by the B cells in the islets of Langerhans of the pancreas. Under normal conditions, insulin is continuously released into the bloodstream in small pulsatile increments (a basal rate), with increased release (bolus) when food is ingested. The activity of released insulin lowers blood glucose and facilitates a stable, normal glucose range of approximately 70 to 120 mg/dl. The average amount of insulin secreted daily by and adult is approx. 40 to 50 U, or 0.6 U/kg of body weight.
Metformin is the generic name of a medication used in the management of diabetes mellitus type 2. Various trade names of this drug include Riomet, Glucophage XR, Carbophage SR, Obimet, Siofor, Fortamet, Glucophage, and Glumetza. The chemical name is 1,1-Dimethylbiguanide monohydrochloride. Doses up to 2000 mg per day may be given twice daily. The circulation of metformin is that the drug’s steady state of concentration within the blood is reached in 24-48 hours and the half life is approximately 6-1/2 hours. The nonabsorbed fraction of the dru...
Astrup, Arne. “Dietary Approaches to Reducing Body Weight.” Clinical Endocrinology and Metabolism. Ed. Jeff P. Holly. New York: AMA 1999. 109-120.
... glucose measurements. Continuation into the immediate postoperative period remains important as well. Once in a steady state, treatment ought to be converted to a subcutaneous BBI regimen. For conversion from intravenous to subcutaneous insulin, a transition protocol should be employed 124.
Evidence of any benefit to the treatment of glucose levels lower than the current criteria for diagnosis are lacking. Studies seen above provide evidence that treatment of even
Within 30 minutes of teaching lesson, the patient will be able to injection insulin properly. The patient will be able to perform self-monitoring of blood glucose using a blood gl...
Patient is a female, aged 65 years old who requires weight loss as GP referral reported. In order to assess her, anthropometric measurements were taken. She has a current weight of 135.5kg and her height is 1.55m.Consequently, she has a body mass index (BMI) of 56.4kg/m² and she is obese class II. According to her biochemical results all parameters are normal except raised glucose and TG. Clinical data obtained include her current, past medical history and medication. She is type 2 diabetic and obese. She has a past medical history of hypertension, hyperlipidemia and sleep apnoea. The medications she takes are glucophage for controlling blood sugar levels and salmeterol for treatment of asthma. Diet history of patient was taken by asking her recall the last 24 hours food and drink intake. Her estimated energy intake is about 2445kcal from which 44.3% from fat and 67g protein. Patient energy requirements calculated from Henry were (BMR) = (8.52W+421H+10.7)*PAL (1.4) =2022kcal/d. Total estimated energy requirements were 2022kcal per day. Protein requirements based on 75% of actual body weight was 101.6g protein per day. Total fluids requirements estimated using 25ml/kg adjusted body weight and is about 2293ml per day. Environmental data include that lives with her family and she does not exercise.