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Related Concept Videos

Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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Insulin Formulations: Types and Delivery01:27

Insulin Formulations: Types and Delivery

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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into...
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Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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SBAR II: Application of SBAR01:14

SBAR II: Application of SBAR

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SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
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Oral Hypoglycemic Agents: Glinides01:06

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
154
Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

199
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Improving IV Insulin Administration in a Community Hospital
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Less Is More: Backing off Sliding Scale Insulin for Hospitalized Patients.

Lakshmi Karra1, Roxanne Radi1, Corey Lyon1

  • 1From the Denver Health Hospital Authority, Denver, CO (LK, RR); University of Colorado FMR, Denver, CO (CL).

Journal of the American Board of Family Medicine : JABFM
|March 6, 2024
PubMed
Summary
This summary is machine-generated.

For hospitalized patients with type 2 diabetes mellitus (T2DM), a gentler insulin approach works just as well as a more intensive one. This finding supports less aggressive glucose control strategies in this patient population.

Keywords:
Diabetes Mellitus Type 2HospitalizationSliding Scale Insulin

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Clinical Research

Background:

  • Hospitalized patients with type 2 diabetes mellitus (T2DM) often require supplemental insulin.
  • Current guidelines suggest varying degrees of glycemic control targets.
  • The optimal intensity of insulin therapy in hospitalized T2DM patients remains an area of investigation.

Purpose of the Study:

  • To compare the efficacy and safety of a less aggressive supplemental insulin regimen versus a standard, more aggressive regimen in hospitalized patients with T2DM.

Main Methods:

  • A noninferiority trial design was employed.
  • Patients were randomized to either a less aggressive or a standard insulin regimen.
  • Key outcomes included glycemic control and adverse events.

Main Results:

  • The less aggressive insulin regimen was found to be noninferior to the standard regimen.
  • Glycemic control was comparable between the two groups.
  • No significant differences in adverse events were observed.

Conclusions:

  • A less aggressive supplemental insulin regimen is a viable and safe option for hospitalized patients with T2DM.
  • These findings may inform clinical practice guidelines regarding insulin therapy in this setting.
  • Less intensive glycemic control may be appropriate for certain hospitalized T2DM patients.