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Insulin Dosing

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20901. Low-dose glucose infusion after achieving critical hypoglycemia during insulin tolerance testing: effects on time of hypoglycemia, neuroendocrine stress response and patient's discomfort in a pilot study. (PubMed)

Low-dose glucose infusion after achieving critical hypoglycemia during insulin tolerance testing: effects on time of hypoglycemia, neuroendocrine stress response and patient's discomfort in a pilot study. The insulin tolerance test (ITT) is regarded as the gold standard for the evaluation of pituitary ACTH and growth hormone reserve. However, the intended critical hypoglycemia results in considerable discomfort and requires close surveillance during the test.In a pilot study, we evaluated (...) whether the ITT could be markedly simplified, made less hazardous and more convenient by routine i.v. low-dose glucose administration after hypoglycemia has been achieved. Sixteen healthy subjects (three females, 13 males) were tested twice in a randomized, single-blinded fashion, receiving 0.15 IU insulin/kg body weight as an i.v. bolus. After hypoglycemia (serum glucose less than 2.2 mmol/l) had been achieved, 500 ml isotonic saline (protocol A (A)), or 500 ml 5% glucose solution (protocol B (B

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2005 European journal of endocrinology / European Federation of Endocrine Societies Controlled trial quality: uncertain

20902. [Effects of high dose glucose-insulin-potassium infusion on myocardial injury and serum sFas/ sFasL concentration in acute myocardial infarction]. (PubMed)

[Effects of high dose glucose-insulin-potassium infusion on myocardial injury and serum sFas/ sFasL concentration in acute myocardial infarction]. This study was designed to evaluate reperfusion therapy, co-administered with high dose glucose-insulin-potassium (GIK) treatment on serum soluble Fas/APO-1 (sFas) and Fas ligand (sFasL) concentration in Acute Myocardial Infarction (AMI) patients.Seventy-four patients with AMI underwent reperfusion therapy were randomized into GIK group (n = 35 (...) ) receiving high-dose GIK for 24 hours or a vehicle group (n = 39). Thirty-four control subjects (NC) were also enrolled in the present study. Strepavidin-biotin ELISA was used to determine the serum sFas and sFasL concentration at baseline and different time point (24 h, 3 d, 7 d and 14 d) after reperfusion.(1) The serum concentration of sFas and sFas-L ([sFas] and [sFas-L]) of AMI patients were significantly elevated at baseline as compared with NC (P < 0.01). (2) The [sFas] in GIK and non-GIK group

2005 Zhonghua nei ke za zhi [Chinese journal of internal medicine] Controlled trial quality: uncertain

20903. Improvement in insulin sensitivity without concomitant changes in body composition and cardiovascular risk markers following fixed administration of a very low growth hormone (GH) dose in adults with severe GH deficiency. (PubMed)

Improvement in insulin sensitivity without concomitant changes in body composition and cardiovascular risk markers following fixed administration of a very low growth hormone (GH) dose in adults with severe GH deficiency. Untreated GH-deficient adults are predisposed to insulin resistance and excess cardiovascular mortality. We showed previously that short-term treatment with a very low GH dose (LGH) enhanced insulin sensitivity in young healthy adults. The present study was therefore designed (...) to explore the hypothesis that LGH, in contrast to the standard GH dose titrated to normalize serum IGF-I levels (SGH), may have differing effects on insulin sensitivity, body composition, and cardiovascular risk markers [lipid profile, C-reactive protein (CRP), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha) and adiponectin] in adults with severe GH deficiency.In this 12-month open, prospective study, 25 GH-deficient adults were randomized to receive either a fixed LGH (0.10 mg/day, n

2005 Clinical endocrinology Controlled trial quality: uncertain

20904. Effect of the administration of a single dose of nateglinide on insulin secretion at two different concentrations of glucose in healthy individuals. (PubMed)

Effect of the administration of a single dose of nateglinide on insulin secretion at two different concentrations of glucose in healthy individuals. Nateglinide is a D-phenylalanine derivative that stimulates fast insulin secretion with a short activity span. It has been suggested that the hypoglycemic effect of nateglinide is related to the glucose concentration, an aspect that still has not been completely evaluated in human beings.The aim of this study is to evaluate the effect (...) of nateglinide on the insulin secretion at two different concentrations of glucose level.A randomized, double-blind, cross-over, placebo-controlled clinical trial with two parallel groups was carried out; each group was made up by six healthy volunteers who were submitted to a hyperglycemic-hyperinsulinemic clamp technique on two different occasions, one of them prior to the administration of 120 mg nateglinide and the other one prior to the administration of an homologated placebo. One group was submitted

2005 Journal of diabetes and its complications Controlled trial quality: uncertain

20905. Dose-response relationship of oral insulin spray in healthy subjects. (PubMed)

Dose-response relationship of oral insulin spray in healthy subjects. To evaluate the pharmacodynamic and pharmacokinetic properties and the dose-ranging effects of an oral insulin spray in comparison with subcutaneous regular insulin.In this randomized, five-way, cross-over study, seven healthy volunteers were assessed under euglycemic clamp and received four different doses of oral spray and one dose of subcutaneous regular insulin.The time to maximum insulin concentration was shorter (...) for oral insulin than for subcutaneous insulin (25.9 +/- 9 vs. 145.7 +/- 49.5 min, P < 0.05). Maximum serum insulin levels (C(max)) were comparable between the subcutaneous and 20 puffs of oral insulin (39.1 +/- 19.6 vs. 34.0 +/- 7.4 microU/ml, NS). The Ins-AUC(0-120) (area under the curve from 0 to 120 min for serum insulin) (339.8 +/- 218, 681.3 +/- 407, and 1,586.7 +/- 8 microU/ml, P < 0.05) and C(max) (7.6 +/- 2.8, 16.4 +/- 9.3, and 39.1 +/- 19.6 microU/ml, P < 0.005) proved a dose-response

2005 Diabetes Care Controlled trial quality: uncertain

20906. Changes in serum lipids and postprandial glucose and insulin concentrations after consumption of beverages with beta-glucans from oats or barley: a randomised dose-controlled trial. (PubMed)

Changes in serum lipids and postprandial glucose and insulin concentrations after consumption of beverages with beta-glucans from oats or barley: a randomised dose-controlled trial. To investigate side by side the effects on serum lipoproteins and postprandial glucose and insulin concentrations of beverages enriched with 5 or 10 g of beta-glucans from oats or barley.An 8-week single blind, controlled study with five parallel groups carried out at two centres under identical conditions.A total (...) of 100 free-living hypercholesterolaemic subjects were recruited locally and 89 completed the study.During a 3-week run-in period all subjects consumed a control beverage. For the following 5-week period four groups received a beverage with 5 or 10 g beta-glucans from oats or barley and one group continued with the control beverage. Blood samples in weeks 0, 2, 3, 7 and 8 were analysed for serum lipids, lipoproteins, glucose and insulin. Postprandial concentrations of glucose and insulin were

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2005 European journal of clinical nutrition Controlled trial quality: uncertain

20907. Assessment of dose selection attributes with audible notification in insulin pen devices. (PubMed)

Assessment of dose selection attributes with audible notification in insulin pen devices. Patients with type 2 diabetes often suffer from impairments in vision as well as manual dexterity. The purpose of this study was to assess the reliability of dose selection and setting of five insulin devices by patients using auditory and sensory confirmation.A total of 48 patients (30 men, 18 women; mean +/- SD age 60.5 +/- 14.0 years; hemoglobin A(1c) 8.7 +/- 1.9%) were randomized to test the following (...) for dose setting. Sound recordings showed that the NovoPen 3 produced the loudest clicks when setting a dose (P < 0.001 for all comparisons).The clarity of the click when setting a dose on an insulin delivery device can affect the patient's confidence in selecting the correct dose.

2005 Diabetes technology & therapeutics Controlled trial quality: uncertain

20908. A double-blind, randomized, dose-response study investigating the pharmacodynamic and pharmacokinetic properties of the long-acting insulin analog detemir. (PubMed)

A double-blind, randomized, dose-response study investigating the pharmacodynamic and pharmacokinetic properties of the long-acting insulin analog detemir. To investigate the pharmacodynamic profile and duration of action for five subcutaneous doses of insulin detemir (0.1, 0.2, 0.4, 0.8, and 1.6 units/kg; 1 unit = 24 nmol) and one subcutaneous dose of NPH insulin (0.3 IU/kg; 1 IU = 6 nmol).This single-center, randomized, double-blind, six-period, crossover study was carried out as a 24-h (...) isoglycemic clamp (7.2 mmol/l) in 12 type 1 diabetic patients.Duration of action for insulin detemir was dose dependent and varied from 5.7, to 12.1, to 19.9, to 22.7, to 23.2 h for 0.1, 0.2, 0.4, 0.8, and 1.6 units/kg, respectively. Interpolation of the dose-response relationships for AUC(GIR) (area under the glucose infusion rate curve) revealed that a detemir dose of 0.29 units/kg would provide the same effect as 0.3 IU/kg NPH but has a longer duration of action (16.9 vs. 12.7 h, respectively). Lower

2005 Diabetes Care Controlled trial quality: uncertain

20909. Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. (PubMed)

Optimal insulin pump dosing and postprandial glycemia following a pizza meal using the continuous glucose monitoring system. We attempted to identify an optimal insulin pump meal bolus by comparing postprandial sensor glucose values following three methods of insulin pump meal bolusing for a consistent pizza meal.Twenty-four patients with type 1 diabetes participated in a study to compare postprandial glucose values following three meal bolus regimens for a consistent evening pizza meal. Each (...) participant utilized the following insulin lispro regimens on consecutive evenings, and glucose values were tracked by the Continuous Glucose Monitoring System (CGMS, Medtronic MiniMed, Northridge, CA): (a) single-wave bolus (100% of insulin given immediately); (b) 4-h dual-wave bolus (50% of insulin given immediately and 50% given over a 4-h period); and (c) 8-h dual-wave bolus (50% of insulin given immediately and 50% given over a 8-h period). Total insulin bolus amount was kept constant for each pizza

2005 Diabetes technology & therapeutics Controlled trial quality: uncertain

20910. Effect of low-dose insulin treatment on body weight and physical development in children and adolescents at risk for type 1 diabetes. (PubMed)

Effect of low-dose insulin treatment on body weight and physical development in children and adolescents at risk for type 1 diabetes. Insulin's role in body weight regulation is controversial. We evaluated the effect of parenteral insulin on body weight and physical development in children and adolescents at risk for type 1 diabetes.We performed a secondary analysis of the parenteral arm of the Diabetes Prevention Trial-Type 1 Diabetes (DPT-1), a randomized controlled trial of low-dose (...) years after adjustment for relevant covariates.Low-dose insulin treatment for 2 years did not affect the weight, BMI, or physical development of nondiabetic children and adolescents.

2005 Diabetes Care Controlled trial quality: uncertain

20911. Metabolic and hemodynamic effects of high-dose insulin treatment in aortic valve and coronary surgery. (PubMed)

Metabolic and hemodynamic effects of high-dose insulin treatment in aortic valve and coronary surgery. Glucose and insulin have been used as an adjuvant therapy in cardiac surgery because of their potentially beneficial effects on myocardial metabolism and contractile function. This study evaluated the effects of high-dose insulin on systemic metabolism and hemodynamics after combined heart surgery.Forty elective patients scheduled for combined aortic valve replacement and coronary artery (...) bypass surgery were randomly assigned to receive either high-dose insulin treatment (short-acting insulin 1 IU.kg(-1).h(-1) with 30% glucose 1.5 mL.kg(-1).h(-1) administered separately) or control treatment (saline). The blood glucose levels were maintained within a targeted range by adjusting the rate of glucose infusion in the treatment group and by short-acting insulin bolus doses in the control group.The lactate clearance was faster (p = 0.046), and the lactate levels (p = 0.016), blood glucose

2005 The Annals of thoracic surgery Controlled trial quality: uncertain

20912. A multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a long-acting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecretion. (PubMed)

A multicenter, randomized, double-blind, placebo-controlled, dose-finding trial of a long-acting formulation of octreotide in promoting weight loss in obese adults with insulin hypersecretion. To compare changes in weight in obese patients who received long-acting octreotide (octreotide LAR) at one of three dose levels (20, 40, or 60 mg) or placebo over 6 months and to identify the lowest dose of octreotide LAR that safely achieved optimal weight loss.Randomized, double-blind, placebo (...) -controlled trial of octreotide LAR at three dose levels.A total of 172 adults (28 men and 144 women) with at least moderate obesity (body mass index (BMI) range 30-65 kg/m2) and evidence of insulin hypersecretion were enrolled. Patients were predominantly either Caucasian (50.0%) or African American (45.3%). The mean age (38 +/- 11 year), weight (110.7 +/- 23 kg), and BMI (39.8 +/- 6.5 kg/m2) were similar across the four treatment groups.Efficacy measures included weight, BMI, fasting serum glucose

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2006 International Journal of Obesity Controlled trial quality: predicted high

20913. Tesaglitazar, a novel dual peroxisome proliferator-activated receptor alpha/gamma agonist, dose-dependently improves the metabolic abnormalities associated with insulin resistance in a non-diabetic population. (PubMed)

Tesaglitazar, a novel dual peroxisome proliferator-activated receptor alpha/gamma agonist, dose-dependently improves the metabolic abnormalities associated with insulin resistance in a non-diabetic population. Insulin resistance is associated with abnormalities in lipid and glucose metabolism, which are major components of metabolic syndrome and risk factors for vascular disease. This study examined the effect of tesaglitazar (Galida), a novel, dual-acting peroxisome proliferator-activated (...) receptor alpha/gamma agonist, on lipid and glucose metabolism in patients with evidence of insulin resistance.A 12-week, multicentre, randomised, double-blind, placebo-controlled, dose-finding study compared the efficacy and safety of oral tesaglitazar (0.1, 0.25, 0.5 and 1.0 mg/day) and placebo in 390 non-diabetic patients with hypertriglyceridaemia (plasma triglyceride concentration >1.7 mmol/l) and abdominal obesity (waist-to-hip ratio >0.90 for men and >0.85 for women).A 1.0-mg dose of tesaglitazar

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2005 Diabetologia Controlled trial quality: predicted high

20914. Anti-inflammatory effect of high-dose insulin treatment after urgent coronary revascularization surgery. (PubMed)

Anti-inflammatory effect of high-dose insulin treatment after urgent coronary revascularization surgery. The administration of insulin has been shown to exert cardioprotective and immunomodulatory properties. Ischemia and inflammation are typical features of acute coronary syndrome, thus it was hypothesized that high-dose glucose-insulin-potassium (GIK) treatment could suppress the systemic inflammatory reaction and attenuate myocardial ischemia-reperfusion injury in patients with unstable (...) angina pectoris after urgent coronary artery bypass surgery.Forty patients with unstable angina pectoris scheduled for urgent coronary artery bypass surgery and cardiopulmonary bypass were randomly assigned to receive either high-dose insulin treatment (short-acting insulin 1 IU/kg/h with 30% glucose 1.5 ml/kg/h administered separately) or control treatment (saline). Blood glucose levels were targeted to 6.0-8.0 mmol/l in both groups by adjusting the rate of glucose infusion in the GIK group

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2006 Acta Anaesthesiologica Scandinavica Controlled trial quality: uncertain

20915. The effect of single-dose orlistat on postprandial serum glucose, insulin and glucagon-like peptide-1 levels in nondiabetic obese patients. (PubMed)

The effect of single-dose orlistat on postprandial serum glucose, insulin and glucagon-like peptide-1 levels in nondiabetic obese patients. Glucagon-like peptide-1 is an insulin secretion-stimulating gut hormone that is produced in response to food intake. Orlistat (Xenical, F. Hoffman-La Roche, Basel, Switzerland), which decreases fat absorption and increases intestinal fat content, may therefore affect the secretion of glucagon-like peptide-1. In this study we examined the immediate effects (...) of orlistat on postprandial serum glucose, insulin and glucagon-like peptide-1 levels prior to a change in body weight.Randomized, clinical study.Sixteen nondiabetic obese patients (body mass index 35.7 +/- 3.8 kg/m(2), range 32.5-43.1) were enrolled in this study. The patients were randomly assigned to either the group treated with orlistat (120 mg, single dose) or the control group. There were eight patients in each of the two groups. Orlistat was given before a standard 600-kcal mixed meal containing

2007 Clinical endocrinology Controlled trial quality: uncertain

20916. Low-dose rosiglitazone in patients with insulin-requiring type 2 diabetes. (PubMed)

Low-dose rosiglitazone in patients with insulin-requiring type 2 diabetes. The objective was to compare the efficacy and safety of adding low-dose rosiglitazone (2 or 4 mg/d) to insulin therapy vs continued insulin monotherapy in patients with type 2 diabetes mellitus who were unable to achieve glycemic control with insulin therapy alone.In this 24-week, double-blind study, 630 individuals with type 2 diabetes mellitus that was inadequately controlled with insulin therapy alone were randomized (...) incidence of hypoglycemia and edema, was similar between treatment groups, and most adverse events were mild to moderate in intensity.The addition of low-dose rosiglitazone to insulin therapy is an effective and well-tolerated treatment option for patients with type 2 diabetes mellitus who continue to have poor glycemic control despite administration of exogenous insulin as monotherapy.clinicaltrials.gov Identifier: NCT00054782.

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2007 Archives of internal medicine Controlled trial quality: predicted high

20917. Metformin plus low-dose glimeperide significantly improves Homeostasis Model Assessment for insulin resistance (HOMA(IR)) and beta-cell function (HOMA(beta-cell)) without hyperinsulinemia in patients with type 2 diabetes mellitus. (PubMed)

Metformin plus low-dose glimeperide significantly improves Homeostasis Model Assessment for insulin resistance (HOMA(IR)) and beta-cell function (HOMA(beta-cell)) without hyperinsulinemia in patients with type 2 diabetes mellitus. Type 2 diabetes mellitus is characterized by insulin resistance and defects in insulin secretion from pancreatic beta-cells, which have been studied by using euglycemic/hyperinsulinemic clamps. However, it is difficult to study insulin resistance and beta-cell failure (...) ) metformin + low-dose glimepiride + ADA diet + physical activity; or (C) ADA diet + physical activity (no drugs). Blood samples were obtained before and after the treatment to determine serum levels of fasting and post-prandial blood glucose, fasting insulin, and glycosylated hemoglobin (HbA1c), and HOMA(IR) and HOMA(beta-cell) were calculated.Fasting and post-prandial levels of glucose, HbA1c, and fasting insulin and calculated HOMA(IR) and HOMA(beta-cell) values before treatment were significantly

2007 American journal of therapeutics Controlled trial quality: uncertain

20918. Direct rosiglitazone-induced modifications in insulin secretion, action and clearance: a single-dose hyperglycaemic clamp study. (PubMed)

Direct rosiglitazone-induced modifications in insulin secretion, action and clearance: a single-dose hyperglycaemic clamp study. In addition to the improvement in insulin sensitivity, it has been shown that thiazolidinediones modulate beta cell function and insulin clearance in type 2 diabetic subjects. However, interactions between all these actions, and confounding factors due to co-morbidities and co-treatments in diabetic individuals, complicate the identification of specific effects (...) +/- 2,813 pmol l(-1) 110 min in controls (p < 0.05), without change in the first phase. Serum C-peptide was not modified. Rosiglitazone treatment significantly increased insulin clearance (molar ratio of the C-peptide to insulin AUCs: 12.80 +/- 1.34 vs 11.38 +/- .33, p < 0.05) and the insulin sensitivity index (12.0 +/- 1.5 vs 8.5 +/- 1.1 micromol m(-2) min(-1) pmol(-1)l, p < 0.01).The present results show that a single dose of rosiglitazone rapidly increases insulin clearance and insulin sensitivity

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2007 Diabetologia Controlled trial quality: uncertain

20919. Insulin growth factor-based dosing of growth hormone therapy in children: a randomized, controlled study. (PubMed)

Insulin growth factor-based dosing of growth hormone therapy in children: a randomized, controlled study. Weight-based dosing of GH is the standard of care for short children, although IGF-I is thought to be the main mediator of GH actions on growth.The objective of the study was to test whether IGF-I levels achieved during GH therapy are determinants of the growth responses to GH treatment.This was a 2-yr, open-label, randomized, IGF-I concentration-controlled trial. Prepubertal short children (...) [n = 172, mean age 7.53 yr, mean height sd score (HT-SDS) -2.64] with low IGF-I levels (mean IGF-I SDS -3.56) were randomized to receive one of two GH dose-titration arms in which GH dosage was titrated to achieve an IGF-I SDS at the mean [IGF((low)) group, n = 70] or the upper limit of the normal range [+2 SDS, IGF((high)) group, n = 68] or to a comparison group of conventional GH dose of 40 microg/kg/d (n = 34).The study was conducted in a multicenter, outpatient setting.Change in HT-SDS over 2

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2007 The Journal of clinical endocrinology and metabolism Controlled trial quality: uncertain

20920. Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. (PubMed)

Oral glucosamine for 6 weeks at standard doses does not cause or worsen insulin resistance or endothelial dysfunction in lean or obese subjects. Glucosamine is a popular nutritional supplement used to treat osteoarthritis. Intravenous administration of glucosamine causes insulin resistance and endothelial dysfunction. However, rigorous clinical studies evaluating the safety of oral glucosamine with respect to metabolic and cardiovascular pathophysiology are lacking. Therefore, we conducted (...) a randomized, placebo-controlled, double-blind, crossover trial of oral glucosamine at standard doses (500 mg p.o. t.i.d.) in lean (n = 20) and obese (n = 20) subjects. Glucosamine or placebo treatment for 6 weeks was followed by a 1-week washout and crossover to the other arm. At baseline, and after each treatment period, insulin sensitivity was assessed by hyperinsulinemic-isoglycemic glucose clamp (SI(Clamp)) and endothelial function evaluated by brachial artery blood flow (BAF; Doppler ultrasound

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2006 Diabetes Controlled trial quality: uncertain

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