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Variable Rate Insulin Infusion

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1. Use of an educational, audiovisual podcast to maximise safety with variable rate intravenous insulin infusions (PubMed)

Use of an educational, audiovisual podcast to maximise safety with variable rate intravenous insulin infusions Variable rate intravenous insulin infusions (VRIII) are used to maintain stable blood glucose in hospitalised patients with diabetes who are unable to eat or have a severe illness where good glycaemic control is paramount. With VRIII it is important to prescribe an adequate substrate to avoid hypoglycaemia and maintain electrolyte balance. Traditionally the substrate would have been (...) varied to achieve this; current guidelines advise varying the infusion rate rather than the type of substrate. The local hospital Trust updated their VRIII prescription chart to reflect the Joint British Diabetes Societies' suggestions for inpatient care in October 2014. A local audit in January 2015 highlighted that 48% of patients on VRIII were prescribed the correct fluid as per the guideline. A questionnaire to assess prescriber knowledge regarding VRIII showed 40.4% of prescribers selected

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2018 BMJ Open Quality

2. Variable Rate Insulin Infusion

Variable Rate Insulin Infusion Variable Rate Insulin Infusion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Variable Rate Insulin (...) Infusion Variable Rate Insulin Infusion Aka: Variable Rate Insulin Infusion , Insulin Infusion , Insulin Drip From Related Chapters II. Indications Patient not eating (e.g. post-operative) III. Preparation 100 units in 100 cc NS (1 u per 1 ml) IV. Protocol: Insulin Infusion Starting dose of Insulin Infusion Type I Diabetic: 0.5 to 1 unit per hour Type II Diabetic or poor control: 2-3 units per hour Weight-based (use true weight, not ) : 0.1 Units/kg/h Non-ketotic: 0.05 Units/kg/h Consider starting

2018 FP Notebook

3. Best Practice Guide: Continuous subcutaneous insulin infusion (CSII) A clinical guide for adult diabetes services

features: temporary basal rates and dual wave boluses • Regular clinic attendance • Regular downloads and review of data (Scheiner et al. 2009, Wilkinson et al. 2010, Cukierman- Yaffe et al. 2011) 013 CLINICAL GUIDELINE BEST PRACTICE GUIDE CONTINUOUS SUBCUTANEOUS INSULIN INFUSION (CSII) Initial insulin setting at CSII initiation Below is a summary flowchart to assist with dose calculation for CSII initiation, adapted from AACE (Consensus statement of AACE task force, 2014). Calculations for Insulin (...) values over basal rate testing • Add additional basal according to need (e.g. Dawn phenomenon) • e.g. TDD 35 units = 400/35 = 11.4, I:C ratio 1 unit: 11g • Most adults require 1 unit: 8-15g • Acceptable post prandial rise is ~3mmol/l • Adjust based on low-fat meals with known quantity of carbohydrate • Correction insulin dose should bring glucose back to target range in 4-5 hours Basal insulin The basal rate is the amount of insulin infused per hour via CSII. The basal rate can be set hour by hour

2018 Association of British Clinical Diabetologists

4. Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study. (PubMed)

at a given time. In the dynamic algorithm, insulin infusion rate is determined according to the rate of change of the BG (the previous and actual BG under a specific insulin infusion rate). Additionally, two distinct glycaemic targets were defined according to the patients' profile: 100-180 mg/dl (5.5-10 mmol/l) for vigorous patients and 140-220 mg/dl (7.8-12.2 mmol/l) for frail ones. Different BG measurements for each patient were collected and recorded in a specific database (e-CRF) in order to analyse (...) Prospective evaluation of a dynamic insulin infusion algorithm for non critically-ill diabetic patients: A before-after study. Insulin infusion is recommended during management of diabetic patients in critical care units to rapidly achieve glycaemic stability and reduce the mortality. The application of an easy-to-use standardized protocol, compatible with the workload is preferred. Glycaemic target must quickly be reached, therefore static algorithms should be replaced by dynamic ones

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2019 PLoS ONE

5. Variability of Directly Measured First-Pass Hepatic Insulin Extraction and its Association With Insulin Sensitivity and Plasma Insulin. (PubMed)

Variability of Directly Measured First-Pass Hepatic Insulin Extraction and its Association With Insulin Sensitivity and Plasma Insulin. Although the β-cells secrete insulin, the liver, with its first-pass insulin extraction (FPE), regulates the amount of insulin allowed into circulation for action on target tissues. The metabolic clearance rate of insulin, of which FPE is the dominant component, is a major determinant of insulin sensitivity (SI). We studied the intricate relationship among FPE (...) , SI, and fasting insulin. We used a direct method of measuring FPE, the paired portal/peripheral infusion protocol, where insulin is infused stepwise through either the portal vein or a peripheral vein in healthy young dogs (n = 12). FPE is calculated as the difference in clearance rates (slope of infusion rate vs. steady insulin plot) between the paired experiments. Significant correlations were found between FPE and clamp-assessed SI (rs = 0.74), FPE and fasting insulin (rs = -0.64), and SI

2018 Diabetes

6. Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus (PubMed)

Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus Traditionally, basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. However, whether this approach is indeed superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications (...) in adult type 1 diabetes mellitus.BR profiles of 3118 female and 2427 male patients from the "Diabetes-Patienten-Verlaufsdokumentation" registry from Germany and Austria were analysed. Acute and chronic complications were recorded 6 months prior and after the most recently documented basal rate. The "variability index" was calculated as variation of basal rate intervals in percent and describes the excursions of the basal rate intervals from the median basal rate.The variability Index correlated

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2016 PloS one

7. Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control. (PubMed)

, a euglycemic clamp was performed with two injections each into LHT and NAT, and on another day one injection per region was given before a standardized mixed meal (75 g carbohydrates), all in randomized order.Compared with NAT, LHT reduced insulin absorption (mean area under the insulin concentration curve [AUCINS0-4h] 131 vs. 165 h * mU/L [LHT vs. NAT]; Cmax 61 vs. 79 mU/L, P < 0.02, respectively) and effect (areas under glucose infusion rate [GIR] curves [AUCGIR0-4h 625 vs. 775 mg/kg, P < 0.05 (...) Insulin Injection Into Lipohypertrophic Tissue: Blunted and More Variable Insulin Absorption and Action and Impaired Postprandial Glucose Control. Lipohypertrophy (LHT) is common in insulin-treated patients but its exact impact on insulin absorption and action is unclear.In this crossover study, 13 patients with type 1 diabetes received subcutaneous abdominal injections of 0.15 units/kg insulin lispro into LHT (confirmed by examination and ultrasound) and normal adipose tissue (NAT). On one day

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2017 Diabetes Care

8. Insulin degludec: lower day-to-day and within-day variability in pharmacodynamic response compared to insulin glargine U300 in type 1 diabetes. (PubMed)

variables were assessed at steady-state from the glucose infusion rate profiles of three 24-hour euglycaemic glucose clamps (days 6, 9 and 12) during each treatment period.Overall, 57 patients completed both treatment periods (342 clamps). The potency of IGlar-U300 was 30% lower than IDeg (estimated ratio 0.70, 95% confidence interval [CI] 0.61; 0.80; P  < .0001). The distribution of glucose-lowering effect was stable across 6-hour intervals (24%-26%) for IDeg, while IGlar-U300 had greater effects (...) Insulin degludec: lower day-to-day and within-day variability in pharmacodynamic response compared to insulin glargine U300 in type 1 diabetes. To compare day-to-day and within-day variability in glucose-lowering effect between insulin degludec (IDeg) and insulin glargine 300 U/mL (IGlar-U300) in type 1 diabetes.In this double-blind, crossover study, patients were randomly assigned to 0.4 U/kg of IDeg or IGlar-U300 once daily for two treatment periods lasting 12 days each. Pharmacodynamic

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2017 obesity & metabolism

9. Day-to-Day and Within-Day Variability in Glucose-Lowering Effect Between Insulin Degludec and Insulin Glargine (100 U/mL and 300 U/mL): A Comparison Across Studies (PubMed)

Day-to-Day and Within-Day Variability in Glucose-Lowering Effect Between Insulin Degludec and Insulin Glargine (100 U/mL and 300 U/mL): A Comparison Across Studies Insulin degludec (IDeg) has significantly lower day-to-day and within-day variability compared to insulin glargine (IGlar) 100U/mL (U100) and 300U/mL (U300). Here, we report post hoc assessments to confirm the robustness of these observations while accounting for potential experimental confounders.Two euglycemic clamp studies in type (...) 1 diabetes patients, comparing IDeg to IGlar-U100 (Study A, parallel design, 54 patients; Study B, crossover, 22 patients) and one study comparing IDeg to IGlar-U300 (Study C, crossover, 57 patients), all dosed at 0.4U/kg, were evaluated. Pharmacodynamic parameters were assessed at steady state from glucose infusion rate (GIR) profiles following three 24-hour euglycemic clamps in Studies A (162 clamps) and C (342 clamps), and one 42-hour clamp in Study B (44 clamps).Pooled data (Studies A and B

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2017 Journal of diabetes science and technology

10. Prolonged amino acid infusion into intrauterine growth-restricted fetal sheep increases leucine oxidation rates. (PubMed)

in the IUGR-AA than IUGR-Sal group (2.5 ± 0.3 vs. 1.7 ± 0.3 μmol·kg-1·min-1, P < 0.05). Fetal protein accretion rate was not statistically different between the IUGR groups (1.6 ± 0.4 and 0.8 ± 0.3 μmol·kg-1·min-1 in IUGR-AA and IUGR-Sal, respectively) due to variability in response to amino acids. Prolonged amino acid infusion into IUGR fetal sheep increased leucine oxidation rates with variable anabolic response. (...) Prolonged amino acid infusion into intrauterine growth-restricted fetal sheep increases leucine oxidation rates. Overcoming impaired growth in an intrauterine growth-restricted (IUGR) fetus has potential to improve neonatal morbidity, long-term growth, and metabolic health outcomes. The extent to which fetal anabolic capacity persists as the IUGR condition progresses is not known. We subjected fetal sheep to chronic placental insufficiency and tested whether prolonged amino acid infusion would

2018 American journal of physiology. Endocrinology and metabolism

11. Heart Rate Variability and Emotion Regulation

Heart Rate Variability and Emotion Regulation Heart Rate Variability and Emotion Regulation - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Heart Rate Variability and Emotion Regulation The safety (...) Party): Mara Mather, University of Southern California Study Details Study Description Go to Brief Summary: Previous research suggests that heart rate variability (HRV) biofeedback aimed at increasing HRV can reduce anxiety and stress. However, some mental quiescence practices that reduce HRV during the practice sessions also lead to positive emotional outcomes. Thus, it is not obvious that the benefits of HRV-biofeedback accrue due to increasing HRV during the session. An alternative possibility

2018 Clinical Trials

12. Pharmacokinetic and Pharmacodynamic Variability of Insulin When Administered by Jet Injection (PubMed)

aspart (0.2 units/kg body weight), either by jet injection or conventional pen, followed by a 6-hour euglycemic glucose clamp. Plasma glucose and insulin levels and glucose infusion rates were measured every 5 to 10 minutes to calculate the variability in pharmacological endpoints.Jet injection advanced the times until maximal insulin concentration (T-INSmax) and glucose infusion rate (T-GIRmax) by ~40% (both P < .01). The difference between the two test days for these endpoints did not differ (...) Pharmacokinetic and Pharmacodynamic Variability of Insulin When Administered by Jet Injection Jet injection has been shown to accelerate the absorption and action of rapid-acting insulin. In this study, we compared the variability of absorption characteristics between jet injection and conventional administration of the rapid-acting insulin analogue aspart.A total of 30 healthy volunteers were enrolled in this randomized controlled blinded parallel study. On two test days, they received insulin

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2017 Journal of diabetes science and technology

13. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients

suggest that the insulin regimen and monitoring system be designed to avoid and detect hypoglycemia (blood glucose ≤70 mg/dL) and to minimize glycemic variability. Important processes of care for insulin therapy include use of a reliable insulin infusion protocol , frequent blood glucose monitoring, and avoidance of finger-stick glucose testing through the use of arterial or venous glucose samples. The essential components of an insulin infusion system include use of a validated insulin titration (...) to be clinically significant ( ). In adult critically ill patients, does achievement of a BG < 150 mg/dL with an insulin infusion reduce mortality, compared with the use of an insulin infusion targeting higher BG ranges? We suggest that a BG ≥ 150 mg/dL should trigger initiation of insulin therapy, titrated to keep BG < 150 mg/dL for most adult ICU patients and to maintain BG values absolutely <180 mg/dL using a protocol that achieves a low rate of hypoglycemia (BG ≤ 70 mg/dL) despite limited impact on patient

2012 Society of Critical Care Medicine

14. Variable Rate Insulin Infusion

Variable Rate Insulin Infusion Variable Rate Insulin Infusion Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Variable Rate Insulin (...) Infusion Variable Rate Insulin Infusion Aka: Variable Rate Insulin Infusion , Insulin Infusion , Insulin Drip From Related Chapters II. Indications Patient not eating (e.g. post-operative) III. Preparation 100 units in 100 cc NS (1 u per 1 ml) IV. Protocol: Insulin Infusion Starting dose of Insulin Infusion Type I Diabetic: 0.5 to 1 unit per hour Type II Diabetic or poor control: 2-3 units per hour Weight-based (use true weight, not ) : 0.1 Units/kg/h Non-ketotic: 0.05 Units/kg/h Consider starting

2015 FP Notebook

15. Substrate Metabolism, Growth Hormone Signaling (GH), and Insulin Sensitivity During GH and Ketone Bodies Infusion

Substrate Metabolism, Growth Hormone Signaling (GH), and Insulin Sensitivity During GH and Ketone Bodies Infusion Substrate Metabolism, Growth Hormone Signaling (GH), and Insulin Sensitivity During GH and Ketone Bodies Infusion - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved (...) studies (100). Please remove one or more studies before adding more. Substrate Metabolism, Growth Hormone Signaling (GH), and Insulin Sensitivity During GH and Ketone Bodies Infusion The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details. ClinicalTrials.gov Identifier: NCT02655263 Recruitment Status : Completed First Posted : January 14, 2016

2016 Clinical Trials

16. Dose-Response and Variability of Inhaled Insulin in Type 2 Diabetes

the curve for glucose infusion rate from 0-12 hours (AUGgir0-12h) [ Time Frame: 0 to 8 hours following each dose ] Assessment of the linearity of the dose-response curves Maximum glucose infusion rate (GIRmax) [ Time Frame: up to 12 hours following each dose ] Assessment of the linearity of the dose-response curves Secondary Outcome Measures : Bioavailability [ Time Frame: 0 to 8 hours following each dose ] Relative delivery efficiency (FREL) of inhaled human insulin (INH) compared to subcutaneous (...) Dose-Response and Variability of Inhaled Insulin in Type 2 Diabetes Dose-Response and Variability of Inhaled Insulin in Type 2 Diabetes - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. Dose-Response

2016 Clinical Trials

17. Blood Glucose Variability and Insulin Action During Menstrual Cycle in Females With Type 1 Diabetes

phase Outcome Measures Go to Primary Outcome Measures : The change in area under the glucose infusion rate (AUCGIR) during different phases of menstrual cycle [ Time Frame: Up to 30 days ] The insulin glucodynamic action will be measured by the amount of dextrose infused during the study as previously described by DeFronzo. The primary outcome measure for the euglycemic clamp studies will be area under the glucose infusion rate (AUCGIR) that will be compared between luteal and follicular phases (...) of menstrual cycle. Glucose Infusion Rate [ Time Frame: Up to 15 days ] During the luteal phase of the menstrual cycle, subjects will go through an insulin time action (clamp) study. Subjects are injected a bolus dose of insulin and blood sugar levels are kept within a 90-100mg/dL range by intravenous fluid infusion during fasting state. GIR stands for the glucose infusion rate that is measured in mg/kg/minute, indicating the amount of glucose delivered per minute per kilogram of body mass. Glucose

2016 Clinical Trials

18. The Effect of Dexmedetomidine on Neuroendocrine Stress Hormone Release and Heart Rate Variability in Patients Undergoing Major Spinal Surgery

The Effect of Dexmedetomidine on Neuroendocrine Stress Hormone Release and Heart Rate Variability in Patients Undergoing Major Spinal Surgery The Effect of Dexmedetomidine on Neuroendocrine Stress Hormone Release and Heart Rate Variability in Patients Undergoing Major Spinal Surgery - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save (...) this study Warning You have reached the maximum number of saved studies (100). Please remove one or more studies before adding more. The Effect of Dexmedetomidine on Neuroendocrine Stress Hormone Release and Heart Rate Variability in Patients Undergoing Major Spinal Surgery The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our for details

2016 Clinical Trials

19. Insulin

), macrovascular complications (cardiovascular, cerebrovascular, and peripheral (...) arterial disease), and metabolic complications (dyslipidaemia and diabetic ketoacidosis). In people with type 2 diabetes, there is a variable combination of increased insulin resistance and progressive loss of pancreatic beta-cell function. Type 2 diabetes is initially managed with lifestyle changes and antidiabetic drugs. However, with time, many people will require insulin therapy as there is insufficient endogenous insulin (...) , MEDLINE, Embase, PsycINFO and CINAHL. We searched registers of ongoing trials and reference lists from 2017 6. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients Guidelines for the use of an insulin infusion for the manage... : Critical Care Medicine You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. You currently have no recent searches Enter your Email address: Wolters

2018 Trip Latest and Greatest

20. Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality (PubMed)

Insulin Pump Therapy Is Associated with Lower Rates of Retinopathy and Peripheral Nerve Abnormality To compare rates of microvascular complications in adolescents with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI).Prospective cohort of 989 patients (aged 12-20 years; diabetes duration >5 years) treated with CSII or MDI for >12 months. Microvascular complications were assessed from 2000-14: early retinopathy (seven-field (...) fundal photography), peripheral nerve function (thermal and vibration threshold testing), autonomic nerve abnormality (heart rate variability analysis of electrocardiogram recordings) and albuminuria (albumin creatinine ratio/timed overnight albumin excretion). Generalized estimating equations (GEE) were used to examine the relationship between treatment and complications rates, adjusting for socio-economic status (SES) and known risk factors including HbA1c and diabetes duration.Comparing CSII

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2016 PloS one

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