BACKGROUND: The initial insulin dose is often determined by clinical experience or with a formula using the body weight. However, it may be difficult to determine the initial insulin dose because various factors such as insulin sensitivity and the glycemic status can influence the insulin requirement. The purpose of this study was to assess the factors that influence the initial insulin requirement in insulin naive patients with type 2 diabetes mellitus. METHODS: A total 128 patients who were admitted for glycemic control were investigated. The patients were managed with long-acting insulin glargine and rapid-acting insulin lispro. RESULTS: The basal insulin requirement was positively correlated with waist circumference, body mass index (BMI), the HbA1C, AST, ALT, fasting plasma glucose and 2-hour postprandial glucose levels and the homeostasis model assessment of insulin resistance (HOMA-IR), but it was negatively correlated with age and the stimulated C-peptide level. The daily insulin requirement was positively correlated with waist circumference, BMI, the HbA1C, AST, ALT, triglyceride, fasting plasma glucose and 2-hour postprandial glucose level and HOMA-IR, but it was negatively correlated with age. On the multiple linear regression analysis, the basal insulin requirement was independently associated with BMI (beta = 0.507, p < 0.001), the 2-hour postprandial glucose level (beta = 0.307, p < 0.001), the ALT level (beta = 0.214, P = 0.015) and the meal-stimulated C-peptide level (beta = -0.209, P = 0.010). The daily insulin requirement was independently associated with BMI (beta = 0.508, p < 0.001) and the 2-hour postprandial glucose level (beta = 0.404, p < 0.001). CONCLUSION: Our results show that the BMI and 2-hour postprandial glucose level are useful predictors of the initial insulin requirement in insulin naive type 2 diabetic patients. It may be prudent to consider the other various factors that influence the insulin requirement together when insulin therapy is required.
Body Mass Index ; Body Weight ; C-Peptide ; Diabetes Mellitus ; Diabetes Mellitus, Type 2 ; Fasting ; Glucose ; Homeostasis ; Humans ; Insulin ; Insulin Lispro ; Insulin Resistance ; Insulin, Long-Acting ; Insulin, Short-Acting ; Linear Models ; Plasma ; Waist Circumference ; Insulin Glargine

PURPOSE: We investigated the clinical characteristics of IDDM patients, treated with NPH only, and evaluated current problems by measurement of serial blood glucose, insulin, C-peptide for 12 hours after administration of intermediate-acting insulin. METHODS: We studied 19 IDDM patients who had been diagnosed and followed up on a regular basis at Severance hospital. They were assigned into 2 groups, one(HbA1c high group) with HbA1c above 12%, the other(HbA1c low group) showing HbA1c below 12%. Their Heights, DM durations, HbA1c, basal C-peptides were primarily measured. Using continuous withdrawal pump, samples were taken every hour for 12 hours from 7:00 am. And serial blood glucose, insulin, C-peptide were assayed. RESULTS: 1) The mean HbA1c of the high group was 16.5+/-3.5% and that of the low group was 11.0+/-0.6%. There were no differences in clinical characteristics. 2) In HbA1c high group, fasting blood glucose, and mean blood glucose levels for 3hours were 156+/-85mg%, 284+/-125mg%(8,9,10am), 250+/-133mg% 11,12am,1pm), 252+/-122mg%(2,3,4pm), and 182+/-105 mg%(5,6,7pm), respectively. In low group, fasting blood glucose, and mean blood glucose levels for 3hours were 130+/-71mg%, 275+/-109 mg%(8,9,10am), 249+/-129mg%(11,12am,1pm), 231+/-81mg%(2,3,4pm), 158+/-62mg%(5,6,7pm), respectively. 3) Fasting blood insulin level was 51+/-47 U/l in high group, 62+/-62 U/l in low group. Thereafter low HbA1c group showed higher insulin levels than high HbA1c group. 4) Fasting blood C-peptide was 0.16+/-0.20 g/l in the high group, and 0.34+/-0.14 g/l in low group. Thereafter low group developed higher C-peptide responses than high group. The curve of C-peptide showed similar change of blood glucose, and maximal response followed 1-2 hours after maximal level of blood glucose. CONCLUSIONS: We concluded that short-acting insulin should be included for good control of blood glucose. Although fasting & dinner blood sugar seemed to be under fair control, intermediate-acting insulin used alone was not effective in preventing severe blood sugar elevation after morning meal.
Blood Glucose* ; Breakfast ; C-Peptide ; Diabetes Mellitus, Type 1* ; Fasting ; Humans ; Insulin* ; Insulin, Short-Acting ; Meals

INTRODUCTION: Diabetic ketoacidosis (DKA) remains a significant complication of diabetes in the world and is associated with high rates of hospital admissions. In mild, uncomplicated cases of DKA a subcutaneous regimen of newer rapid-acting insulin analogues has been proposed as a safe and effective alternative to intravenous regular insulin in prospective, randomized trials. Our primary objective is to compare the efficacy and safety of intermittent subcutaneous (SC) rapid insulin administration with continuous intravenous (IV) regular insulin infusion in the treatment of mild to moderate DKA.

METHODOLOGY: A retrospective chart review of all adult Filipino patients admitted for mild to moderate DKA at UST Hospital private and clinical divisions from 2012 - 2015 was done. Chart cases were divided into two groups, namely:group one who received IV infusion of regular insulin and group two who received SC rapid insulin analog astreatment. The clinical and biochemical characteristics of the patients on admission were obtained. Efficacy and safety of both treatment regimens were compared as to the duration of time and amount of insulin administered from admission until resolution of DKA was achieved, occurrence of hypoglycemia and hypokalemia, mortality and length of hospitalization.

RESULTS: Twenty-one chart cases were included, twelve in the continuous IV insulin infusion group and nine in the intermittent SC rapid insulin group. The baseline characteristics of patients were almost similar. There was no significant difference between the treatment groups in the duration of time and amount of insulin administered to achieve DKA resolution, occurrence of hypoglycemia, and death. Hypokalemia occurred more frequently and hospital stay was longer in the IV insulin group.

CONCLUSION: Intermittent subcutaneous rapid insulin regimen is an effective, safe, and potentially cost-effective alternative to continuous intravenous insulin infusion for treatment of mild to moderate cases of DKA.

Human ; Male ; Female ; Adult ; Insulin, Short-acting ; Diabetic Ketoacidosis ; Insulin ; Hypokalemia ; Hypoglycemia ; Hospitalization ; Infusions, Intravenous ; Safety

BACKGROUND: The present study investigates the efficacy in glycemic control by adding once-a-day glulisine to glargine as a basal plus regimen and factors influencing glycemic control with the basal plus regimen in Korean subjects with type 2 diabetes. METHODS: In the present retrospective study, subjects previously treated with the basal plus regimens for at least 6 months were reviewed. Changes in glycemic profiles and clinical parameters were evaluated. RESULTS: A total of 87 subjects were ultimately enrolled in this study. At baseline, mean glycated hemoglobin (A1c) and glycated albumin were 8.5% (8.0% to 9.6%) and 25.2+/-7.6%, respectively. After treatment with the basal plus regimen, patients had significant reductions of A1c at 6 months (0.8+/-0.1%, P<0.001) and their postprandial glucose levels were decreased by 48.7+/-10.3 mg/dL (P<0.001). Multiple logistic regression showed old age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02 to 1.55), high initial A1c (OR, 22.21; 95% CI, 2.44 to 201.78), and lower amounts of glargine (OR, 0.85; 95% CI, 0.76 to 0.99), and glimepiride (OR, 0.23; 95% CI, 0.06 to 0.93) at baseline were independently associated with good responders whose A1c reduction was more than 0.5%. CONCLUSION: The authors suggest a basal plus regimen may be effective in reducing glucose levels of subjects with old age, high initial A1c, and patients on low doses of glimepiride and glargine. Despite the use of high doses of hypoglycemic agents, elderly patients with poorly-controlled diabetes are preferred for early initiation of the basal plus regimen.
Aged ; Diabetes Mellitus, Type 2 ; Glucose ; Hemoglobins ; Humans ; Hypoglycemic Agents ; Insulin ; Insulin, Long-Acting ; Insulin, Short-Acting ; Logistic Models ; Retrospective Studies ; Serum Albumin ; Sulfonylurea Compounds ; Insulin Glargine

BACKGROUND: This is part of a prospective study carried out as a national project to secure standardized public resources for type 2 diabetes mellitus (T2DM) patients in Korea. We compared various characteristics of long-standing T2DM patients with diabetic retinopathy (DR) and macular edema (ME). METHODS: From September 2014 to July 2015, T2DM patients with disease duration of at least 15 years were recruited at a single university hospital. Clinical data and samples were collected according to the common data elements and standards of procedure developed by the Korean Diabetes Association Research Council. Each participant was assessed by ophthalmologists for DR and ME. RESULTS: Among 220 registered patients, 183 completed the ophthalmologic assessment. DR was associated with longer disease duration (odds ratio [OR], 1.071; 95% confidence interval [CI], 1.001 to 1.147 for non-proliferative diabetic retinopathy [NPDR]) (OR, 1.142; 95% CI, 1.051 to 1.242 for proliferative diabetic retinopathy [PDR]) and the use of long-acting insulin (OR, 4.559; 95% CI, 1.672 to 12.427 for NPDR) (OR, 4.783; 95% CI, 1.581 to 14.474 for PDR), but a lower prevalence of a family history of cancer (OR, 0.310; 95% CI, 0.119 to 0.809 for NPDR) (OR, 0.206; 95% CI, 0.063 to 0.673 for PDR). ME was associated with higher glycosylated hemoglobin levels (OR, 1.380; 95% CI, 1.032 to 1.845) and the use of rapid-acting insulin (OR, 5.211; 95% CI, 1.445 to 18.794). CONCLUSION: Various clinical features were associated with DR and ME. Additional epidemiological and biorepository-based studies using this cohort are being conducted to deepen our understanding of diabetic complications in Korea.
Cohort Studies ; Common Data Elements ; Diabetes Complications ; Diabetes Mellitus, Type 2* ; Diabetic Retinopathy* ; Hemoglobin A, Glycosylated ; Humans ; Insulin, Long-Acting ; Insulin, Short-Acting ; Korea ; Macular Edema ; Prevalence ; Prospective Studies

Adolescent ; Child ; Diabetes Mellitus ; drug therapy ; Humans ; Hypoglycemic Agents ; pharmacokinetics ; therapeutic use ; Insulin, Short-Acting ; pharmacokinetics ; therapeutic use

BACKGROUND: Insulin glulisine  is a  new  rapid-acting insulin  analogue.  Currently,  few  data   are   available on its safety and tolerability among patients in the Asia-Pacific   region.
OBJECTIVES:
Primary Objective: To assess the safety and tolerability of insulin glulisine as part of an insulin treatment   regimen   in   Filipinos   with   diabetes
Secondary  Objectives:
1.    To compare the change in glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG) and post-prandial blood glucose (PPBG) levels at baseline and after  three  and  six months on an insulin treatment regimen with insulin  glulisine
2.    To measure patients' level of  satisfaction  in  using   the   Insulin   glulisine  pen
METHODS: This was a multicenter, observational, post- marketing  surveillance  study   of   adult   patients   (18   to Results: Among 1,805 patients included, 132 (7.31%) experienced hypoglycemia. The overall incidence of adverse events other than hypoglycemia was 0.78%. There  was  a  significant  reduction  in   baseline  levels   of HbA1c,  FBG  and  PPBG  during  the  follow-up  visits  at third and sixth months (all p<0.0001). Patient satisfaction  with  using  the  pen  was  good  to    excellent.
CONCLUSION: This post-marketing surveillance study demonstrates the safety and tolerability of  insulin  glulisine  when  used   as   part   of   an   insulin   regimen in an actual clinical setting for the management of diabetes among Filipino  patients.  Insulin  glulisine  as  part of  a   diabetes  treatment  regimen  was   effective  in improving glycemic  parameters.  The  glulisine  pen  was   also   well   tolerated   and   accepted   by patients.

Human ; Male ; Female ; Aged ; Middle Aged ; Adult ; Hemoglobin A, Glycosylated ; Insulin Glulisine ; Diabetes Mellitus, Type 2 ; Insulin, Short-acting ; Excipients ; Fasting ; Insulin ; Hypoglycemia

Pregnant women with diabetes are at greater risk for adverse outcomes, such as miscarriage, macrosomia, and preterm birth. Advances in the care of diabetes have reduced maternal and perinatal mortality rates to the levels expected in nondiabetic pregnancies. Lifestyle modification such as medical nutritional therapy and exercise is a first step in therapy for gestational diabetes. Rapid-acting insulin analogs (lispro, aspart) are comparable in safety and superior in glucose control to regular human insulin. Because the safety of long-acting insulin analogs (glargine, detemir) in pregnancy has not firmly established, the use of human insulin is preferred over basal insulin. Among the oral hypoglycemic agents, metformin and glyburide might be considered as alternative therapies.
Abortion, Spontaneous ; Administration, Oral ; Complementary Therapies ; Diabetes, Gestational ; Female ; Glucose ; Glyburide ; Humans ; Hypoglycemic Agents ; Insulin ; Insulin, Long-Acting ; Insulin, Short-Acting ; Life Style ; Metformin ; Perinatal Mortality ; Pregnancy ; Pregnant Women ; Premature Birth ; Resin Cements

The incidence of type 1 diabetes is increasing worldwide, and the greatest increase has been observed in very young children under 4 years of age. A case of infantile diabetic ketoacidosis in a 10-month-old male infant was encountered by these authors. The infant's fasting glucose level was 490 mg/dL, his PH was 7.13, his pCO₂ was 15 mmHg, and his bicarbonate level was 5.0 mmol/L. The glycosylated hemoglobin level had increased to 9.4%. Ketonuria and glucosuria were detected in the urinalysis. The fasting C-peptide and insulin levels had decreased. The infant was positive for anti-insulin and antiglutamic acid decarboxylase antibodies. Immediately after the infant's admission, fluid therapy and intravenous insulin infusion therapy were started. On the second day of the infant's hospitalization and after fluid therapy, he recovered from his lethargic condition, and his general condition improved. Feeding was started on the third day, and he was fed a formula 5 to 7 times a day and ate rice, vegetables, and lean meat. Due to the frequent feeding, the frequency of rapid-acting insulin injection was increased from 3 times before feeding to 5 times, adjusted according to the feeding frequency. The total dose of insulin that was injected was 0.8-1.1 IU/kg/day, and the infant was discharged on the 12th day of his hospitalization. The case is presented herein with a brief review of the relevant literature.
Antibodies ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis* ; Fasting ; Fluid Therapy ; Glucose ; Hemoglobin A, Glycosylated ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant* ; Insulin* ; Insulin, Short-Acting ; Ketosis ; Male ; Meat ; Urinalysis ; Vegetables

The incidence of type 1 diabetes is increasing worldwide, and the greatest increase has been observed in very young children under 4 years of age. A case of infantile diabetic ketoacidosis in a 10-month-old male infant was encountered by these authors. The infant's fasting glucose level was 490 mg/dL, his PH was 7.13, his pCO₂ was 15 mmHg, and his bicarbonate level was 5.0 mmol/L. The glycosylated hemoglobin level had increased to 9.4%. Ketonuria and glucosuria were detected in the urinalysis. The fasting C-peptide and insulin levels had decreased. The infant was positive for anti-insulin and antiglutamic acid decarboxylase antibodies. Immediately after the infant's admission, fluid therapy and intravenous insulin infusion therapy were started. On the second day of the infant's hospitalization and after fluid therapy, he recovered from his lethargic condition, and his general condition improved. Feeding was started on the third day, and he was fed a formula 5 to 7 times a day and ate rice, vegetables, and lean meat. Due to the frequent feeding, the frequency of rapid-acting insulin injection was increased from 3 times before feeding to 5 times, adjusted according to the feeding frequency. The total dose of insulin that was injected was 0.8-1.1 IU/kg/day, and the infant was discharged on the 12th day of his hospitalization. The case is presented herein with a brief review of the relevant literature.
Antibodies ; C-Peptide ; Child ; Diabetes Mellitus, Type 1* ; Diabetic Ketoacidosis* ; Fasting ; Fluid Therapy ; Glucose ; Hemoglobin A, Glycosylated ; Hospitalization ; Humans ; Hydrogen-Ion Concentration ; Incidence ; Infant* ; Insulin* ; Insulin, Short-Acting ; Ketosis ; Male ; Meat ; Urinalysis ; Vegetables