Latest & greatest articles for insulin

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Top results for insulin

1061. Insulin prophylaxis in individuals at high risk of type I diabetes. (Abstract)

Insulin prophylaxis in individuals at high risk of type I diabetes. Prevention of type I diabetes is now a practical goal thanks to the ability to define confidently a high-risk group and the success of preventive strategies in animal models. We describe here a pilot trial of low-dose insulin to prevent diabetes in relatives of patients with type I diabetes.

1993 Lancet

1062. Preliminary study of the efficacy of insulin aerosol delivered by oral inhalation in diabetic patients. (Abstract)

Preliminary study of the efficacy of insulin aerosol delivered by oral inhalation in diabetic patients. To maximize deposition of an aerosolized dose of insulin (mean +/- SD = 0.99 +/- 0.06 U/kg of body weight) in the lungs of subjects with non-insulin-dependent diabetes mellitus (NIDDM), and investigate its efficacy in normalizing plasma glucose levels during the fasting state.Nonrandomized, placebo-controlled trial.A primary care facility.Six nonobese, nonsmoking volunteers with NIDDM (...) . No subjects withdrew from the study.Aerosolized insulin was administered by oral inhalation after a 12-hour period of fasting. Aerosol was generated by a raindrop nebulizer from regular 500 U/mL pork insulin. During inhalation, inspiratory flow was regulated at 17 L/min. Plasma samples were collected after inhalation and analyzed for insulin and glucose levels.Plasma insulin and glucose levels.Deposition of the aerosol was maximized within the lungs, with 79% +/- 17% of the inhaled dose depositing below

1993 JAMA

1063. Double blind clinical and laboratory study of hypoglycaemia with human and porcine insulin in diabetic patients reporting hypoglycaemia unawareness after transferring to human insulin. Full Text available with Trip Pro

Double blind clinical and laboratory study of hypoglycaemia with human and porcine insulin in diabetic patients reporting hypoglycaemia unawareness after transferring to human insulin. To compare awareness of hypoglycaemia and physiological responses to hypoglycaemia with human and porcine insulin in diabetic patients who reported loss of hypoglycaemia awareness after transferring to human insulin.Double blind randomised crossover study of clinical experience and physiological responses during (...) slow fall hypoglycaemic clamping with porcine and human insulin.Clinical investigation unit of teaching hospital recruiting from diabetes clinics of five teaching hospitals and one district general hospital.17 patients with insulin dependent diabetes mellitus of more than five years' duration who had reported altered hypoglycaemia awareness within three months of transferring to human insulin.Glycaemic control and frequency of hypoglycaemic episodes during two months' treatment with each insulin

1993 BMJ Controlled trial quality: uncertain

1064. Comparison of reduction in microalbuminuria by enalapril and hydrochlorothiazide in normotensive patients with insulin dependent diabetes. Full Text available with Trip Pro

Comparison of reduction in microalbuminuria by enalapril and hydrochlorothiazide in normotensive patients with insulin dependent diabetes. To compare the effects of sodium depletion and of angiotensin I converting enzyme inhibition on microalbuminuria in insulin dependent diabetes.Randomised, double blind, double dummy parallel study of normotensive diabetic patients with persistent microalbuminuria (30-300 mg/24 h) treated with enalapril or hydrochlorothiazide for one year after a three month

1993 BMJ Controlled trial quality: uncertain

1065. Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care. Full Text available with Trip Pro

Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care. To evaluate the effectiveness and acceptability of centrally organised prompting for coordinating community care of non-insulin dependent diabetic patients.Randomised single centre trial. Patients allocated to prompted care in the community or to continued attendance at hospital diabetic clinic (controls). Median follow up two years.Two hospital outpatient clinics (...) differences between the groups in last recorded random plasma glucose concentration, glycated haemoglobin value, numbers admitted to hospital for a diabetes related reason, and number of deaths. Questionnaires revealed a high level of patient, general practitioner, and optometrist satisfaction.Six monthly prompting of non-insulin treated diabetic patients for care by inner city general practitioners and by optometrists is effective and acceptable.

1993 BMJ Controlled trial quality: uncertain

1066. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. (Abstract)

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease (...) the frequency and severity of these complications.A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed

1993 NEJM Controlled trial quality: uncertain

1067. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. (Abstract)

The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. A cause-and-effect relation between blood glucose concentrations and microvascular complications in patients with insulin-dependent diabetes mellitus has not been established.We randomly assigned 102 patients with insulin-dependent diabetes mellitus, nonproliferative retinopathy, normal serum creatinine concentrations, and unsatisfactory blood glucose control (...) to intensified insulin treatment (48 patients) or standard insulin treatment (54 patients). We then evaluated them for microvascular complications after 18 months and 3, 5, and 7.5 years.Mean (+/- SD) glycosylated hemoglobin values were reduced from 9.5 +/- 1.3 percent to 7.1 +/- 0.7 percent in the group receiving intensified treatment and from 9.4 +/- 1.4 percent to 8.5 +/- 0.7 percent in the group receiving standard treatment (P = 0.001). In 12 of the patients receiving intensified treatment (27 percent

1993 NEJM Controlled trial quality: uncertain

1068. Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide. Full Text available with Trip Pro

Muslims with non-insulin dependent diabetes fasting during Ramadan: treatment with glibenclamide. To compare the efficacy of two glibenclamide regimens in patients with non-insulin dependent diabetes who were fasting during Ramadan and regular glibenclamide treatment in the non-fasting group.Non-randomised control group of patients who did not fast during Ramadan and two groups of patients who fasted randomised equally to one of two regimens: to take their usual morning dose of glibenclamide (...) the end of Ramadan there were no significant differences between the groups in fructosamine concentration (400 mumol/l in controls and 381 mumol/l and 376 mumol/l in the fasting groups); percentage of glycated haemoglobin (14.7%, 14.0%, and 13.6%); or number of hypoglycaemic events during Ramadan (11, 14, and 10).Glibenclamide is effective and safe for patients with non-insulin dependent diabetes who fast during Ramadan. The easiest regimen is to take the normal morning dose (together with any midday

1993 BMJ Controlled trial quality: uncertain

1069. Double-blind crossover comparison of human and porcine insulins in patients reporting lack of hypoglycaemia awareness. (Abstract)

Double-blind crossover comparison of human and porcine insulins in patients reporting lack of hypoglycaemia awareness. There has been much debate about reports that some insulin-treated diabetic patients lose awareness of hypoglycaemic symptoms on changing from porcine to human insulin. In a double-blind, crossover study, we sought differences between porcine and human insulin in the frequency and characteristics of hypoglycaemic episodes among patients who reported a reduction of awareness (...) of hypoglycaemia after changing treatment. We studied 50 patients referred by their physicians because of complaints of lack of awareness of hypoglycaemia on human insulin. They had had diabetes for a mean of 20 (SD 12) years and 70% had good or acceptable glycaemic control. Each patient was treated in a double-blind manner for four 1-month periods, two with human and two with porcine insulin, in random order. Only 2 patients correctly identified the sequence of insulin treatments used; 8 or 9 would have been

1992 Lancet Controlled trial quality: uncertain

1070. Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. (Abstract)

Coronary revascularisation in insulin-dependent diabetic patients with chronic renal failure. Insulin-dependent diabetic patients found to have substantial coronary artery disease at the time of assessment for renal transplantation have 2-year survival of less than 50%. Because most of these patients have no angina symptoms their management is controversial. We tried to find out whether coronary artery revascularisation in such patients might decrease the combined incidence of unstable angina (...) , myocardial infarction, and cardiac death. 151 consecutive insulin-dependent diabetic candidates for renal transplantation underwent coronary angiography. 31 had stenoses greater than 75% in one or more coronary arteries, atypical chest pain or no chest pain, and a left ventricular ejection fraction greater than 0.35. Of these, 26 agreed to be randomly assigned medical treatment (a calcium-channel-blocking drug plus aspirin) or revascularisation (angioplasty or coronary bypass surgery). 10 of 13 medically

1992 Lancet Controlled trial quality: uncertain

1071. Comparison of enalapril and nifedipine in treating non-insulin dependent diabetes associated with hypertension: one year analysis. Full Text available with Trip Pro

Comparison of enalapril and nifedipine in treating non-insulin dependent diabetes associated with hypertension: one year analysis. To compare the efficacy, safety, and tolerance of enalapril and nifedipine in hypertensive patients with non-insulin dependent diabetes.One year double blind follow up of patients randomly allocated to either enalapril or nifedipine with matching placebos for the alternative drug.Metabolic Investigation Unit, Hong Kong.102 patients were randomised: 52 to nifedipine

1992 BMJ Controlled trial quality: uncertain

1072. Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes. (Abstract)

Somatostatin analogue, octreotide, reduces increased glomerular filtration rate and kidney size in insulin-dependent diabetes. To determine whether treatment with a somatostatin analogue can reduce kidney hyperfiltration and hypertrophy in insulin-dependent diabetes mellitus, we studied 11 patients with insulin-dependent diabetes mellitus and glomerular hyperfiltration. The patients were assigned randomly to receive continuous subcutaneous infusion of either octreotide, 300 micrograms/24 h (...) was significantly lower after treatment in the octreotide group (379 mL/1.73 m2; range, 307 to 454 mL/1.73 m2) than in the placebo group (389 mL/1.73 m2; range, 347 to 465 mL/1.73 m2). Glycemic control did not change significantly in either group. We conclude that subcutaneous infusion of octreotide for 12 weeks reduces increased glomerular filtration rate and kidney size in patients with insulin-dependent diabetes mellitus despite the fact that glycemic control remains unchanged.

1991 JAMA Controlled trial quality: uncertain

1073. Intensified conventional insulin treatment and neuropsychological impairment. Full Text available with Trip Pro

Intensified conventional insulin treatment and neuropsychological impairment. To assess whether intensified insulin treatment, with an increased frequency of hypoglycaemic episodes, leads to cognitive deterioration.Prospective randomised trial of intensified conventional treatment and standard treatment.Outpatient clinic for patients with insulin dependent diabetes.96 patients with insulin dependent diabetes, high blood glucose concentrations, and non-proliferative retinopathy were randomised (...) interval 53% to 100%) of the patients given intensified treatment and 29 (56%, 36% to 75%) of the others had at least one episode of serious hypoglycaemia (p less than 0.05). The intensified conventional treatment group had a mean of 1.1 episodes of serious hypoglycaemia per patient per year compared with 0.4 episodes in the standard treatment group. Results of the neuropsychological tests were similar in the two groups after five years.Intensified conventional insulin treatment led to lower blood

1991 BMJ Controlled trial quality: uncertain

1074. Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus. (Abstract)

Effect of restricting dietary protein on the progression of renal failure in patients with insulin-dependent diabetes mellitus. Restriction of dietary protein may slow the progression of renal failure in diverse renal diseases, but the extent to which such a diet is beneficial in patients with diabetic nephropathy is uncertain.We studied the effect of reduced intake of protein and phosphorus on the progression of renal disease in 35 patients with insulin-dependent (Type I) diabetes mellitus

1991 NEJM Controlled trial quality: uncertain

1075. Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. Full Text available with Trip Pro

Efficacy of captopril in postponing nephropathy in normotensive insulin dependent diabetic patients with microalbuminuria. To assess the effectiveness of angiotensin converting enzyme inhibition in preventing the development of diabetic nephropathy (albuminuria greater than 300 mg/24h).Open randomised controlled study of four years' duration.Outpatient diabetic clinic in tertiary referral centre.44 normotensive (mean blood pressure 127/78 (SD 12/10) mm Hg) insulin dependent diabetic patients (...) , and urinary excretion of sodium and urea remained practically unchanged in the two groups.The findings suggest that angiotensin converting enzyme inhibition postpones the development of clinical overt diabetic nephropathy in normotensive insulin dependent diabetic patients with persistent microalbuminuria.

1991 BMJ Controlled trial quality: uncertain

1076. Human insulin and awareness of acute hypoglycaemic symptoms in insulin-dependent diabetes. (Abstract)

Human insulin and awareness of acute hypoglycaemic symptoms in insulin-dependent diabetes. Some insulin-dependent diabetic patients who have clear symptoms of hypoglycaemia during animal insulin treatment have reported loss of these symptoms when human insulin preparations are introduced. A survey of Mersey Region, UK, identified eleven patients whose awareness of hypoglycaemia was lost after introduction of human insulin but returned with animal insulin treatment; seven took part in the study (...) . Acute hypoglycaemia was induced in these patients on two occasions by intravenous infusion of porcine or human soluble insulin (2.5 mU.kg-1, min-1) in random order. There was no significant difference between porcine and soluble insulin in the plasma glucose profile; mean (SEM) plasma glucose fell from 7.1 (0.4) mmol/l to a nadir of 1.5 (0.1) mmol/l with porcine insulin and from 7.1 (0.5) mmol/l to 1.6 (0.2) mmol/l with human insulin. An acute autonomic reaction occurred in all seven patients

1991 Lancet Controlled trial quality: uncertain

1077. Influence of human insulin on symptoms and awareness of hypoglycaemia: a randomised double blind crossover trial. Full Text available with Trip Pro

Influence of human insulin on symptoms and awareness of hypoglycaemia: a randomised double blind crossover trial. To investigate the apparent increased risk of severe hypoglycaemia associated with use of human insulin by comparing the pattern of symptoms of hypoglycaemia with human insulin and porcine insulin.Randomised controlled double blind crossover trial of treatment with human insulin and porcine insulin, with two treatment periods of six weeks.Diabetes outpatient department (...) of a university teaching hospital in Berne, Switzerland.44 patients (25 men, 19 women) aged 14 to 60 years, with insulin dependent diabetes mellitus. All patients met the following criteria: receiving treatment with fast acting soluble insulin and long acting protamine insulin; performing multiple daily fingerstick blood glucose self measurements; and had stable glycaemic control with about one mild hypoglycaemic episode a week during the preceding two months.Patients were randomised to receive either human

1991 BMJ Controlled trial quality: uncertain

1078. Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus. (Abstract)

Effect of long-term monitoring of glycosylated hemoglobin levels in insulin-dependent diabetes mellitus. The value of routine measurements of glycosylated hemoglobin (hemoglobin A1c) in the care of patients with diabetes mellitus is uncertain. We undertook this study to determine whether knowledge of hemoglobin A1c values would result in improved metabolic control in a group of patients with insulin-dependent diabetes mellitus (IDDM).We randomly assigned 240 patients with IDDM to one of two (...) was monitored but did not change significantly (45 to 50 percent) in the control group. The patients in the group whose hemoglobin A1c level was monitored were seen and their insulin regimens changed more often, but they were hospitalized for acute care of their diabetes less often than those in the control group. A similar decrease in hemoglobin A1c values occurred in the control group in the following year, when their care givers knew their hemoglobin A1c values.Regular measurements of hemoglobin A1c lead

1990 NEJM Controlled trial quality: uncertain

1079. Rotation of the anatomic regions used for insulin injections and day-to-day variability of plasma glucose in type I diabetic subjects. (Abstract)

Rotation of the anatomic regions used for insulin injections and day-to-day variability of plasma glucose in type I diabetic subjects. Treatment of type I diabetes mellitus is hindered by the often large fluctuations in blood glucose concentration experienced by affected individuals. To determine to what extent day-to-day variation in blood glucose levels can be reduced if insulin is injected in the same anatomic region rather than in different regions using a rotational scheme, as is commonly (...) recommended, 12 type I diabetic subjects were studied. Insulin injections were given in the abdomen for 3 days and rotated among arms, abdomen, and thighs for 3 days using a crossover design with random assignment of treatment order. Blood samples for measurement of plasma glucose levels were obtained at nine scheduled times on each day. Insulin dose, diet, and physical activity were held constant for each subject. During the abdominal injection period, the mean SD of plasma glucose levels and the mean

1990 JAMA Controlled trial quality: uncertain

1080. Comparison of insulin analogue B9AspB27Glu and soluble human insulin in insulin-treated diabetes. (Abstract)

Comparison of insulin analogue B9AspB27Glu and soluble human insulin in insulin-treated diabetes. Postprandial plasma glucose excursions and plasma levels of free insulin after subcutaneous bolus injection of a rapidly absorbed monomeric insulin analogue (B9AspB27Glu) or soluble human insulin ('Actrapid HM' U100) were studied in six insulin-treated diabetic subjects. 10 U actrapid or an equimolar amount of the analogue were injected, in random order with an interval of 1 week, immediately (...) before a 500 kcal test meal. Basal insulin levels were similar on the 2 study days (mean 74.1 [SE 5.1] pmol/l, actrapid; 79.7 [13.0] pmol/l, analogue). After injection of actrapid plasma free insulin levels rose slowly, reaching a plateau by 105 min at 222 (19) pmol/l. Injection of the analogue resulted in a rapid early peak at 30 min (798 [112] pmol/l), and levels were significantly higher than those after actrapid between 15 and 210 min. The more physiological plasma insulin levels achieved

1990 Lancet Controlled trial quality: uncertain