Insulin therapy:
Gespeichert in:
Format: | Buch |
---|---|
Sprache: | English |
Veröffentlicht: |
Philadelphia, Pa.
Saunders
2012
|
Schriftenreihe: | Endocrinology and metabolism clinics of North America
41,1 |
Schlagworte: | |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | XIV, 230 S. Ill., graph. Darst. 24 cm |
ISBN: | 9781455738571 1455738573 |
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650 | 4 | |a Insulin / Therapeutic use | |
650 | 4 | |a Diabetes / Hormone therapy | |
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Datensatz im Suchindex
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adam_text | Titel: Insulin therapy
Autor: Leahy, Jack L
Jahr: 2012
Insulin Therapy
Contents
Foreword ix
Derek LeRoith
XIII
Preface
Jack L. Leahy and William T. Cefalu
Insulins: Past, Present, and Future
Caria A. Borgono and Bernard Zinman
This article highlights selected milestones in insulin discovery and its con-
tinued development as a pivotal therapy for diabetes. The last 90 years
have witnessed tremendous progress in insulin therapy, from the initial
crude, yet life-saving, animal insulin extracts to novel human insulin ana-
logues. Although the complete physiologic replacement of insulin is inher-
ently difficult to achieve with open-loop subcutaneously administered
insulin, the continued development of improved injectable insulin formula-
tions with superior pharmacokinetics and pharmacodynamics will en-
hance glucose control, and represents important clinical advances in the
treatment of both type 1 and type 2 diabetes.
Physiology of Glucose Homeostasis and Insulin Therapy in Type 1 and
Type 2 Diabetes 25
Ele Ferrannini
An input-output schematization of plasma glucose homeostasis provides
quantitative information on glucose fluxes and their control by insulin. In-
sulin action is dependent on the target tissue, the route of delivery, and
the kinetics of insulin activation and deactivation, which are different for
glucose production and disposal and are a function of insulin resistance.
Under normal conditions, the closed-loop control of minute-by-minute in-
sulin release by arterial glucose levels protects against both hyperglyce-
mia and hypoglycemia. Open-loop insulin therapy faces the complexities
of insulin pharmacokinetics and pharmacodynamics. Insulin therapy thus
remains defiantly empiric.
Reevaluating Goals of Insulin Therapy: Perspectives from Large Clinical Trials 41
Matthew C. Riddle and Kevin C.J. Yuen
Recent large clinical trials have shown that intensive glycémie control can
reduce microvascular complications, but appropriate and safe glycémie
goals to improve macrovascular outcomes in patients with type 2 diabetes
remain poorly defined. This article surveys recent epidemiologic studies
and interventional trials, examines the current understanding of the natural
history of type 2 diabetes, and proposes new goals and tactics for optimiz-
ing insulin therapy.
Contents
Insulin Therapy and Hypoglycemia 57
Anthony L. McCall
Hypoglycemia is the most important and common side effect of insulin
therapy. It is also the rate limiting factor in safely achieving excellent glycé-
mie control. A three-fold increased risk of severe hypoglycemia occurs in
both type 1 and type 2 diabetes with tight glucose control. This dictates
a need to individualize therapy and glycemia goals to minimize this risk.
Several ways to reduce hypoglycemia risk are recognized and discussed.
They include frequent monitoring of blood sugars with home blood glucose
tests and sometimes continuous glucose monitoring (CGM) in order to
identify hypoglycemia particularly in hypoglycemia unawareness. Consid-
erations include prompt measured hypoglycemia treatment, attempts to
reduce glycémie variability, balancing basal and meal insulin therapy,
a pattern therapy approach and use of a physiological mimicry with insulin
analogues in a flexible manner. Methods to achieve adequate control while
focusing on minimizing the risk of hypoglycemia are delineated in this
article.
Intensive Insulin Therapy in Patients with Type 1 Diabetes Mellitus 89
Sean M. Switzer, Emily G. Moser, Briana E. Rockier, and Satish K. Garg
There has been a significant increase in the prevalence of type 1 diabetes
mellitus and type 2 diabetes mellitus in the past decade. The International
Diabetes Foundation reported that there will be more than a half-billion
people with diabetes by 2030, largely in emerging economies. Improved
glucose control reduces microvascular and macrovascular complications
and can be accomplished with intensive diabetes management. Continu-
ous glucose monitors allow further improvement. The best way to emulate
normal physiology is the development of an artificial pancreas. Early ver-
sions of closed-loop technology may be available in the United States in
the next 3 to 5 years.
Closed-Loop Insulin Delivery in Type 1 Diabetes 105
Hood Thabit and Roman Hovorka
Advances in diabetes technology have led to significant improvements in
the quality of life and care received by individuals with diabetes. Despite
this, achieving tight glycémie control through intensive insulin therapy
and modern insulin regimens is challenging because of the barrier of hypo-
glycemia, the most feared complication of insulin therapy as reported by
patients, caregivers, and physicians. This article outlines the individual
components of the closed-loop system together with the existing clinical
evidence. The artificial pancreas prototypes currently used in clinical stud-
ies are reviewed as well as obstacles and limitations facing the technology.
Insulin Therapy in Type 2 Diabetes Mellitus 119
Jack L. Leahy
Health care providers and patients have lots of choice to treat type 2 dia-
betes, but the blood glucose improvement is limited. The one therapy with
unlimited potential (at least theoretically) is insulin. Many studies show that
Contents
glucose control is achievable with insulin safely in most patients with type 2
diabetes. Effective diabetes management at the primary care or specialty
level requires a belief in the importance of insulin therapy in uncontrolled
patients with type 2 diabetes. This review details the theories, observed
outcomes, and how-tos regarding insulin use in type 2 diabetes.
Insulin Therapy in Children and Adolescents 145
William V. Tamborlane and Kristin A. Sikes
Insulin therapy is the mainstay of treatment in children and adolescents
with type 1 diabetes (T1D) and is a key component in the treatment of
type 2 diabetes (T2D) in this population as well. A major aim of current in-
sulin replacement therapy is to simulate the normal pattern of insulin
secretion as closely as possible. This aim can best be achieved with
basal-bolus therapy using multiple daily injections (MDI) or continuous
insulin infusion (CSU) pump therapy. Only a few years ago, options for in-
sulin formulations were limited. There are now more than 10 varieties of
biosynthetic human and analogue insulin.
Insulin Therapy in Pregnancy 161
Aidan McElduff and Robert G. Moses
Insulin therapy is essential for optimal glycémie control during pregnancy
in women with type 1 diabetes and is frequently required to optimize con-
trol in women with type 2 diabetes. Less commonly, women with gesta-
tional diabetes mellitus (GDM) require insulin for glycémie control.
However, because of its greater prevalence, GDM is the most common
reason for insulin use in pregnancy. The most frequently used insulin reg-
imen in pregnancy is a basal/bolus combination of long- and short-acting
insulin preparations. There is no evidence base to support one treatment
regimen over another. Therapy should be individualized and based on lo-
cal expertise.
Insulin Therapy for the Management of Hyperglycemia in Hospitalized Patients 175
Marie E. McDonnell and Guillermo E. Umpierrez
It has long been established that hyperglycemia with or without a prior
diagnosis of diabetes increases both mortality and disease-specific mor-
bidity in hospitalized patients and that goal-directed insulin therapy can
improve outcomes. This article reviews the pathophysiology of hypergly-
cemia during illness, the mechanisms for increased complications and
mortality due to hyperglycemia and hypoglycemia, and beneficial mecha-
nistic effects of insulin therapy and provides updated recommendations
for the inpatient management of diabetes in the critical care setting and
in the general medicine and surgical settings.
Index 203
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id | DE-604.BV040290765 |
illustrated | Illustrated |
indexdate | 2024-07-10T00:20:54Z |
institution | BVB |
isbn | 9781455738571 1455738573 |
language | English |
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physical | XIV, 230 S. Ill., graph. Darst. 24 cm |
publishDate | 2012 |
publishDateSearch | 2012 |
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publisher | Saunders |
record_format | marc |
series | Endocrinology and metabolism clinics of North America |
series2 | Endocrinology and metabolism clinics of North America |
spelling | Insulin therapy guest ed. Jack L. Leahy ; William T. Cefalu Philadelphia, Pa. Saunders 2012 XIV, 230 S. Ill., graph. Darst. 24 cm txt rdacontent n rdamedia nc rdacarrier Endocrinology and metabolism clinics of North America 41,1 Insulin / Therapeutic use Diabetes / Hormone therapy Leahy, Jack L. Sonstige oth Cefalu, William T. Sonstige oth Endocrinology and metabolism clinics of North America 41,1 (DE-604)BV000625447 41,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025145952&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
spellingShingle | Insulin therapy Endocrinology and metabolism clinics of North America Insulin / Therapeutic use Diabetes / Hormone therapy |
title | Insulin therapy |
title_auth | Insulin therapy |
title_exact_search | Insulin therapy |
title_full | Insulin therapy guest ed. Jack L. Leahy ; William T. Cefalu |
title_fullStr | Insulin therapy guest ed. Jack L. Leahy ; William T. Cefalu |
title_full_unstemmed | Insulin therapy guest ed. Jack L. Leahy ; William T. Cefalu |
title_short | Insulin therapy |
title_sort | insulin therapy |
topic | Insulin / Therapeutic use Diabetes / Hormone therapy |
topic_facet | Insulin / Therapeutic use Diabetes / Hormone therapy |
url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=025145952&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
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