2018 AAHA Diabetes Management Guidelines for Dogs and Cats*
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Management of Diabetes Mellitus Standards of Care and Clinical Practice Guidelines
WHO-EM/DIN6/E/G MANAGEMENT OF DIABETES MELLITUS STANDARDS OF CARE AND CLINICAL PRACTICE GUIDELINES Edited by Dr A.A.S. Alwan Regional Adviser, Noncommunicable Diseases WHO Regional Office for the Eastern Mediterranean WHO-EM/DIN6/E/G INTRODUCTION Available data from many countries of the Eastern Mediterranean Region (EMR) indicate that diabetes mellitus has become a problem of great magnitude and a major public health concern. Studies have demonstrated that, in some countries, diabetes affects up to 10% of the population aged 20 years and older. This rate may be doubled if those with impaired glucose tolerance (IGT) are also included. The manifestations of diabetes cause considerable human suffering and enormous economic costs. Both acute and late diabetic complications are commonly encountered. Long-term complications represented by cardiovascular diseases, cerebrovascular accidents, end-stage renal disease, retinopathy and neuropathies are already major causes of morbidity, disability and premature death in countries of this Region. The development of long-term complications is influenced by hyperglycaernia. Poor control of diabetes accelerates their progression. Thus, to prevent complications, good control of diabetes is essential and the management of diabetes should therefore aim to improve glycaemic control beyond that required to control its symptoms. Intensified therapy and maintaining near-normal blood glucose levels can result in considerable reduction in the risk of development of retinopathy, nephropathy and neuropathy. However, despite the high prevalence of diabetes and its complications and the availability of successful prevention strategies, essential health care requirements and facilities for self-care are often inadequate in this Region. Action is needed at all levels of health care and in the various aspects of diabetes care to bridge this gap and to improve health care delivery to people with diabetes. -
LANTUS® (Insulin Glargine [Rdna Origin] Injection)
Rev. March 2007 Rx Only LANTUS® (insulin glargine [rDNA origin] injection) LANTUS® must NOT be diluted or mixed with any other insulin or solution. DESCRIPTION LANTUS® (insulin glargine [rDNA origin] injection) is a sterile solution of insulin glargine for use as an injection. Insulin glargine is a recombinant human insulin analog that is a long-acting (up to 24-hour duration of action), parenteral blood-glucose-lowering agent. (See CLINICAL PHARMACOLOGY). LANTUS is produced by recombinant DNA technology utilizing a non- pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, it is 21A- B B Gly-30 a-L-Arg-30 b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. It has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 IU (3.6378 mg) insulin glargine. Inactive ingredients for the 10 mL vial are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. Inactive ingredients for the 3 mL cartridge are 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for injection. The pH is adjusted by addition of aqueous solutions of hydrochloric acid and sodium hydroxide. LANTUS has a pH of approximately 4. CLINICAL PHARMACOLOGY Mechanism of Action: The primary activity of insulin, including insulin glargine, is regulation of glucose metabolism. -
Treatment of Diabetes Mellitus
TREATMENT OF DIABETES MELLITUS DIABETES is a condition that affects how the body makes energy from food. Food is broken down into sugar (glucose) in the body and released into the blood. When the blood sugar level rises after a meal, insulin responds to let the sugar into the cells to be used as energy. In diabetes, the body either does not make enough insulin or it stops responding to insulin as well as it should. This results in sugar staying in the blood and leads to serious health problems over time. DIAGNOSIS OF DIABETES1 • A1C Test: Lab test measuring average blood sugar over past two to three months • Fasting Blood Sugar Test: Lab test measuring blood sugar after eight hours of no food or drink • Oral Glucose Tolerance Test (OGTT): Measures blood sugar before and two hours after drinking a specific sugary liquid • Random Blood Sugar Test: Measures blood sugar at a moment in time, without any kind of preparation (like fasting) FASTING BLOOD ORAL GLUCOSE TOLERANCE RANDOM BLOOD RESULT A1C TEST SUGAR TEST TEST SUGAR TEST Diabetes ≥ 6.5% ≥126 mg/dL ≥ 200 mg/dL ≥ 200 mg/dL Prediabetes 5.7 – 6.4% 100 – 125 mg/dL 140 – 199 mg/dL N/A Normal < 5.7% ≤99 mg/dL < 140 mg/dL N/A NON-DRUG TREATMENTS2 THERAPY COST WHAT TO EXPECT Diet (Mediterranean diet) and exercise (30 minutes a day, five days a week of moderate- Weight loss $-$$ intensity exercise); 7% weight loss decreases risk of diabetes3 Psychological intervention $$-$$$ Psychotherapy may reduce diabetic distress and improve glycemic control4,5 nationalcooperativerx.com PRESCRIPTION TREATMENTS -
MEDICAL DIRECTIVE Point of Care Glucose Meter Testing And
MEDICAL DIRECTIVE Point of Care Glucose Meter Testing and Treatment for Out-Patients with Suspected Hypoglycemia in the Diabetes Education Program Approved by/Date: Medical Advisory Comm. – June 25, 2013 Authorizing physician(s) Dr. Rachel Chong Dr. Angeline Chong Dr. Theodore Monchesky Authorized to whom Nurses and dietitians working in the diabetes education program at LH who have received education and validation of glucose meter testing according to Ontario Laboratory Accreditation Standards (OLA). Patient Description / Population Any outpatient 18 years of age or older at LH exhibiting signs or symptoms of hypoglycemia. Any outpatient 18 years of age or older suspected of having hypoglycemia. Medical Directive Description/Physician’s Order The nurse/dietitian will obtain a capillary blood sample from a patient’s finger upon suspecting hypoglycemia. The nurse/dietitian will perform a blood glucose meter test, and treat hypoglycemia as per protocol outlined below. Patient/Population Description: All LH Patients 18 years and over registered with the LH Diabetes Education Program. Contraindications to implementing the Protocol: • Patients unwilling or unable to provide blood sample. • Patient less than 18 years of age • Refusal of patient/family consent for testing and/or treatment; call code blue and 911 immediately Originating Committee: RNS Program Council – Feb 26, 2013 Medical Advisory Committee: June 25, 2013 This material has been prepared solely for the use at Lakeridge Health. Lakeridge Health accepts no responsibility for use of this material by any person or organization not associated with Lakeridge Health. No part of this document may be reproduced in any form for publication without the permission of Lakeridge Health. -
Diabetic Ketoacidosis and Hyperosmolar BMJ: First Published As 10.1136/Bmj.L1114 on 29 May 2019
STATE OF THE ART REVIEW Diabetic ketoacidosis and hyperosmolar BMJ: first published as 10.1136/bmj.l1114 on 29 May 2019. Downloaded from hyperglycemic syndrome: review of acute decompensated diabetes in adult patients Esra Karslioglu French,1 Amy C Donihi,2 Mary T Korytkowski1 1Division of Endocrinology and Metabolism, Department of ABSTRACT Medicine, University of Pittsburgh, Pittsburgh, PA, USA Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome (HHS) are life threatening 2University of Pittsburgh School of complications that occur in patients with diabetes. In addition to timely identification of the Pharmacy, Pittsburgh, PA, USA Correspondence to: M Korytkowski precipitating cause, the first step in acute management of these disorders includes aggressive [email protected] administration of intravenous fluids with appropriate replacement of electrolytes (primarily Cite this as: BMJ 2019;365:l1114 doi: 10.1136/bmj.l1114 potassium). In patients with diabetic ketoacidosis, this is always followed by administration Series explanation: State of the of insulin, usually via an intravenous insulin infusion that is continued until resolution of Art Reviews are commissioned on the basis of their relevance to ketonemia, but potentially via the subcutaneous route in mild cases. Careful monitoring academics and specialists in the US and internationally. For this reason by experienced physicians is needed during treatment for diabetic ketoacidosis and HHS. they are written predominantly by Common pitfalls in management include premature termination of intravenous insulin US authors therapy and insufficient timing or dosing of subcutaneous insulin before discontinuation of intravenous insulin. This review covers recommendations for acute management of diabetic ketoacidosis and HHS, the complications associated with these disorders, and methods for http://www.bmj.com/ preventing recurrence. -
Diabetes Control in Thyroid Disease
In Brief Thyroid disease is commonly found in most types of diabetes. This article defines the prevalence of thyroid disease in diabetes and elucidates through case studies the assessment, diagnosis, and clinical management of thyroid disease in diabetes. Diabetes Control in Thyroid Disease Thyroid disease is a pathological state abnormality. Several studies, including that can adversely affect diabetes con- the Colorado study, have documented trol and has the potential to negative- a higher prevalence of thyroid disease Jennal L. Johnson, MS, RNC, FNP, ly affect patient outcomes. Thyroid in women, with prevalence rates rang- BC-ADM, CDE disease is found commonly in most ing from 4 to 21%, whereas the rate in forms of diabetes and is associated men ranges from 2.8 to 16%.1 with advanced age, particularly in Thyroid disease increases with age. In type 2 diabetes and underlying the Colorado study, the 18-year-olds autoimmune disease in type 1 dia- had a prevalence rate of 3.5% com- betes. This article defines the preva- pared with a rate of 18.5% for those lence of thyroid disease in diabetes, ≥ 65 years of age. discusses normal physiology and The prevalence of thyroid disease in screening recommendations for thy- diabetes has been estimated at 10.8%,2 roid disease, and elucidates through with the majority of cases occurring as case studies the assessment, diagnosis, hypothyroidism (~ 30%) and subclini- and clinical management of thyroid cal hypothyroidism (~ 50%).2 Hyper- disease and its impact on diabetes. thyroidism accounts for 12%, and postpartum thyroiditis accounts for Thyroid Disease Prevalence 11%.2 Of the female patients with The prevalence of thyroid disease in type 1 diabetes, 30% have thyroid dis- the general population is estimated to ease, with a rate of postpartum thy- be 6.6%, with hypothyroidism the roid disease three times that of the most common malady.1 Participants normal population. -
Glossary of Common Diabetes Terms
Glossary of Common Diabetes Terms A1C: a test that reveals exactly how well your blood sugar (glucose) has been controlled over the previous three months Beta cells: cells found in the pancreas that make insulin Blood glucose: also known as blood sugar, glucose comes from food and is then carried through the blood to deliver energy to cells Blood glucose meter: a small medical device used to check blood glucose levels Blood glucose monitoring: the simple blood test used to check the amount of glucose in the blood; a tiny drop of blood, taken by pricking a finger, is placed on a test strip and inserted in the meter for reading Diabetes: the shortened name for diabetes mellitus, the condition in which the pancreas doesn’t produce enough insulin or your body is unable to use insulin to move glucose into cells of the body Diabetic retinopathy: the eye disease that occurs in someone with diabetes when the small blood vessels of the retina become swollen and leak liquid into the retina, blurring vision; it can sometimes lead to blindness Gestational diabetes: the diabetes some women develop during pregnancy; it typically subsides after the baby is delivered, but many women who have had gestational diabetes may develop type 2 diabetes later in life Glucagon: the hormone that is injected into a person with diabetes to raise their blood glucose level when it’s very low (hypoglycemia) Glucose: blood sugar that gives energy to cells Hyperglycemia: also known as high blood glucose, this condition occurs when your blood glucose level is too high; -
ATC) Codes and Drug Identification Numbers (Dins
Anatomical Therapeutic Chemical (ATC) Codes and Drug Identification Numbers (DINs) of Drugs in the Drug Program Information Network (DPIN) Used to Define Diabetes in Manitoba Children from 2001/02–2003/04 to 2007/08–2009/10 DIN ATC Code Equivalent Generic Product Name Product Description Ingredients 446564 A10AA01 INSULIN ZINC (BEEF/PORK) ILETIN INSULIN REGULAR 100UNIT INSULIN ZINC (100 UNIT) 1986805 A10AA01 INSULIN INJECTION HUMAN SEMI-* VELOSULIN HUMAN INJ LIQ 100U/M INSULIN INJECTION HUMAN SEMI-SYNTHETIC (100 UNIT) 446572 A10AA02 INSULIN ISOPHANE(NPH) ((BEEF * ILETIN NPH INSULIN 100UNIT/ML INSULIN ISOPHANE (NPH) (100 UNIT) 446580 A10AA02 INSULIN ZINC ((BEEF & PORK)) ILETIN LENTE INSULIN INJ 100UN INSULIN ZINC (100 UNIT) 586714 A10AB01 INSULIN DNA ORIGIN HUMAN HUMULIN R INJ INSULIN SEMI SYNTHETIC HUMAN (100 UNIT) 1959220 A10AB01 INSULIN INJECTION HUMAN BIOSY HUMULIN R CARTRIDGE INSULIN INJECTION HUMAN BIOSYNTHETIC (100 UNIT) 2024233 A10AB01 INSULIN INJECTION HUMAN BIOSY NOVOLIN GE TORONTO INJ 100U/ML INSULIN INJECTION HUMAN BIOSYNTHETIC (100 UNIT) 2024284 A10AB01 INSULIN INJECTION HUMAN BIOSY* NOVOLIN GE TORONTO PENFILL INJ INSULIN INJECTION HUMAN BIOSYNTHETIC (100 UNIT) 2025256 A10AB01 INSULIN INJECTION HUMAN BIOSY NOVOLINSET GE TORONTO INSULIN INJECTION HUMAN BIOSYNTHETIC (100 UNIT) 1934074 A10AB02 INSULIN SULPHATED BEEF SULPHATED INSULIN INJ LIQ 100U INSULIN SULPHATED BEEF (100 UNIT) 513644 A10AB03 INSULIN (REGULAR) PORK REGULAR PURIFIED PORK INSULIN INSULIN (PORK) (100 UNIT) 2275872 A10AB03 INSULIN INJECTION PORK HYPURIN REGULAR -
Clinical Use of Hemoglobin A1c to Improve Diabetes Management
PRACTICAL POINTERS Clinical Use of Hemoglobin A1c to Improve Diabetes Management Alan M. Delamater, PhD, ABPP or more than 25 years, the hemo- one recent study conducted in Norway6 A1C values. Only 14% of the youths globin A1c (A1C) test has been revealed that the majority (82.6%) of were able to accurately describe the A1C Fthe most widely accepted out- 201 adult patients with type 1 diabetes test. Just 11, 7.8, and 7.8% correctly come measure for evaluating glycemic knew what their last A1C was, and most identified the A1C ranges for good, fair, control in individuals with diabetes. patients (90%) knew what a satisfactory and poor glycemic control, respectively. The test provides an index of a patient’s A1C value would be. But a significant Very few youths (1.6–3.2%) knew the average blood glucose level during the number of patients (42%) reported they blood glucose values corresponding to past 2–3 months1 and is considered to had low knowledge of A1C testing in specific A1C results. Only a small num- be the most objective and reliable general. Furthermore, 25% of patients ber of youths correctly estimated the measure of long-term metabolic con- did not think that treatment intensifica- short- and long-term risks associated trol.2,3 The Diabetes Control and tion should occur at an A1C value of with A1C values of 7 and 12%. In this Complications Trial established that 10%. sample, there was a significant lack of maintaining A1C levels as close as pos- A recent cross-sectional study knowledge concerning the meaning and sible to the normal range results in con- examined the relationship between implications of the A1C test. -
CANINE INSULINOMA: DIAGNOSIS, TREATMENT, & STAGING Eliza Reiss Grant, DVM, and Kristine E
Peer Reviewed PRACTICAL ONCOLOGY CANINE INSULINOMA: DIAGNOSIS, TREATMENT, & STAGING Eliza Reiss Grant, DVM, and Kristine E. Burgess, DVM, Diplomate ACVIM (Oncology) Tufts University An insulinoma is a malignant pancreatic tumor that DIAGNOSIS inappropriately secretes excessive insulin, resulting in Aside from a histologic confirmation of insulinoma, profound hypoglycemia.1 no currently available diagnostic test provides a de- Pancreatic tumors are classified as: finitive diagnosis of insulinoma. Existing techniques • Exocrine, which includes adenocarcinomas of may help increase suspicion for an insulin-secreting ductular or acinar origin tumor but, with most diagnostic testing, it is im- • Endocrine, which arise from the islets of perative to interpret all results in the context of the Langerhans. coexisting clinical signs. Insulinomas are functional neuroendocrine tumors that originate in the beta cells of the islets Differential Diagnosis of Langerhans.1 A complete work-up, including careful patient history, physical examination, bloodwork, and PRESENTATION diagnostic imaging tests, should be performed to Signalment rule out other causes of hypoglycemia, such as Any breed of dog can be affected, but large sepsis, hepatic failure, adrenal cortical insufficiency, breeds tend to be overrepresented.1 While, in toxin ingestion, and other forms of neoplasia. humans, insulinomas affect females far more frequently than males, there is no apparent sex Laboratory Tests predilection in dogs.1-3 Dogs also commonly Blood Glucose present with a malignant variant, while humans A simple fasting blood glucose level of less than often have a benign adenoma (80%).1 Insulino- 40 mg/dL can suggest hyperinsulinemia, although ma is rare in cats.4 careful monitoring of a fasted dog with suspected insulinoma is strongly recommended due to high Clinical Signs risk for seizure activity. -
Decrease of Fructosamine Levels During Treatment with Adalimumab
European Journal of Endocrinology (2007) 156 291–293 ISSN 0804-4643 CASE REPORT Decrease of fructosamine levels during treatment with adalimumab in patients with both diabetes and rheumatoid arthritis I C van Eijk1, M J L Peters1,2, M T Nurmohamed1,2,3, A W van Deutekom4, B A C Dijkmans1,2 and S Simsek4 1Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands, 2Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands, 3Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands and 4Department of Endocrinology/Diabetes Center, VU University Medical Center, PO Box 7057, 1007 MB, Boelelaan 1117, Amsterdam, The Netherlands (Correspondence should be addressed to S Simsek; Email: [email protected]) Abstract Tumour necrosis factor a (TNFa) is a pro-inflammatory cytokine which has been closely linked to obesity and insulin resistance. We present two cases of patients with rheumatoid arthritis (RA) and concomitant diabetes mellitus, who showed a marked decrease of fructosamine levels after initiating therapy with adalimumab, a TNFa-blocking agent, for active RA. This finding may implicate that TNFa blockade causes better glycaemic control in RA patients with concomitant diabetes, possibly by improving insulin resistance. European Journal of Endocrinology 156 291–293 Introduction Research design and methods Tumour necrosis factor a (TNFa), a pro-inflammatory A patient with known diabetes type 1 and concomitant cytokine, plays an important role in inflammatory and RA showed a marked improvement of HbA1c levels after autoimmune diseases like rheumatoid arthritis (RA). initiation of adalimumab, a recombinant human IgG1- TNFa has also been closely linked to obesity and insulin MAB, therapy for active RA when she visited the resistance (1). -
In-Vitro Anti-Diabetic Activity and In-Silico Studies of Binding Energies
Pharmacia 67(4): 363–371 DOI 10.3897/pharmacia.67.e58392 Research Article In-vitro anti-diabetic activity and in-silico studies of binding energies of palmatine with alpha-amylase, alpha-glucosidase and DPP-IV enzymes Patrick Okechukwu1, Mridula Sharma1, Wen Hui Tan1, Hor Kuan Chan1, Kavita Chirara1, Anand Gaurav1, Mayasah Al-Nema1 1 UCSI Universit, Kuala Lumpur, Malaysia Corresponding author: Patrick Okechukwu ([email protected]) Received 5 September 2020 ♦ Accepted 18 October 2020 ♦ Published 27 November 2020 Citation: Okechukwu P, Sharma M, Tan WH, Chan HK, Chirara K, Gaurav A, Al-Nema M (2020) In-vitro anti-diabetic activity and in-silico studies of binding energies of palmatine with alpha-amylase, alpha-glucosidase and DPP-IV enzymes. Pharmacia 67(4): 363–371. https://doi.org/10.3897/pharmacia.67.e58392 Abstract Palmatine a protoberberine alkaloid has been previously reported to possess in vivo antidiabetic and antioxidant property. The aim of the experiment is to evaluate the in vitro antidiabetic activity and in-silico studies of the binding energies of Palmatine, acarbose, and Sitagliptin with the three enzymes of alpha-amylase, alpha-glucosidase, and dipeptidyl peptidase-IV (DPP-IV). The in vitro antidiabetic study was done by evaluating the inhibitory effect of palmatine on the activities of alpha-amylase, alpha-glucosidase, and DPP-IV. Acarbose, and sitagliptin was used as standard drug. The molecular docking study was performed to study the binding interactions of palmatine with alpha-glucosidase, a-amylase, and DPP-IV. The binding interactions were compared with the standard compounds Sitagliptin and acarbose. Palmatine with IC50 (1.31 ± 0.27 µM) showed significant difference of (< 0.0001) higher inhib- iting effect on alpha-amylase and weak inhibiting effect on alpha-glucosidase enzyme with IC50 (9.39 ± 0.27 µM) and DPP-IV with IC50 (8.7 ± 1.82 µM).