Nursing a patient with latent autoimmune diabetes in adults with insulin-related lipodystrophy, allergy, and exogenous insulin autoimmune syndrome: A case report.

BACKGROUND: Latent autoimmune diabetes in adults (LADA) is a special type of type 1 diabetes mellitus. During the early stages, patients with LADA are treated with oral antidiabetics. However, insulin treatment is still required as islet function gradually declines. Once patients have developed insulin allergy, clinical treatment and nursing care become very challenging. CASE SUMMARY: Here, we report a case of LADA with insulin-related lipodystrophy, allergy, and exogenous insulin autoimmune syndrome during insulin treatment, thus making it very difficult to effectively control glucose levels with insulin. We attempted subcutaneous injection and an insulin pump to desensitize the patient's response to insulin, and finally assisted the doctor to select the appropriate insulin treatment for the patient. We describe the management of this patient from a nursing viewpoint. CONCLUSION: We summarize the nursing experience of a case with complex insulin allergy requiring desensitization treatment. Our approach is very practical and can be applied to similar patients needing insulin desensitization.

Deoxyribonucleic acid telomere length shortening can predict the incidence of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus.

AIMS/INTRODUCTION: To investigate the effect of telomere shortening and other predictive factors of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetes mellitus patients in a 6-year prospective cohort study. MATERIALS AND METHODS: A total of 70 type 2 diabetes mellitus (mean age 57.8 ± 6.7 years) patients without NAFLD were included in the study, and 64 of them were successfully followed up 6 years later, excluding four cases with significant alcohol consumption. NAFLD was diagnosed by the hepatorenal ratio obtained by a quantitative ultrasound method using NIH image analysis software. The 39 individuals that developed NAFLD were allocated to group A, and the 21 individuals that did not develop NAFLD were allocated to group B. Fluorescent real-time quantitative polymerase chain reaction was used to measure telomere length. RESULTS: There was no significant difference between the two groups in baseline telomere length; however, at the end of the 6th year, telomere length had become shorter in group A compared with group B. There were significant differences between these two groups in baseline body mass index, waistline, systolic blood pressure, glycated hemoglobin and fasting C-peptide level. In addition, the estimated indices of baseline insulin resistance increased in group A. Fasting insulin level, body mass index, systolic blood pressure at baseline and the shortening of telomere length were independent risk factors of NAFLD in type 2 diabetes mellitus patients. CONCLUSIONS: Telomere length became shorter in type 2 diabetes mellitus patients who developed NAFLD over the course of 6 years. Type 2 diabetes mellitus patients who developed NAFLD had more serious insulin resistance compared with those who did not develop NAFLD a long time ago.

[A comparative study of the effects of needle free (INJEX30) versus insulin pen injection on insulin absorption in diabetic patients].

OBJECTIVE: To evaluate the effect of the needle free injection system (INJEX30) and insulin pen on insulin absorption and glycemic control in diabetic patients. METHODS: A total of 30 diabetic patients on insulin therapy without obvious complications were enrolled in the study with average BMI of 25.24 kg/m(2). A comparison study was carried out in those subjects with the INJEX30 and insulin pen at 1(st) day and 5(th) day. After an overnight fasting of 8-10 h, a standard mixed meal (50 g bread, 50 g egg and 250 ml milk) was given to each patient. Blood samples at 0, 20, 40, 60 min of the standard mixed meal were collected to test plasma glucose, serum insulin and C peptide. RESULTS: No difference was shown in fasting plasma glucose, serum insulin and C peptide between the patients with the two injection methods. The area under the curve (AUC) of plasma glucose and serum C peptide was significantly lower after the INJEX30 injection than that after insulin pen injection [plasma glucose AUC (542 ± 172)min·mmol·L(-1) vs (601 ± 199) min·mmol·L(-1), P < 0.01; C peptide AUC (70 ± 53) min·µg· L(-1) vs (80 ± 58) min·µg·L(-1), P < 0.01]. The AUC of serum insulin was significantly higher after the INJEX30 injection than that after insulin pen injection [serum insulin AUC (5621 ± 3790) min·mIU·L(-1) vs (4285 ± 3376) min·mIU· L(-1), P < 0.01]. No difference was found in the AUC of serum insulin between the two injection methods in the patients with BMI below 25.24 kg/m(2), while the AUC of serum insulin was significantly higher after the INJEX30 injection than the insulin pen injection in the patients with BMI above 25.24 kg/m(2) [serum insulin AUC (6453 ± 4099) min·mIU· L(-1) vs (4879 ± 3701) min·mIU·L(-1), P < 0.01]. CONCLUSION: The INJEX30 improves the serum insulin level which may lead to a beneficial effect on the glycemic control. Such effect is more obvious in the overweight patients.

Association between four adipokines and insulin sensitivity in patients with obesity, type 1 or type 2 diabetes mellitus, and in the general Chinese population.

BACKGROUND: Hyperinsulinemic euglycemic clamp is the gold standard to evaluate the insulin sensitivity, but it is too complicated and expensive to use in clinic. We tried to find an alternative indicator to reflect insulin sensitivity. To evaluate the association between the four adipokines, adiponectin, leptin, resistin and tumor necrosis factor-alpha (TNF-alpha) with insulin sensitivity, we used a hyperinsulinemic euglycemic clamp to test insulin sensitivity in Chinese patients with obesity and type 1 or type 2 diabetes mellitus versus controls. METHODS: In this parallel control study, we tested insulin sensitivity using a hyperinsulinemic euglycemic clamp in different groups, then examined levels of adiponectin, leptin, resistin and TNF-alpha in serum, and the relationship between the different adipokines and glucose disposal rate (M value), as well as insulin sensitivity index (M value/insulin, M/I), which are the "gold standard" indices of insulin sensitivity. RESULTS: There were significant differences in mean leptin values in the four adipokines from the four different groups (P < 0.001; comparison of the variation between different groups was analyzed by variance analysis). Compared to controls (using multiple comparison two-way Dunnett t test), only the leptin level showed significant differences in the four adipokines from the four different groups at the same time (P < 0.001). The association analysis between the different adipokines and M or M/I values also showed that only leptin negatively correlated with M (r = -0.64, P < 0.001) or M/I values (r = -0.56, P < 0.001); there was no relationship between the other three adipokines and M or M/I values. CONCLUSION: Only leptin was associated with M or M/I values. Therefore, leptin might be one of the predictive factors of the degree of insulin resistance and risk of the accompanying disease.

[Pharmacodynamics, pharmacokinetics and bioavailability of insulin enteric-coated soft capsules].

OBJECTIVE: To study the pharmacokinetic and pharmacodynamic properties of the insulin enteric-coated soft capsules. METHODS: In this open, single-center, randomized, two-period, cross-over, euglycemic glucose clamp study, 20 healthy volunteers (14 men, 6 women), aged (28.6 +/- 5.2) years, whose BMI was (21.2 +/- 1.1) kg/m(2), received insulin enteric-coated soft capsules (50 IU) or regular insulin (15 IU) administration after a baseline period of 2 hours. After the administration, 29 blood samples were taken for serum insulin measurement. Meanwhile, glucose infusion rates (GIR) were determined per 5 minutes over a period of 12 hours. RESULTS: The maximal concentration (Cmax) of insulin was (22.1 +/- 8.0) mIU/L vs (118.6 +/- 25.2) mIU/L (tested vs reference preparation); the time for reaching Cmax (Tmax) was (255.8 +/- 142.2) min vs (115.5 +/- 43.4) min. The maximal GIR (GIRmax) were (3.56 +/- 0.85) mg.kg(-1).min(-1) vs (4.87 +/- 1.26) mg.kg(-1).min(-1); the time for reaching GIRmax (T(GIRmax)) was (166.3 +/- 75.9) min vs (148.0 +/- 40.8) min. The relative bioavailability and bioefficacy of insulin enteric-coated soft capsules were (7.42 +/- 3.25)% and (24.78 +/- 0.08)%. CONCLUSIONS: The difference between relative bioavailability and relative bioefficacy indicates that the oral administration of insulin enteric-coated soft capsules may mimic physiological procedure of insulin endosecretion. These pharmacokinetic and pharmacodynamic data provide a useful guide for further clinical trial.