Descarte correto de resíduo doméstico de pessoas em uso de insulina: tecnologia para educação ao paciente / Correct disposal of domestic waste from people using insulin: technology for patient education / Correcta eliminación de residuos domésticos de personas que utilizan insulina: tecnología para la educación del paciente

Objetivo: Analisar as formas de descarte correto do resíduo doméstico advindo da insulinoterapia e elaborar uma tecnologia para educação aos pacientes (cartilha). Métodos: Estudo descritivo e exploratório, do tipo revisão integrativa. O levantamento das publicações foi realizado entre os meses de julho a dezembro de 2021, a partir das bases de dados Literatura Latino-Americana em ciências da saúde (Lilacs), Scientific Electronic Library Online (Scielo) e Biblioteca Virtual em Saúde (BVS), utilizando como descritores: Diabetes Mellitus; Insulina; Gerenciamento de Resíduos. Resultados: Identificou-se que a orientação a pessoa com Diabetes Mellitus quanto ao descarte correto de agulhas, seringas, lancetas, fitas reagentes, entre outros é deficiente e que a falta de legislação brasileira específica para resíduos de saúde produzidos em residências é o principal problema para o gerenciamento inadequado dos resíduos de serviços de saúde. A partir dos achados foi possível desenvolver uma tecnologia para educação a pessoas em uso de insulina. Conclusão: Há necessidade de investir em ações de orientação e prevenção, para reforçar aos usuários os cuidados no descarte dos resíduos de serviços de saúde. A capacitação dos profissionais da saúde possibilita o repasse de orientações adequadas e consistentes aos usuários, visando a proteção de quem produz os resíduos, dos coletores e do meio ambiente. (AU)

Objective: To analyze the forms of correct disposal of domestic waste from insulin therapy and develop a technology for patient education (booklet). Methods: Descriptive and exploratory study, integrative review type. The survey of publications was conducted between July and December 2021, from the Latin American Literature in Health Sciences (Lilacs), Scientific Electronic Library Online (Scielo) and Virtual Health Library (VHL) databases, using the following descriptors: Diabetes Mellitus; Insulin; Waste Management. Results: It was identified that the guidance to people with Diabetes Mellitus regarding the correct disposal of needles, syringes, lancets, reagent strips, among others is deficient and that the lack of specific Brazilian legislation for health care waste produced in households is the main problem for the inadequate management of health care waste. From the findings it was possible to develop a technology for education of people using insulin. Conclusion: There is a need to invest in guidance and prevention actions, to reinforce to users the care in the disposal of health services waste. The training of health professionals enables the transfer of appropriate and consistent guidance to users, aiming to protect those who produce waste, the collectors and the environment. (AU)

Objetivo: Analizar las formas de eliminación correcta de los desechos domésticos resultantes de la terapia con insulina y desarrollar una tecnología para la educación del paciente (cuaderno). Métodos: Estudio descriptivo y exploratorio, del tipo revisión integradora. El relevamiento de publicaciones se realizó entre julio y diciembre de 2021, a partir de las bases de datos Literatura Latinoamericana en Ciencias de la Salud (Lilacs), Biblioteca Científica Electrónica en Línea (Scielo) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Diabetes Mellitus; Insulina; Gestión de residuos. Resultados: Se identificó que la orientación a las personas con Diabetes Mellitus sobre el correcto desecho de agujas, jeringas, lancetas, tiras reactivas, entre otros, es deficiente y que la falta de legislación brasileña específica para los desechos sanitarios producidos en los domicilios es el principal problema por la gestión inadecuada de los residuos sanitarios. Con base en los hallazgos, fue posible desarrollar una tecnología para educar a las personas que usan insulina. Conclusión: Existe la necesidad de invertir en acciones de orientación y prevención, para reforzar la atención de los usuarios en la eliminación de los residuos de los servicios de salud. La formación de los profesionales de la salud permite transmitir orientaciones adecuadas y coherentes a los usuarios, con el objetivo de proteger a los productores de residuos, a los recolectores y al medio ambiente. (AU)

Efeito da consulta de enfermagem na promoção de práticas seguras em insulinoterapia: estudo retrospectivo / The effect of nursing consultation on the promotion of safe practices in insulin therapy: a retrospective study

OBJETIVO: Analisar a correlação entre a consulta de enfermagem e o cumprimento de ações de autocuidado e práticas seguras em insulinoterapia por pessoas com diabetes. MÉTODO: Estudo observacional, retrospectivo e analítico. Analisaram-se características sociodemográficas e clínicas e acertos em questionário com 16 itens sobre práticas seguras em insulinoterapia, aplicado na primeira e segunda consulta de enfermagem. RESULTADOS: Constatou-se aumento significativo de acertos no questionário nos aspectos relacionados à insulinoterapia na segunda consulta (14,22±1,59), em comparação com a primeira (9,24±3,13) (p<0,001), sugerindo melhoria do autocuidado e da adesão às práticas seguras em insulinoterapia. CONCLUSÃO: Houve melhora do cumprimento de ações de autocuidado e práticas seguras em insulinoterapia, após as consultas de enfermagem, mostrando que essa intervenção é eficaz para promoção do tratamento insulínico adequado.

OBJECTIVE: To analyze the correlation between nursing consultation and the execution of self-care actions and safe practices in insulin therapy by people with diabetes. METHOD: Observational, retrospective, and analytical study. Sociodemographic and clinical characteristics and correct answers in a questionnaire with 16 items on safe practices in insulin therapy, applied in the first and second nursing consultations, were analyzed. RESULTS: There was a significant increase in the number of correct answers in the questionnaire regarding aspects related to insulin therapy in the second consultation (14.22±1.59) compared to the first (9.24±3.13) (p<0.001), suggesting improvement in self-care and adherence to safe practices in insulin therapy. CONCLUSION: There was an improvement in the execution of self-care actions and safe practices in insulin therapy after the nursing consultations, showing that this intervention effectively promotes adequate insulin treatment.

Efectos a corto plazo del tratamiento con insulina, sobre los índices hematimétricos en diabéticos / Short-term effects of insulin treatment on hematimetricindices in diabetic subjects

Evaluar el efecto a corto plazo del tratamiento con insulina, sobre los índices hematimétricos en sujetos adultos diabéticos tipo 2. Metodología: Estudio retrospectivo, donde se registraron los índices hematimétricos y la glicemia de 44 pacientes hospitalizados (24 masculinos),de 58,7 ± 4,4 años de edad, diabéticos tipo 2, antes y después de 6 ± 2 horas del tratamiento con insulina. Resultados: No se encontraron diferencias estadísticamente significativas entre los índices hematimétricos antes y después del tratamiento y tampoco entre los sexos. La glicemia basal se correlacionó con el contaje de glóbulos rojos (r = 0,417; p = 0,03), el volumen corpuscular medio (r = 0,424; p= 0,04), la hemoglobina (r =0,626; p = 0,001), el hematocrito (r = 0,574; p = 0,005) y la hemoglobina corpuscular media (r = 0,537; p = 0,01). Al dividir a la muestra en dos grupos (G1 y G2), tomando en cuenta el valor de la mediana de la diferencia de la glicemia antes y después del tratamiento (G1:<139 mg/dL y G2 ≥ 139 mg/dL), se encontró diferencia estadísticamente significativa en el volumen corpuscular medio del G2 antes y después del tratamiento; en la hemoglobina entre G1 y G2, tanto antes como después del tratamiento y en el volumen corpuscular medio entre G1 y G2,después del tratamiento (p < 0,05). Conclusión: La insulina pareciera provocar a corto plazo, un aumento del volumen corpuscular medio en sujetos que disminuyen significativamente su glicemia(AU)

To evaluate the short-term effect of insulintreatment on hematimetric indices in type 2 diabetic adultsubjects. Methodology: It was a retrospective study, wherehematimetric indices and glycemia of 44 hospitalized patients(24 male), 58.7 ± 4.4 years old, type 2 diabetics, were recordedbefore and ather 6 ± 2 hours of insulin treatment. Results:no statistically significant differences were found between thehematimetric indices before and aer treatment and neitherbetween the sexes. Basal glycemia correlated with red blood cellcount (r = 0,417; . = 0,03), mean corpuscular volume (r =0,424; . = 0,04), hemoglobin (r = 0,626; . = 0,001), hematocrit(r = 0,574; . = 0,005), and mean corpuscular hemoglobin(r=0,537; .=0,01). When dividing the sample into two groups,taking into account the median value of the difference inglycemia before and aer treatment (G1: < 139 mg/dL and G2 ≥ 139 mg/dL), a statistically significant difference was found inthe mean corpuscular volume of G2 before and after treatment;in hemoglobin between G1 and G2, both before and aertreatment and in mean corpuscular volume between G1 and G2,after treatment (. <0.05). Conclusion: Insulin seems to cause,in the short term, an increase in mean corpuscular volume insubjects who significantly lower their glycemia(AU)

Hipertrofia y resistencia a la insulina en un modelo in vitro de obesidad y DMT2 inducida por alta glucosa e insulina / Hypertrophy and insulin resistance in an in vitro model of obesity and T2DM induced by high glucose and insulin

Resumen Introducción: La obesidad es considerada un factor de riesgo para desarrollar resistencia a la insulina. La expansión del tejido adiposo se ha relacionado con el aumento de la producción de citoquinas proinflamatorias que, junto a los ácidos grasos son responsables, al menos en parte, del desarrollo de la resistencia a la insulina y esta a su vez, facilita el desarrollo de diabetes mellitus tipo 2 (DMT2). Objetivo: El propósito de este estudio fue realizar y caracterizar un modelo in vitro de obesidad empleando concentraciones altas de glucosa e insulina en una línea de células adipocitarias. Métodos: Se indujo modelo de hipertrofia celular realizando un estímulo en adipocitos maduros con una concentración de glucosa (450 mg/dL) e insulina (106 pmol/L) (modelo HGHI). Tras estímulo se realizaron ensayos de viabilidad celular, diámetro celular, movilización de lípidos y marcadores de señalización de insulina. Resultados: Tras el tratamiento con HGHI, se evidencia hipertrofia adipocitaria, incremento en la acumulación de lípidos, reducción de la ruptura de éstos, alteración de la señalización de insulina y tendencia a modificación de proteínas de marcadores de estrés de retículo y estrés oxidativo. Conclusión: Estos resultados demuestran la validez del modelo in vitro que simula al menos en parte la obesidad asociada a insulino resistencia, siendo una herramienta útil para estudiar los mecanismos de susceptibilidad a obesidad y resistencia a la insulina inducida in vitro con diferentes moléculas.

Abstract Introduction: Obesity is considered a risk factor for developing insulin resistance. The increase in adipose tissue has been related to the increase in the production of pro-inflammatory cytokines, which together with fatty acids are responsible, at least in part, for the development of insulin resistance, and this in turn facilitates the development of T2 diabetes mellitus type 2 (DMT2). Objective: The purpose of this study was to perform and characterize an in vitro model of obesity using high concentrations of glucose and insulin on an adipocyte cell line. Methods: A cell hypertrophy model was induced by stimulating mature adipocytes with a concentration of glucose (450 mg/dL) and insulin (106 pmol/L) (HGHI model). The cell viability, cell diameter, lipid mobilization and insulin signalling markers were evaluated. Results: After HGHI treatment, adipocytes show hypertrophy, increase in lipid accumulation, reduction of lipid breakdown, alteration of insulin signalling, a tendency to modify proteins of reticulum stress markers and, oxidative stress. Conclusion: These results demonstrate a new in vitro model that simulates, at least in part, obesity associated with insulin resistance being a useful tool to study the mechanisms of susceptibility to obesity and insulin resistance induced in vitro by different molecules.

Diabetes Mellitus gestacional: perfil epidemiológico de maternidade de alto risco / Gestational Diabetes Mellitus: epidemiological profile of high- risk maternity / Diabetes Mellitus gestacional: perfil epidemiológico de una maternidad de alto riesgo

O Diabetes Mellitus Gestacional é definido como doença que se caracteriza pelos altos níveis de glicemia sanguínea, diagnosticada durante a gestação. Este adoecimento pode acarretar várias complicações maternas e fetais, muitas vezes, necessitando de internamento precoce e cuidados avançados. Objetivou-se caracterizar o perfil epidemiológico de gestantes com diabetes mellitus gestacionais atendidas em serviço de referência. Trata-se de estudo descritivo, documental, retrospectivo, de caráter quantitativo, realizado com gestantes atendidas na maternidade do Hospital Regional do Sudoeste ­ PR, Francisco Beltrão. A amostra foi constituída por 216 gestantes, cujos dados foram coletados dos prontuários das pacientes. Incluíram-se as gestantes atendidas e diagnosticadas com diabetes mellitus gestacional no período de 2020 e com pelo menos um exame de glicose em jejum ou um teste de tolerância oral à glicose para comprovação diagnóstica. Foram exclusas as gestantes dos anos de 2019 e 2021 e oito transferências. A amostra teve maior porcentual do Diabetes mellitus gestacional (90,7%), com prevalência na raça branca (69,9%), faixa etária de 15- 35 anos (68,5%). Ademais,65,7% realizaram controle com dieta e 32,4 % necessitaram realizar o uso de insulina e 51,9%delas eram obesas. A presente pesquisateve considerável relevância, pois permitiu obter perfil epidemiológico de gestantes diagnosticadas com diabetes mellitus, trazendo benefícios, como identificação precocemente da doença, de modo a evitar complicações para gestantes e bebês. PALAVRAS-CHAVE: Gestacional; Diabetes; Prevalência; Maternidade.

Gestational Diabetes Mellitus is defined as a disease characterized by high levels of blood glucose, which is diagnosed for the first time during pregnancy. It can cause several maternal and fetal complications, often requiring early hospitalization and advanced care. The aim of thestudy was to characterize the epidemiological profile of pregnant women with gestational diabetes mellitus seen at a reference service. This is a descriptive, documentary, retrospective, quantitative study, carried out with pregnant women attended at the maternity hospital of the Hospital Regional do Sudoeste - PR in the city of Francisco Beltrão. The sample consisted of216 pregnant women, and data were collected from the patients' medical records. The study included all pregnant women who were attended and diagnosed with GDM in the period described, and who had at least one fasting glucose test or an oral glucose tolerance test for diagnostic confirmation. All pregnant women from the year 2019 and 2021 were excluded fromthe study. The sample had a higher percentage of GDM 90.7% according to race 69.9% werewhite, aged 15-35 years 68 , 5%, while 65.7% performed control with diet and 32.4% neededto use insulin and 51.9% of them were obese. This research had great results because it had an epidemiological profile of pregnant women diagnosed with Diabetes Mellitus, bringing benefitsand thus being able to identify gestational Diabetes mellitus early, aiming to avoid complications for the pregnant woman and the baby.

La diabetes mellitus gestacional se define como una enfermedad caracterizada por niveles elevados de glucosa en sangre, diagnosticada durante el embarazo. Esta enfermedad puede dar lugar a varias complicaciones maternas y fetales, que a menudo requieren una hospitalización temprana y cuidados avanzados. El objetivo es caracterizar el perfil epidemiológico de las gestantes con diabetes mellitus atendidas en el servicio de referencia. Se trata de un estudio descriptivo, documental, retrospectivo, de carácter cuantitativo, realizado con gestantes atendidas en la maternidad del Hospital Regional del Sudoeste - PR, Francisco Beltrão. La muestra estaba formada por 216 mujeres embarazadas, cuyos datos se recogieron de las historias clínicas de las pacientes. Se incluyeron las mujeres embarazadas atendidas y diagnosticadas de diabetes mellitus gestacional en el periodo 2020 y con al menos una prueba de glucosa en ayunas o una prueba de tolerancia oral a la glucosa para su diagnóstico. Se excluyeron las embarazadas de los años 2019 y 2021 y ocho traslados. La muestra tuvo un mayor porcentaje de Diabetes mellitus gestacional (90,7%), con prevalencia en la raza blanca (69,9%), grupo de edad 15-35 años (68,5%). Además, el 65,7% se controlaba con la dieta y el 32,4% necesitaba utilizar insulina y el 51,9% era obeso. La presente investigación tiene una relevancia considerable, ya que permite obtener el perfil epidemiológico de las gestantes diagnosticadas con diabetes mellitus, lo que conlleva beneficios, como la identificación precoz de la enfermedad, a fin de evitar complicaciones para las gestantes y los bebés.

Recomendaciones para la práctica clínica sobre el manejo de la actividad física, ejercicio y deporte en niños, niñas y adolescentes con diabetes mellitus tipo 1 / Management of type 1 diabetes mellitus about physical activity, exercise and sports in children and adolescents

La presente recomendación busca brindar un marco de seguridad para la prescripción de actividad física en niños, niñas y adolescentes con diabetes mellitus tipo 1 (DM1), considerando la evaluación de las situaciones que puedan presentarse antes, durante y después de su práctica. Incluye las estrategias terapéuticas sobre el tipo de ejercicio, el control glucémico capilar (o mediante el uso de monitoreo continuo de glucosa, MCG) y la adecuación de la insulinoterapia y de la ingesta de hidratos de carbono. Se prioriza que, para optimizar los beneficios del ejercicio como parte del tratamiento de la DM1, es importante una completa y constante educación diabetológica para el paciente y sus cuidadores brindada por un equipo interdisciplinario entrenado en el manejo integral de niños, niñas y adolescentes con DM1.

These recommendations seek to provide a safety framework for the prescription of physical activity in children and adolescents with DM1, considering the evaluation of the situations that may arise before, during and after the practice of physical activity. It includes therapeutic strategies on the type of exercise, intensive capillary glycemic control or through the use of continuous glucose monitoring (CGM) and the adequacy of insulin therapy and carbohydrate intake. It is prioritized that to optimize the benefits of exercise as part of the treatment of DM1, a complete and constant diabetes education is important, provided by an interdisciplinary team trained in the comprehensive management of children and adolescents with DM1

Autoaplicação de insulina em adultos com diabetes mellitus no contexto domiciliar: revisão integrativa / Insulin self-application in adults with diabetes mellitus in the home context: integr ative review / Autouso de insulina en adultos con diabetes mellitus en el contexto domiciliario: revisión integrativa

Objetivo: sintetizar a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar Método: revisão integrativa realizada entre dezembro de 2019 e janeiro de 2020, a partir da busca de publicações em periódicos indexados no PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS e BDENF utilizando-se os termos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal e self administration e seus correspondentes em português, combinados com o operador booleano AND. Foram incluídos artigos originais publicados entre 2009 e 2019, nos idiomas inglês, português e espanhol e que responderam à questão norteadora: qual a produção científica sobre a técnica da autoaplicação de insulina em adultos com diabetes Mellitus no contexto domiciliar nos últimos 10 anos? Resultados: compuseram a amostra final oito artigos. Predominaram estudos realizados no Brasil, por enfermeiros no contexto da atenção primária à saúde. Em relação à técnica de autoaplicação de insulina, os resultados foram agrupados em quatro eixos: pré-aplicação, técnica de preparo da insulina, aplicação e pós-aplicação. Observaram-se ações inadequadas em todos os eixos tais como: transporte, armazenamento, autoaplicação, reutilização de agulhas e descarte incorreto. Tais inadequações podem resultar em procedimentos dolorosos, prejuízos no controle glicêmico e complicações para a saúde da pessoa com diabetes Mellitus. Conclusão: os resultados evidenciaram que a realidade da autoaplicação de insulina em adultos com diabetes Mellitus no domicílio pode ser modificada a partir da educação em saúde pelo enfermeiro, bem como colaborar para o planejamento das ações estratégicas para diminuir tais problemas.(AU)

Objective: to synthesize the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context. Method: integrative review carried out between December 2019 and January 2020, based on the search for publications in journals indexed in PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS and BDENF using the controlled terms diabetes Mellitus, self-care, insulin, health education, disposable equipment, medical waste disposal and self-administration and their corresponding words in Portuguese, combined with the Boolean operator AND. Original articles published between 2009 and 2019, in English, Portuguese and Spanish, were included, which answered the guiding question: what is the scientific production on the technique of self-administration of insulin in adults with diabetes Mellitus in the home context in the last 10 years? Results: the final sample comprised eight articles. Studies carried out in Brazil by nurses in the context of primary health care predominated. Regarding the insulin self-administration technique, the results were grouped into four axes: pre-administration, insulin preparation technique, administration, and post-administration. Inadequate actions were observed in all axes such as: transport, storage, self-application, reuse of needles and incorrect disposal. Such inadequacies can result in painful procedures, impaired glycemic control, and health complications for the person with diabetes Mellitus. Conclusion: the results showed that the reality of self-administration of insulin in adults with diabetes Mellitus at home can be modified based on health education by nurses, as well as collaborating in the planning of strategic actions to reduce such problems.(AU)

Objetivo: sintetizar la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario. Método: revisión integradora realizada entre diciembre de 2019 y enero de 2020, a partir de la búsqueda de publicaciones en revistas indexadas en PubMed, CINAHL, EMBASE, SCOPUS, Web of Science, LILACS y BDENF utilizando los términos controlados diabetes Mellitus, self care, insulin, health education, disposable equipment, medical wastedisposal y self administration y sus equivalentes en portugués, combinados con el operador booleano AND. Se incluyeron artículos originales publicados entre 2009 y 2019, en inglés, portugués y español, que respondieron a la pregunta orientadora: ¿cuál es la producción científica sobre la técnica de autoadministración de insulina en adultos con diabetes Mellitus en el contexto domiciliario en los últimos 10 años? Resultados: la muestra final estuvo formada por ocho artículos. Predominaron los estudios realizados en Brasil por enfermeros en el contexto de la atención primaria de salud. En cuanto a la técnica de auto aplicación de insulina, los resultados se agruparon en cuatro ejes: antes de la aplicación, técnica de preparación de insulina, aplicación y post aplicación. Se observaron acciones inadecuadas en todos los ejes, tales como: transporte, almacenamiento, auto aplicación, reutilización de agujas y disposición incorrecta. Tales deficiencias pueden resultar en procedimientos dolorosos, deterioro del control glucémico y complicaciones de salud para las personas con diabetes Mellitus. Conclusión: los resultados mostraron que la realidad de la insulina autoadministrada en adultos con diabetes Mellitus en el hogar puede modificarse a partir de la educación en salud brindada por enfermeros, además de ayudar a planificar acciones estratégicas para reducir dichos problemas.(AU)

Fundamentos que caracteriza la adherencia a la insulinoterapia de los pacientes con diabetes tipo II / Foundations that characterize adherence to the insulin therapy of patients with type II diabetes

La diabetes Mellitus es un padecimiento que empieza cuando el páncreas no realiza un uso adecuado de la insulina que produce o no puede lograr producir insulina. Se descomponen en glucosa en la sangre todos los alimentos ricos en hidratos de carbono; la insulina da ayuda a la glucosa para que esta pueda ingresar en las células. Los niveles de azúcar en la sangre al no funcionar bien el páncreas suben, lo cual debe ser controlado por medio de un tratamiento médico de por vida, y lo más importante la persona debe cambiar de hábitos en su salud. Objetivo: El objetivo principal de esta investigación es definir el efecto que produce la adherencia a la insulinoterapia en los pacientes con diabetes tipo II del Hospital del Día Mariana de Jesús. Materiales y Métodos: Se utilizó una investigación cuantitativa, transversal ya que se realizó una encuesta a los pacientes, la cual se procedió a la recolección y análisis e interpretación de datos. La muestra trabajada fue de 100 pacientes, los cuales fueron atendidos en el Hospital por concepto de diabetes tipo II en el área de emergencia. Resultados: Como resultado de la investigación tenemos que el 76% de los encuestados conocen sobre el tratamiento de la insulinoterapia, el 85% se rehusó a utilizar insulina cuando inició su tratamiento, el 75% ha tenido dificultad para la conservación de la insulina, el 63% considera que el uso de la insulina es riesgos, el 53% indicó haber recibido asesoría sobre los posibles efectos de la insulina, al 65% de encuestados su jornada laboral no le permite asistir a su control médico, el 72% ha sentido un desmejoro en su salud al dejar el tratamiento y el 63% de los encuestados indicó que ha abandonado en algún momento su tratamiento por temor a los efectos secundarios que dicen tener. Conclusiones: Se estableció el tipo de complicaciones que se dan en los pacientes ante la no adherencia a la insulinoterapia, uno de ellos fue, que al dejar el tratamiento los pacientes sintieron un desmejoro en su estado de salud, así también, los pacientes han abandonado el tratamiento en algún momento por miedo a los efectos secundarios que dicen tener la insulina(AU)

Diabetes Mellitus is a condition that begins when the pancreas does not make proper use of the insulin it produces or cannot achieve produce insulin. All foods rich in glucose are broken down into glucose in the blood. carbohydrates; insulin helps glucose to enter the cells cells. When the pancreas does not work well, blood sugar levels rise, which must be controlled by lifelong medical treatment, and most importantly the person must change their health habits. Objective: The main objective of this research is to define the effect produced by adherence to insulin therapy in patients with type II diabetes at Hospital del Día Mariana de Jesús. Materials and Methods: A quantitative, cross-sectional investigation was used since a patient survey which proceeded to the collection and analysis and interpretation of data. The sample worked was 100 patients who were treated at the Hospital for type II diabetes concept in the emergency area. Results: Like result of the investigation we have that 76% of the respondents know about the insulin therapy treatment, 85% refused to use insulin when they started their treatment, 75% have had difficulty conserving insulin, 63% considers that the use of insulin is risky, 53% indicated having received counseling about the possible effects of insulin, 65% of those surveyed did not care about their working hours. allows them to attend their medical control, 72% have felt a deterioration in their health when leaving the treatment and 63% of those surveyed indicated that they had abandoned their treatment at some point. treatment for fear of the side effects they claim to have. Conclusions: If established the type of complications that occur in patients due to non-adherence to insulin therapy, one of them was that when leaving the treatment the patients felt a deterioration in their state of health, as well as the patients have abandoned the treatment at some point for fear of the side effects that they claim to have insulin(AU)

Elevated levels of interleukin-18 are associated with several indices of general and visceral adiposity and insulin resistance in women with polycystic ovary syndrome

ABSTRACT Objective: Our aim was to analyze levels of proinflammatory biomarker interleukin-18 (IL-18) in healthy controls and patients with polycystic ovary syndrome (PCOS) focusing on its association with obesity, clinical, hormonal, and metabolic characteristics. Subjects and methods: Fifty-eight patients with PCOS were enrolled in the study fulfilling the Rotterdam criteria and were matched for age, body mass index (BMI), and ethnicity with 30 healthy controls. Detailed anthropometric measurements, clinical investigations, hormonal and biochemical tests were obtained between the 3rd and 5th day of a menstrual cycle. A subanalysis of the PCOS group was performed separating patients into several groups according to a waist-to-height ratio (WHtR), insulin resistance (IR), and free androgen index (FAI). Serum IL-18 levels were measured using the ELISA method. Results: Levels of IL-18 were similar between PCOS patients and controls. IL-18 was higher in overweight/obese women compared to normal-weight women when analyzing all participants together and separately PCOS or controls group (p < 0.001, p < 0.001, p = 0.01, respectively). Additionally, IL-18 levels were higher in high-WHtR and IR subgroups compared to low-WHtR (p < 0.001) and non-IR PCOS women (p < 0.001). PCOS women with high FAI had greater serum IL-18 levels than normal-FAI patients (p = 0.002). Levels of IL-18 correlated positively with most of the anthropometric and metabolic parameters. In multiple linear regression, age, waist circumference, and fasting insulin were independently related factors with IL-18. Conclusion: Elevated levels of IL-18 were related to several indices of general and visceral adiposity and insulin resistance in PCOS.

Fasting levels of appetite regulating hormones predict caloric intake at breakfast in a group of Chilean adolescents / Los niveles en ayunas de hormonas reguladoras del apetito predicen la ingesta energética en el desayuno en adolescentes

BACKGROUND: Appetite regulation is integral to food intake and is modulated by complex interactions between internal and external stimuli. Hormonal mechanisms which stimulate or inhibit intake have been characterized, but the physiologic effects of serum levels of such hormones in short-term appetite regulation have received little attention. AIM: To evaluate whether fasting levels of orexigenic/anorexigenic hormones were associated with energy intake at breakfast, served soon after drawing a fasting blood sample, in a group of adolescents. MATERIAL AND METHODS: Anthropometry, body composition and fasting blood levels of leptin, insulin, ghrelin, and orexin-A were measured in 655 Chilean adolescents aged 16.8 ± 0.3 years (52% males). Energy intake was measured at a semi-standardized breakfast. Associations between hormone levels and energy intake were studied using multivariate linear models. RESULTS: Thirty nine percent of participants were overweight/ obese. After an overnight fast, median values for leptin, insulin, ghrelin and orexin-A were 7.3 ng/mL, 6.7 IU/dL, 200.8 pg/mL, and 16.1 pg/mL, respectively. Participants ate on average 637 ± 239 calories at breakfast. In multivariable models, insulin levels were inversely and independently associated with caloric intake at breakfast (β = −18.65; p < 0.05), whereas leptin, ghrelin and orexin-A levels were positively and independently associated with intake: β= 5.56, β = 0.34 and β = 8.40, respectively, p < 0.05. CONCLUSIONS: Fasting leptin, ghrelin and orexin-A were positively associated with energy intake during breakfast provided soon after the blood draw. Insulin was negatively associated with energy intake. Modifiable factors influencing levels of appetite regulating hormones could be a potential target for influencing food intake.

ANTECEDENTES: La regulación del apetito es parte integral de la ingesta alimentaria y es modulada por complejas interacciones entre estímulos internos y externos. Se han caracterizado los mecanismos hormonales que estimulan o inhiben la ingesta, pero los efectos fisiológicos de los niveles séricos de tales hormonas en la regulación del apetito a corto plazo han recibido poca atención. OBJETIVO: Evaluar si los niveles en ayunas de hormonas orexigénicas/ anorexigénicas se asocian con la ingesta energética en el desayuno, entregado inmediatamente después de una muestra de sangre en ayunas, en un grupo de adolescentes. MATERIAL Y MÉTODO: Se efectuaron mediciones antropométricas, composición corporal y medición de niveles en ayunas de leptina, insulina, grelina y orexina-A en 655 adolescentes de 16,8 ± 0,26 años. La ingesta energética se midió en un desayuno semiestandarizado. Se estudiaron las asociaciones entre los niveles hormonales y la ingesta energética mediante modelos lineales multivariados. RESULTADOS: Los valores de leptina, insulina, grelina y orexina-A fueron 7,3 ng/mL, 6,7 UI/dL, 200,8 pg/mL y 16,1 pg/mL respectivamente. Los participantes comieron un promedio de 637 ± 239 calorías en el desayuno. Los niveles de insulina se asociaron inversa e independientemente con la ingesta del desayuno (β = −18,65; p < 0,05), mientras que los niveles de leptina, grelina y orexina-A se asociaron positiva e independientemente con la ingesta: β = 5,65; β = 0,34; β = 8,40, (p < 0,05). CONCLUSIONES: La leptina, grelina y orexina-A en ayunas se asociaron positivamente con la ingesta de energía durante el desayuno proporcionado poco después de la muestra de sangre. La insulina se asoció negativamente con la ingesta de energía. Los factores modificables que influyen en las hormonas reguladoras del apetito podrían ser un objetivo potencial para influir en la ingesta de alimentos.

Effect of Prosopis ruscifolia on incretin and insulin secretion in alloxan-induced hyperglycemic rats / Efecto de Prosopis ruscifolia sobre la secreción de incretina e insulina de ratas hiperglicémicas por aloxano

Background: Diabetes mellitus treatment is based on oral hypoglycemic agents or insulin. Medicinal plants constitute an option, and the leaves of Prosopis ruscifolia (Pr) were shown to be effective in reducing glycemia in hyperglycemic animals. Objective: In this paper, we report the effect of P. rusciofolia (Pr) on insulin and incretin secretion in alloxan-induced hyperglycemic rats. Methodology: The effective dose was selected, and four groups (n=10) of Wistar rats were used. Two groups with normal glycemia received water or Pr (75 mg/Kg, per os, p.o.), and two groups with hyperglycemia induced by alloxan (intraperitoneal, ip), received water or Pr (75 mg/Kg, p.o.) for 2 weeks. Oral glucose tolerance test, and incretin and insulin levels were measured at the end of the experimental period. Results: The results showed that extract promotes better tolerance to oral glucose overload, in addition to a statistically significant (p<0.001) increase in blood levels of incretin and insulin, compared to the hyperglycemic rats. Conclusion: It is concluded that the ethanolic extract of P. ruscifolialeaves has a hypoglycemic effect in hyperglycemic animals by a mechanism that involves the incretin-insulin system

Antecedentes: la diabetes mellitus es una enfermedad metabólica cuyo tratamiento se basa en el uso de agentes hipoglicemiantes orales o insulina. Una opción al tratamiento son las plantas medicinales y en ese sentido, estudios previos en animales con hojas de Prosopis ruscifolia (Pr) han demostrado efecto hipoglicemiante. Objetivo: en este trabajo se reporta el efecto de P. rusciofolia (Pr) en la secreción de insulina e incretina, en ratas hiperglicémicas por aloxano. Metodología: se emplearon cuatro grupos de ratas Wistar (n=10). Dos grupos con glicemia normal que fueron tratadas con agua Pr (75 mg/Kg, per os, p.o.) y dos grupos con hiperglicemia inducida por la inyección intraperitoneal de aloxano recibieron agua Pr (75 mg/Kg, per os, p.o.) durante dos semanas. Se midieron la tolerancia oral a la glucosa, y los niveles de incretina e insulina al final del periodo de experimentación. Resultados: se encontró que el extracto promueve una mayor tolerancia a la sobrecarga de glucosa, y además un incremento significativo (p<0.001) de los niveles de incretina e insulina en sangre, comparados al grupo de ratas hiperglicémicas. Conclusión: se concluye que e l estracto etanólico de las hojas de P. ruscifolia tienen efecto hipoglicemiante en animales hiperglicémicos por un mecanismo que incluye al sistema incretina-insulina

Recurrent hypoglycemic coma and diabetic ketoacidosis caused by insulin antibody: a rare case of type 1 diabetes mellitus / Hipoglicemia hiperinsulinémica causada por anticuerpos antiinsulina: informe de un caso

ABSTRACT Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal: 300 mU/L and < 0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.

Los anticuerpos contra la insulina (AI) inducidos por la insulina exógena raramente causan hipoglucemia. No obstante, los autoanticuerpos contra la insulina (AIA) en el síndrome autoinmune de insulina (SAI) pueden causar hipoglucemia. Las manifestaciones típicas del SAI son la hipoglucemia en ayunas o posprandial, niveles elevados de insulina, la disminución del nivel de péptido C y AIA positivos. Presentamos un paciente hombre de 45 años con diabetes mellitus de tipo 1 (DMT1) tratado con análogos de insulina, que sufría comas hipoglucémicos recurrentes y cetoacidosis diabética (CAD). Sus síntomas fueron causados por la insulina exógena y fueron similares al SAI. La posible razón fue que la insulina exógena indujo AI. El título de AI era del 61,95% (Normal: 300 mU/L y < 0,02 nmol/L cuando se producía la hipoglucemia. Basados en sus síntomas clínicos y otros exámenes, se le diagnosticó hipoglucemia hiperinsulinémica causada por la AI. Sus síntomas mejoraron después de cambiar el régimen de insulina de lispro más insulina detemir a insulina humana recombinante (Gensulin R) y de empezar a tomar prednisona.

Risk factors for inpatient Hypoglycemia in a tertiary care hospital in Indonesia / Journal of the ASEAN Federation of Endocrine Societies

Introduction@#Hypoglycemia is an important and harmful complication that often occurs in inpatient and outpatient settings. This study aims to assess the incidence of inpatient hypoglycemia and its related factors. We also assessed mortality and length of hospital stay.@*Methodology@#We performed a retrospective cohort study among patients with type 2 diabetes mellitus admitted to a tertiary hospital in Indonesia. Using multivariate regression, we analyzed age, sex, body mass index, comorbidities, history of hypoglycemia, hyperglycemia treatment administered, nutritional intake, and medical instruction as the related risk factors for inpatient hypoglycemia.@*Results@#From 475 subjects, 80 (16.8%) had inpatient hypoglycemia, of which, 7.4% experienced severe hypoglycemia. We found that patients with a history of hypoglycemia (RR: 4.6; 95% CI: 2.8-7.6), insulin and/or sulfonylurea treatment (RR 6.4; 95% CI: 1.6-26.5), and inadequate nutritional intake (RR 2.6; 95% CI: 1.5-4.3) were more likely to have hypoglycemic events compared to those who did not. The length of hospital stay for patients in the hypoglycemic group is significantly longer than those in the non-hypoglycemic group (13 vs 7 days, p<0.001), but their mortality rates did not differ (16% vs 10.9%, p=0.18).@*Conclusion@#Inpatient hypoglycemia may be affected by a history of hypoglycemia and inadequate nutritional intake. Patients who had inpatient hypoglycemia tend to have a longer median length of hospital stay.

The role of first trimester HbA1c as a rredictor of Gestational Diabetes Mellitus and adverse maternal and perinatal outcomes among non-diabetic pregnant Filipino women

Objectives@#This study aims to determine the role of HbA1c level during first trimester in predicting gestational diabetes mellitus in Filipino non-diabetic women. Hence, to identify those will be at increased risk of its adverse maternal and perinatal outcomes, and who will benefit from early intervention. This will aid in preventing maternal and perinatal morbidity and mortality and reducing health care cost by avoiding strategies which can result in false positive cases.@*Methodology@#A cross-sectional study conducted in a tertiary hospital in the Philippines. Seventy-one Filipino pregnant women were included in the final analysis. HbA1c levels were taken during the first trimester and routine screening of gestational diabetes mellitus (GDM) utilizing 75 grams OGTT during 24th-28th weeks age of gestation. Binary logistic regression modeling was performed to determine if HbA1c was a predictor of gestational diabetes mellitus. The calculated median for Hba1c was then utilized as a threshold value to predict GDM. Odds ratio, relative risk and corresponding 95% confidence intervals from binary logistic regression were computed to determine the association of variables.@*Results@#In this study the prevalence rate of GDM is 38%. It showed that first-trimester HbA1c level is not a predictor of GDM and adverse maternal and perinatal outcomes. However, in utilizing an HbA1c threshold of ≥ 5.2%, there is a two-fold increase risk of developing hypertensive disorders, requiring insulin during pregnancy, and macrosomic newborns and a four-fold increase risk of having large for gestational age newborns. It has a positive predictive value (PPV) of only 16%. However, it has a high negative predictive value (NPV) of 88% therefore it can be used to rule out risk of GDM as early as in the first trimester.@*Conclusion@# The association of HbA1c level and the occurrence of GDM was not observed in this study. However, by using an HbA1c threshold of ≥ 5.2%, as opposed to the standard reference range for diagnosing type 2 diabetes mellitus and gestational diabetes mellitus in Caucasians, the relative risk of developing GDM in 24th-28th weeks AOG is 1.26 (0.6865, 2.3242).

CD36 gene deletion reduces muscle insulin sensitivity in mice by up-regulating PTP1B expression / 南方医科大学学报

OBJECTIVE@#To investigate the effect CD36 deficiency on muscle insulin signaling in mice fed a normal-fat diet and explore the possible mechanism.@*METHODS@#Wild-type (WT) mice and systemic CD36 knockout (CD36-/-) mice with normal feeding for 14 weeks (n=12) were subjected to insulin tolerance test (ITT) after intraperitoneal injection with insulin (1 U/kg). Real-time PCR was used to detect the mRNA expressions of insulin receptor (IR), insulin receptor substrate 1/2 (IRS1/2) and protein tyrosine phosphatase 1B (PTP1B), and Western blotting was performed to detect the protein expressions of AKT, IR, IRS1/2 and PTP1B in the muscle tissues of the mice. Tyrosine phosphorylation of IR and IRS1 and histone acetylation of PTP1B promoter in muscle tissues were detected using co-immunoprecipitation (Co-IP) and chromatin immunoprecipitation (ChIP), respectively.@*RESULTS@#CD36-/- mice showed significantly lowered insulin sensitivity with obviously decreased area under the insulin tolerance curve in comparison with the WT mice (P < 0.05). CD36-/- mice also had significantly higher serum insulin concentration and HOMA-IR than WT mice (P < 0.05). Western blotting showed that the p-AKT/AKT ratio in the muscle tissues was significantly decreased in CD36-/- mice as compared with the WT mice (P < 0.01). No significant differences were found in mRNA and protein levels of IR, IRS1 and IRS2 in the muscle tissues between WT and CD36-/- mice (P>0.05). In the muscle tissue of CD36-/- mice, tyrosine phosphorylation levels of IR and IRS1 were significantly decreased (P < 0.05), and the mRNA and protein levels of PTP1B (P < 0.05) and histone acetylation level of PTP1B promoters (P < 0.01) were significantly increased as compared with those in the WT mice. Intraperitoneal injection of claramine, a PTP1B inhibitor, effectively improved the impairment of insulin sensitivity in CD36-/- mice.@*CONCLUSION@#CD36 is essential for maintaining muscle insulin sensitivity under physiological conditions, and CD36 gene deletion in mice causes impaired insulin sensitivity by up-regulating muscle PTP1B expression, which results in detyrosine phosphorylation of IR and IRS1.

Factors related to tissue complications resulting from insulin therapy: a cross-sectional study / Factores relacionados con las complicaciones tisulares derivadas de la terapia con insulina: estudio transversal / Fatores relacionados a complicações teciduais decorrentes da insulinoterapia: estudo transversal

Abstract Objective: To identify factors related to tissue complications resulting from insulin therapy. Method: This is a descriptive, cross-sectional study carried out in a capital of northeastern Brazil. A semi-structured form and an observation guide were applied to assess the performance of insulin preparation and administration techniques. Descriptive statistics, association test, and multivariate logistic regression were used for data analysis. Results: Most participants were female (74.2%), aged between 51 and 70 years (50.0%), and had nine to eleven years of education (36.7%). The presence of some type of local complication in 73.5% of the participants and the failure to rotate the injection sites in 82.3% are highlighted. Being single/widowed and not rotating insulin application sites were related to local complications and increased the chances of their occurrence by 3.51 and 6.70 times, respectively. Conclusion: Marital status and nonrotation of injection site were related to the increased chances of tissue complications resulting from insulin therapy.

RESUMEN Objetivo: Identificar factores relacionados con la aparición de complicaciones tisulares resultantes de la terapia con insulina. Método: Estudio descriptivo, transversal, realizado en la capital del noreste de Brasil. Se aplicó un formulario semiestructurado y un guión de observación para evaluar el desempeño de las técnicas de preparación y administración de insulina. Para el análisis de los datos se utilizó estadística descriptiva, prueba de asociación y regresión logística multivariante. Resultados: La mayoría de los participantes eran mujeres (74,2%), con edades comprendidas entre 51 y 70 años (50,0%) y con nueve a once años de escolaridad (36,7%). Se destaca la presencia de algún tipo de complicación local en el 73,5% de los participantes y mala rotación de los sitios de inyección en el 82,3%. Ser soltero/viudo y no rotar los sitios de aplicación de insulina se relacionaron con complicaciones locales y aumentaron la posibilidade de su ocurrencia en 3,51 y 6,70 veces, respectivamente. Conclusión: Se demostró que el estado civil y la mala rotación de los sitios de aplicación estaban relacionados con el aumento de las posibilidades de complicaciones tisulares como resultado de la terapia con insulina.

RESUMO Objetivo: Identificar os fatores relacionados à ocorrência de complicações teciduais decorrentes da insulinoterapia. Método: Estudo descritivo, transversal, realizado em capital do nordeste brasileiro. Aplicaram-se formulário semiestruturado e roteiro de observação para avaliação do desempenho das técnicas de preparo e administração de insulina. Estatística descritiva, teste de associação e regressão logística multivariada foram utilizadas para análise dos dados. Resultados: A maioria dos participantes era do sexo feminino (74,2%), com idades entre 51 e 70 anos (50,0%), e nove a onze anos de estudo (36,7%). Destaca-se a presença de algum tipo de complicação local em 73,5% dos participantes e a não realização do rodízio dos locais de injeção em 82,3%. Estar solteiro/viúvo e não realizar rodízio dos locais de aplicação da insulina relacionaram-se às complicações locais e aumentaram as chances de ocorrência destas em 3,51 e 6,70 vezes, respectivamente. Conclusão: O estado civil e a não realização de rodízio dos locais de aplicação mostraram-se relacionados ao aumento das chances de complicações teciduais decorrentes da insulinoterapia.

Myricitrin and Its Solid Lipid Nanoparticle Increase Insulin Secretion and Content of Isolated Islets from the Pancreas of Male Mice

Abstract Glucose exposure induces toxic effects on the function of the pancreatic islets. Moreover, myricitrin as a flavonoid glycoside may have favorable effects on insulin secretion of Langerhans islets. The present study aimed to investigate the effect of Myricitrin and its solid lipid nanoparticles (SLN) on the insulin secretion as well as the content of isolated pancreatic islets from male mice. In this experimental study, Langerhans islets were separated from adult male NMRI mice using the collagenase method. The insulin secretion and content of islets were assessed in glucose-containing medium (2.8, 5.6, and 16.7mM). Further, islets treated were prepared by the administration of Myricitrin and its SLN (1, 3 and 10µM). Myricitrin 3µM, and SLN containing Myricitrin 3 and 10µM increased insulin secretion in medium containing glucose concentration 2.8mM. Accordingly, this variable increased in Myricitrin 3 and 10µM, SLN containing Myricitrin 1, 3, and 10µM utilization as well as glucose concentration 5.6mM. Afterward, the insulin secretion increased in medium containing 16.7mM glucose after the addition of Myricitrin and SLN containing Myricitrin 1, 3, and 10µM. Also, the insulin content increased in Myricitrin and SLN containing Myricitrin 1, 3, and 10µM administered groups in all medium containing glucose concentrations. Myricitrin and its SLN increased islets insulin secretion and content in low, moderate, and high glucose concentration mediums