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1.
In. The University of the West Indies, Faculty of Medical Sciences. Faculty of Medical Sciences, Research Day. St. Augustine, Caribbean Medical Journal, March 21, 2019. .
Não convencional em Inglês | MedCarib | ID: biblio-1023945

RESUMO

Introduction: Type 2 diabetes (T2D) is a global public health crisis that threatens the economies of all nations, particularly developing countries. The growing demand for insulin therapy has created an economic burden thus impacting on equality. Objectives: The aim of the study is to determine the impact of the removal of Glargine U100 insulin (GI) due to an economic recession among patients with T2D attending a primary care in North Trinidad. Design and Methodology: A retrospective cohort study was conducted in Chronic Disease Clinics across the Arima Cluster of the North Central Regional Health Authority. All patients who were T2 diabetics on insulin therapy were eligible for entry. Patients were selected using systematic sampling to fulfill a sample size of 250. Demographic and clinical data were extracted from there medical records. Results: The major finding of the study was 75% of patients who started insulin therapy with GI while it was freely available elected to convert to premixed insulin (PMI) 70/30 by 2017. An important finding included a disproportionate number of women (72%) compared to men (28%) who advanced to insulin therapy. Conclusion: We provide evidence on the burden of a subgroup of patients with T2D as well as generating opportunities for debate on the rational allocation of resources.


Assuntos
Humanos , Masculino , Feminino , Saúde Pública , Diabetes Mellitus , Insulina/economia , Trinidad e Tobago , Região do Caribe/etnologia
2.
Primary care diabetes ; 4(3): 187-192, October 2010. graf, tab
Artigo em Inglês | MedCarib | ID: med-17509

RESUMO

AIMS: To determine the relationship between plasma adiponectin levels and obesity, inflammation, blood lipids and insulin resistance in type 2 diabetics (T2DM) and non-diabetics in a patient population in Trinidad. METHODS: A cohort study of a total of 126 type 2 diabetic (42 males and 84 females) and 140 (43 males and 97 females) non-diabetic public clinic attendees were assessed between December 2008 and July 2009. Along with clinical history and anthropometry, adiponectin, TNF-α, IL-6, CRP, lipid profile, glucose, and insulin were measured in fasting blood samples and insulin resistance (HOMA-IR) was calculated. RESULTS: Diabetics had higher (p<0.05) glucose, insulin, HOMA-IR, triglycerides (TG), VLDL and systolic blood pressure than non-diabetics, but lower (p<0.05) HDL and adiponectin levels. Adiponectin levels were lower (p<0.05) in obese than in non-obese individuals regardless of diabetic status. There were significant gender differences in HDL, LDL and TG. Among non-obese persons, adiponectin correlated negatively with triglycerides (r=-0.280; adiponectin), IL-6 (r=-0.216; p<0.005), HOMA-IR (r=-0.373; p=000) and positively correlated with HDL (r=0.355; p=0.000). Diabetic status (p=0.025), TNF-α (p=0.048) and BMI (p=0.027) were identified as useful predictors of adiponectin by multiple linear regression methods. In addition binary logistic regression analysis found glucose (p=0.001) and adiponectin (p=0.047) to be useful indicators of type 2 diabetes. CONCLUSIONS: Adiponectin decreases with increasing adiposity and insulin resistance. Adiponectin and TNF-α appear to be related to differences in the insulin mediated glucose turnover.


Assuntos
Humanos , Masculino , Feminino , Plasma , Diabetes Mellitus Tipo 2 , Obesidade , Adiponectina , Insulina , Trinidad e Tobago
3.
Artigo em Inglês | MedCarib | ID: med-17639

RESUMO

The low affinity sodium glucose cotransporter (SGLT2) plays a major role in physiology of glucose re-absorption from proximal part of kidney. Almost all glucose excreted through glomerular filtration, is re-absorbed via SGLT2 until blood glucose level reaches to its threshold value for glucose excretion i.e. - 180mg/dl. Increasing the glucose excretion by inhibiting the SGLT2 is the novel approach for the treatment of diabetes. Safe and normal life of patients having familial renal glucosuria due to SLC5A2 gene mutation is accelerating the development of SGLT2 inhibitors. Weight loss and very low risk of hypoglycemia are the potential benefits of these inhibitors. There are number of molecules in this class under the stage of development.


Assuntos
Humanos , Masculino , Feminino , Diabetes Mellitus Tipo 2 , Insulina , Hipoglicemia , Transportador 2 de Glucose-Sódio
4.
West Indian Veterinary Journal ; 5(1): 23-26, November 2005. graf
Artigo em Inglês | MedCarib | ID: med-17845

RESUMO

One week after the onset of polyuria, polydipsia, lethargy and weight loss and a one-day history of anorexia and vomiting, a 3.9kg, middle aged, spayed female Yorkshire terrier was presented to the Veterinary Teaching Hospital. Clinical examination was unremarkable except for cranial abdominal pain. Based on blood analyses, radiographic findings, and urinalysis, a diagnosis of diabetes mellitus was made. Insulin therapy was initiated at the hospital and adjusted appropriately based on monitoring clinical signs and serial blood glucose determinations. Despite acheiving adequate glycaemic control in the hospital environment, this dog developed cataracts after two months of therapy at home, but was otherwise clinically normal.


Assuntos
Cães , Cães , Diabetes Mellitus , Insulina , Hiperglicemia , Cetoacidose Diabética , Trinidad e Tobago
5.
West Indian veterinary journal ; 5(1): 23-26, November 2005. graf
Artigo em Inglês | MedCarib | ID: med-18173

RESUMO

One week after the onset of polyuria, polydipsia, lethargy and weight loss and a one-day history of anorexia and vomiting, a 3.9kg, middle aged, spayed female Yorkshire terrier was presented to the Veterinary Teaching Hospital. Clinical examination was unremarkable except for cranial abdominal pain. Based on blood analyses, radiographic findings, and urinalysis, a diagnosis of diabetes mellitus was made. Insulin therapy was initiated at the hospital and adjusted appropriately based on monitoring clinical signs and serial blood glucose determinations. Despite acheiving adequate glycaemic control in the hospital environment, this dog developed cataracts after two months of therapy at home, but was otherwise clinically normal.


Assuntos
Cães , Cães , Diabetes Mellitus , Insulina , Hiperglicemia , Cetoacidose Diabética , Trinidad e Tobago
6.
Caribbean Health ; 4(5): 22-25, Oct. 2001. tab, gra
Artigo em Inglês | MedCarib | ID: med-17078

RESUMO

Insulin therapy is essential in the management of type 1 diabetes, and extremely useful in the management of type 2. There are a number of established treatment strategies, including basal-bolus, twice-daily, and insulin/tablet combinations. There are currently emerging a number of new insulin analogues - both very rapid-acting and truly once-daily, and they potentially have a great deal to offer to the management of our patients. Current development is also focused on the possibility of giving insulin via a route in which injection could be avoided. At present, however, these are still a number of years away from availability (AU)


Assuntos
Insulina/uso terapêutico , Tratamento Farmacológico , Hipoglicemia/tratamento farmacológico , Diabetes Mellitus/tratamento farmacológico
7.
West Indian Med. J ; 49(4): 285-9, Dec. 2000. tab, gra
Artigo em Inglês | MedCarib | ID: med-461

RESUMO

The efficacy and tolerability of acarbose was studied in type 2 diabetic patients eating a typical Jamaican diet. The study was an open label parallel group study without placebo control. Of the 51 subjects recruited, five (9.8 percent) did not complete the study and were excluded from further analysis. Six (13 percent) of the remaining 46 had adverse side effects and did not complete the protocol. Of the remaining 40 (Gp A), acarbose was added to their previous regime of diet alone (n=15), [Gp B], oral hypoglycaemic agents, OHAs (n=17), [Gp C], or insulin (n=8), Gp D]. In addition, during the run in period all subjects had one session each with a dietitian and a diabetes educator. Over a 3 month period, significant reductions in average glucose (mmol) were observed in Gp B 10.5 ñ 1.1 to 8.4 ñ 0.9 (p<0.027) and, from 11.0 ñ 1.0 to 8.7 ñ 0.7 (p<0.01) in Gp C. Similarly, total glycosylated haemoglobin fell from 14.8 ñ 1.1 percent to 12.2 ñ 1.0 percent (p<0.016) in Gp B, from 14.8 ñ 1.1 to 11.9 ñ 1.1 percent (p<0.002) in Gp C, and from 14.1 ñ 1.4 to 11.8 ñ 1.4 (p<0.02) in Gp D. Twenty-three per cent (23 percent) of the patients experienced flatulence; 7.5 percent changes in bowel habits and 5 percent, abdominal cramps and discomfort. Acarbose is effective as monotherapy and as combination therapy with oral hypoglycaemic agents or insulin. Side effects were common, but tolerable.(Au)


Assuntos
Adulto , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Acarbose/uso terapêutico , Diabetes Mellitus Tipo 2/dietoterapia , Dieta , Quimioterapia Combinada , Flatulência/induzido quimicamente , Hipoglicemiantes/efeitos adversos , Jamaica , Resultado do Tratamento , Insulina/uso terapêutico , Acarbose/efeitos adversos
8.
West Indian med. j ; 49(suppl.4): 19, Nov. 9, 2000.
Artigo em Inglês | MedCarib | ID: med-385

RESUMO

OBJECTIVE: To evaluate the safety of starting insulin therapy in type 2 diabetics in a sub-optimal outpatient setting and to evaluate the efficacy of the use of a specific regime. METHODS: Hyperglycaemic patients who require insulin to attain euglycaemia are usually hospitalised. Close monitoring is done to identify hypoglycaemia. We identified 20 patients with type 2 diabetes mellitus who remained hyperglycaemic despite maximum dosages of a sulphonylurea and a biguanide plus or minus an alpha glucosidase inhibitor and who had been switched to insulin at the Diabetes Clinic of the University Hospital of the West Indies over a 3-year period. All patients had been started on human (recombinant DNA) 70/30 mixed insulin at the dose of 15 units per day. Data pertaining to insulin dose needed to attain eculycaemia, number of hospital visits necessary during this period and the complications of weight gain and hypoglycaemia were collected. RESULTS: Eighty-five per cent of patients were females. It required 55 (SD ñ 20.8) units per day to attain euglycaemia. More than 5 weekly/biweekly visits to the clinic for evaluation were necessary but the cost of this was significantly lower than if they had been hospitalized for the same procedure. Hypoglycaemia was minimal and insignificant. CONCLUSION: Despite sub-optimal conditions outpatient conversion to insulin is safe and cost-effective.(Au)


Assuntos
Feminino , Humanos , Masculino , Insulina/uso terapêutico , Diabetes Mellitus Tipo 2/terapia , Insulina/economia , Jamaica , Análise Custo-Benefício
9.
West Indian med. j ; 49(2): 138-42, Jun. 2000. tab
Artigo em Inglês | MedCarib | ID: med-807

RESUMO

We investigated twenty-one insulin-using patients, who had all been labelled as having diabetes mellitus (IDDM) or type one diabetes. Physicians have been erroneously using the term IDDM loosely to include all diabetics on insulin. The clinical criteria of the National Diabetes Data Group/WHO were used to reclassify these patients. Only thirteen were found to have IDDM and eight non-insulin dependent diabetes mellitus (NIDDM). Using fasting C-peptide values, only five of the thirteen with clinical IDDM truly had IDDM, the others might have maturity onset diabetes of the young (MODY) or diabetes in the young. Of the eight with clinical NIDDM seven had normal to high C-peptide values; the lone patient with low C-peptide values had diabetes diagnosed at 64 years. We conclude that the clinical classification of diabetes mellitus may be inaccurate and that C-peptide evaluation improves the accuracy of the classification.(AU)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Masculino , Adolescente , Idoso , Peptídeo C/sangue , Diabetes Mellitus/classificação , /diagnóstico , /dietoterapia , /classificação , Erros de Diagnóstico , Insulina/uso terapêutico , Prevalência
10.
Cajanus ; 33(3): 126-32, 2000.
Artigo em Inglês | MedCarib | ID: med-418

RESUMO

Hypertension (Htn), is a condition describing the presence of a consistently elevated blood pressure in an individual, and diabetes mellitus (DM), is a heterogeneous condition due to defective production or action of insulin and characterised by a state of hyperglycemia. The two types of diabetes are chronic medical conditions with varying prevalence depending on the population studied. Pregestational diabetes mellitus (PGDM) and chronic (essential) hypertension (CH) are associated with tissue damage resulting in complications, the most severe of which results in vascular disease. In the pregnant woman these entities occur either separately or together and are associated with a significant increase in both maternal and perinatal morbidity and mortality. The other entities of concern are gestational diabetes mellitus (GDM) and pregnancy induced hypertension (PIH) with or without proteinuria.(Au)


Assuntos
Adulto , Pessoa de Meia-Idade , Feminino , Humanos , Gravidez , Hipertensão/complicações , Gravidez em Diabéticas/complicações , Diabetes Mellitus/complicações , Prevalência , Resultado da Gravidez , Insulina/uso terapêutico , Nefropatias Diabéticas/diagnóstico , Retinopatia Diabética/diagnóstico , Jamaica
11.
Mona; s.n; Oct. 1999. ii,63 p. maps, tab, gra.
Tese em Inglês | MedCarib | ID: med-17212

RESUMO

This cross sectional survey of diabetics on insulin therapy sought to identify the level of knowledge of patients on insulin regarding diabetes and insulin therapy and to ascertain the preception, attitudinal and behavioural practices of these clients as it relates to insulin therapy and self administration in St. Thomas, Jamaica. A total of 107 clients were interviewed using a structured questionnaire which was administered as an interview schedule. Three focus group discussions were also conducted. Knowledge was high in the area of responses to whether or not insulin lowers the blood sugar, what is to be done if the respondents felt bad after taking insulin and also where insulin is injected. The highest percentage response to the question assessing knowledge was found in clients who used insulin between 5-9 years. There was poor knowledge in the questions addressing identification of insulin by type and brand and in addition most persons felt it was alright to miss insulin for a day. This could influence the practices being carried out by diabetics and quite likely place them at high risk for hypoglycaemia and hyperglycaemia. Most respondents had a fair attitude towards insulin therapy when compared to the length of use of insulin. Most persons also showed a fair attitude towards their treatment particularly those with over ten years of use. The role of health education and other types of support for diabetics on insulin therapy were identified among factors that could facilitate better as it impacts readily on these clients especially the elderly and the indignet in their ability to care for themselves (AU)


Assuntos
Humanos , Conhecimento , Insulina/uso terapêutico , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 1/terapia , Jamaica , Região do Caribe
12.
West Indian med. j ; 48(Suppl. 1): 24-5, Mar. 7, 1999.
Artigo em Inglês | MedCarib | ID: med-1246

RESUMO

Nitric oxide (NO), a potent modulator of cellular function, and NO donors have been useful tools in both experimental and clinical setting. Low molecular weight thiols such as cysteine and glutathoine were proposed to act as NO-carriers. The study was undertaken to investigate the pharmacological activity of the NO donor, S-nitrosoglutathoine (GSNO), on the plasma glucose and on the gluco-regulatory hormones, insulin and glucagon in healthy normoglycaemic dogs. Plasma glucose levels were measured by the glucose oxidase method, while the insulin and glucagon levels were determined by radioimmunoassay. In healthy normoglycaemic dogs, administration of 50 mg/kg GSNO caused an increase in post-prandial plasma glucose levels. The plasma glucose levels were significantly (p<0.05) elevated at 1.5 hr, 2.0 hr and 2.5 hr of the oral glucose tolerance test. These values were significantly higher than those obtained for the controls. The increase in glucose level was associated with a significant decrease in insulin levels and increase in glucagon levels (p<0.05). The fasting insulin level was 8.0 ñ 0.3 IU/ml in the control. The insulin level increased to a maximum of 34.0 ñ 0.3 IU/ml 1.5 hr post-prandial, and then decreased to 12.4 ñ 0.4 IU/ml after 2.5 hr. On administration of 50 mg/kg GSNO, the insulin level increased to a maximum of 23.0 ñ 0.6 IU/,l after 1.5 hr post-prandial and then decreased to 17.0 ñ 0.4 IU/ml after 2.5 hr. The blood glucagon levels increased from 40.0 ñ 0.3 pg/ml to 53.0 ñ 0.3 pg/ml after 1 hr in controls. In dogs administered with GSNO, the blood glucagon level increases to a maximum level of 80.0 ñ 0.5 pg/ml 1.5hr post-prandial. These results suggest that in healthy normoglycaemic dogs, nitric oxide released from GSNO caused a transient increase in post-prandial plasma glucose levels, inhibited glucose stimulated insulin secretion and elevated glucagon levels.(AU)


Assuntos
Cães , 21003 , Óxido Nítrico/farmacologia , Compostos Nitrosos/sangue , Glutationa/farmacologia , Glucagon/administração & dosagem , Insulina/administração & dosagem , Cães/metabolismo , Teste de Tolerância a Glucose
13.
West Indian med. j ; 48(Suppl. 1): 13, Mar. 7, 1999.
Artigo em Inglês | MedCarib | ID: med-1266

RESUMO

There is a fourfold increase in the incidence of major malformations in pregnant diabetic women who have poor metabolic control during the period of organogenesis. The goals of preconception care are: Screening for underlying non-diabetic medical conditions, assessment of diabetes-related complications, obstetric evaluation, intensive education of woman and family, attainment of optimum diabetic control, timing and planning of pregnancy. To achieve these goals, education must be implemented to ensure that the woman understands the effects of diabetes on pregnancy. She must undergo a review of self-management skill; that is nutrition counselling, insulin administration, exercise, blood glucose monitoring. The feasibility and cost-effectiveness of such programmes can be assessed in terms of the successful outcomes for both mother and child.(AU)


Assuntos
Feminino , Humanos , Gravidez , Gravidez em Diabéticas/complicações , Desenvolvimento Embrionário e Fetal , Aconselhamento , Educação Alimentar e Nutricional , Exercício Físico , Insulina/administração & dosagem , Automonitorização da Glicemia , Educação de Pacientes como Assunto
14.
Kingston; s.n; 1999. x,63 p. ilus, maps, tab, gra.
Tese em Inglês | MedCarib | ID: med-1162

RESUMO

This cross-sectional survey of diabetics on insulin therapy sought to identify the level of knowledge of patients on insulin regarding diabetes and insulin therapy and to ascertain the perception, attitudinal and behavioural practices of these clients as it relates to insulin therapy and self administration in St. Thomas, Jamaica. A total of 107 clients were interviewed using a structured questionnaire which was administered as an interview schedule. Three focus group discussions were also conducted. Knowledge was high in the area of responses to whether or not insulin lowers the blood sugar, what is to be done if the respondents felt bad after taking insulin and also where insulin is injected. The highest percentage response to the question assessing knowledge was found in clients who used insulin between 5-9 years. There was poor knowledge in the questions addressing identification of insulin by type brand and in addition most persons felt it was alright to miss insulin for a day. This could influence the practices being carried out by the diabetics and quite likely place them at high risk for hypoglycaemia and hyperglycaemia. Most respondents had a fair attitude towards insulin therapy when compared to the length of use of insulin. Most persons also showed a fair attitude towards their treatment particularly those with over ten years of use. The role of health education and other types of support for diabetics on insulin therapy were identified among factors that could facilitate better practices. Keen attention should be paid to the socio economic environment as it impacts readily on these clients especially the elderly and the indigent in their ability to care for themselves.(Au)


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Conhecimentos, Atitudes e Prática em Saúde , Insulina/uso terapêutico , /tratamento farmacológico , Automonitorização da Glicemia , Estudos Transversais , Inquéritos e Questionários , Jamaica , Educação de Pacientes como Assunto , Educação em Saúde , Fatores de Risco , Hipoglicemia/complicações , Hiperglicemia/complicações , Idoso de 80 Anos ou mais
15.
West Indian med. j ; 47(Suppl. 3): 29, July 1998. tab
Artigo em Inglês | MedCarib | ID: med-1717

RESUMO

Using clinical criteria only, the newly diagnosed diabetic may be wrongly labelled as having type 1 diabetes mellitus (IDDM), if the possibility of the presence of maturity onset diabetes of the young (MODY) is not considered. It is our contention that some patients labelled as type I diabetes may be MODY. Fasting C peptide was determined in 24 insulin using patients, who have been labelled as having type I diabetes. Considering the age at diagnosis and the C peptide levels now, the patients were re-classified to form groups, in which the age at diagnosis, duration of diabetes and insulin requirement as compared. Group A consists of patients who could be said to have MODY. Groups C and D appeared to have type 2 diabetes mellitus with insulin requirements. We conclude that C peptide assessment enhances the classification of diabetes mellitus in clinical practices.(AU)


Assuntos
Humanos , Diabetes Mellitus/classificação , Peptídeo C/diagnóstico , Insulina/diagnóstico
16.
West Indian med. j ; 47(suppl. 1): 30-1, Mar. 5-8, 1998.
Artigo em Inglês | MedCarib | ID: med-1550

RESUMO

Nitric oxide is a pathogenic factor of inflammatory islet cell death in type 1 diabetes. An early event in the pathogenesis of insulin-dependent diabetes mellitus (IDDM) is intraislet accumulation of activated macrophages. Their secretory products such as nitric oxide (NO) are found to play a crucial role in islet destruction. Macrophage activity and progressive islet cell destruction persist during a long period of chronic inflammatory events preceding diabetes, suggesting the presence of nitric oxide contributing to continued immunostimulation. It has been shown previously that the nitric oxide donor, S-nitrosoglutathione (GSNO) caused persistent postprandial hyperglycaemia in normal healthy dogs at 35 and 50mg/kg. parallel with an increase in plasma nitrate concentration and decrease in insulin secretion. This study was designed to investigate differences in cellular binding of insulin in dogs administered with the GSNO. A time course assay of insulin binding, to isolate erythrocytes and mononuclear leucocytes from dog administered with GSNO, was done during the oral glucose tolerance test (OFTT). The erthrocyte receptor assay performed was the methodology used by Ghambir et al (1977). A modification was also done for mononuclear leucocytes insulin binding assay. The plasma glucose levels were measured by the glucose oxidase method, while the insulin levels were determined by radio-immunoassay. The results of these studies show that erythrocytes and mononuclear leucocytes from dogs administered with GSNO have decreased ability to bind insulin when compared to erythrocytes and mononuclear leucocytes from the controls. In dogs administered with GSNO, there was less binding of erythrocytes and mononuclear leucocytes, 44 percent and 29 percent respectively, when compared to the bound free ratio value of the controls. The data also shows that erythrocytes and mononuclear leucocytes from dogs administered with GSNO have 256 and 10.7x10 insulin receptor sites per cell, respectively, compared with 296 and 18.4x10 per cell for the control (P<0.05). Competitive inhibition studies using unlabelled insulin indicate that the affinity of insulin for its receptor on erythrocytes from dogs administered with GSNO was also significantly different from the controls, while that of mononuclear leucocytes from both group was comparable.(AU)


Assuntos
Cães , 21003 , Eritrócitos/efeitos dos fármacos , Insulina/uso terapêutico , Leucócitos Mononucleares/efeitos dos fármacos , Glutationa/efeitos dos fármacos , Compostos Nitrosos/uso terapêutico , Óxido Nítrico/uso terapêutico
17.
West Indian med. j ; 47(Suppl. 1): 17, Mar. 5-8, 1998.
Artigo em Inglês | MedCarib | ID: med-1554

RESUMO

Individuals with diabetes mellitus are being encouraged to engage in regular sports and other recreational activities for a variety of reasons. These include personal enjoyment, to overcome a sense of feeling different from peers, to feel better from both a physical and psychological perspective, and to enjoy the numerous health benefits of regular activity. Increasing evidence supports the important role of increased physical activity levels in reducing cardiovascular risk, and important consideration in people with diabetes. The major challenge to the individual with type 1 diabetes and the health care provider is to devise a strategy to accommodate increased exercise safely without an excessive risk of acute metabolic decompensation. This is best accomplished with an individualized treatment algorithm which takes into account the patient's food and insulin pattern, the type and duration of exercise, and his or her previous experience with similar types of exercise. Because of interindividual differences, frequent testing of blood glucose levels is important to gauge the response to exercise. Development of an individual routine with regard to the time of day of exercise, and its relation to meals, allows for a greater degree of predictability of the response to exercise. Insulin regimens which provide increased numbers of injections (3 - 4 per day), or the continuous delivery of subcutaneous insulin, generally provide the patient with greater ease in making appropriate adjustments of insulin doses before and after exercise. In patients with type 1 diabetes, these include Multiple Dosing of Insulin regimens which provide short-acting insulin before each meal with bedtime intermediate-acting insulin, or the use of an insulin pump. The latter offers distinct advantages for the endurance athlete, who needs to provide a constant delivery of a small amount of insulin over the duration of exercise. Anecdotal reports of the use of fast-acting Humalog (lispro) insulin in the insulin pump suggest that this may allow for more rapid adjustments in insulin dosing immediately before and after exercise, without loss of glycaemic stability. In type 2 diabetes, the individuals is less prone to ketosis, but may s till develop marked hyperglycaemia due to exercise, especially if dehydration occurs. In addition, the usual presence of insulin resistance makes these individuals less likely to develop significant degrees of hypoglycaemia during or after exercise.(AU)


Assuntos
Humanos , Diabetes Mellitus Tipo 2 , Exercício Físico , Insulina/uso terapêutico
18.
West Indian med. j ; 47(suppl. 1): 10-11, Mar. 5-8, 1998.
Artigo em Inglês | MedCarib | ID: med-1896
20.
West Indian med. j ; 46(Suppl.2): 40, Apr. 1997.
Artigo em Inglês | MedCarib | ID: med-2449

RESUMO

Most cases of gestational diabetes are found in women older than 30 years. Insulin response generally decreases with increased age. To correlate the relationship between maternal age; insulin response and subsequent development of gestational diabetes, 120 pregnant women were classified into three age groups; ages 18-24 years, 25-29 years and o30 years. All women were classified as normal weight when adjusted for expected pregnancy weight gain. The three groups were administered a 50g glucose screen at 27 weeks of gestation. Blood samples were taken 1 hour after ingesttion. Analyses were done for glucose, c-peptide and insulin. Patients in the age group in 18 - 24 years had mean ñSD glucose concentration of 5.6ñ 1.0 mmol/l and showed the greatest insulin response with a mean ñSD of 160ñ 24æU/ml. Patients in the age group 25 - 29 years had a mean glucose value of 6.4ñ 1.0 mmol/l and the mean insulin value of 148ñ 31æU/ml was less than that of the younger group. The oldest women had the lowest mean insulin value of 100ñ 49æU/ml and showed some general glucose intolerance with mean glucose value of 8.1ñ 1.0mmol/l. A significant difference (p=0.001) was formed in insulin values when the women in the age groups 18-24 years and 25-19 years were compared. However the difference was greater (p=0.000002) when the women in the age groups 18 - 24 years and o30 years were compared. A 4.25 percent prevalence rate of gestational diabetes was found among the oldest women. Our findings that glucose tolerance and insulin response are lowest in older pregnant women support the concept that gestational diabetes in more prevalent in older gravidas. (AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Gravidez , Adolescente , Adulto , Diabetes Gestacional , Idade Materna , Glicemia , Insulina/sangue , Jamaica , Teste de Tolerância a Glucose
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