Diabetics, insulin-requiring

Diabetes Insulin requirements in diabetes mellitus may be altered in association with the use of anorexigenic drugs and the concomitant dietary restrictions. 

Diabetes pretransplant Insulin Oral hypoglycemics Metformin Glucocorticoids, TAC, and CSA also increase hypoglycemic requirements insulin requirements will increase with improving renal function Avoid in those with Rl... 

At present, antioxidants are extensively studied as supplements for the treatment diabetic patients. Several clinical trials have been carried out with vitamin E. In 1991, Ceriello et al. [136] showed that supplementation of vitamin E to insulin-requiring diabetic patients reduced protein glycosylation without changing plasma glucose, probably due to the inhibition of the Maillard reaction. Then, Paolisso et al. [137] found that vitamin E decreased glucose level and improved insulin action in noninsulin-dependent diabetic patients. Recently, Jain et al. [138] showed that vitamin E supplementation increased glutathione level and diminished lipid peroxidation and HbAi level in erythrocytes of type 1 diabetic children. Similarly, Skyrme-Jones et al. [139] demonstrated that vitamin E supplementation improved endothelial vasodilator function in type 1 diabetic children supposedly due to the suppression of LDL oxidation. Devaraj et al. [140] used the urinary F2-isoprostane test for the estimate of LDL oxidation in type 2 diabetics. They also found that LDL oxidation decreased after vitamin E supplementation to patients. 

Availability. Some 170 million people suffer from diabetes worldwide, a figure projected to double by 2030. Insulin administration is essential to the survival of those with type-1 (insulin-dependent) diabetes, and is required to control the progression of a minority of those with (the more common) insulin-independent type-2 diabetes. The annual insulin requirement has surpassed 5000 kg and continues to grow, prompting concern of an insulin shortfall from slaughterhouse sources. 

There is not room here to discuss the complex problems and complications involved in diabetes. We are limiting our discussion largely to the question of insulin production without attempting to discuss fully its exact role in diabetes. There are a number of environmental factors including nutrition which influence the disease. Exercise, for example, lessens one s insulin requirement. 

In overweight adults, a diabetic metabolic condition may develop (type II or non-insuUn-dependent diabetes) when there is a relative insulin deficiency-enhanced demand cannot be met by a diminishing insulin secretion. The cause of increased insulin requirement is a loss of insulin receptors or an impairment of the signal cascade activated by the insulin receptor. Accordingly, insulin sensitivity of cells declines. This can be illustrated by comparing concentration-binding curves in cells from normal and obese individuals... 

Indications for use and the mechanism of action are also similar to those of all of the examined compounds, i.e. stimulation of insulin secretion in the presence of functional pancreas tissue. It is used to treat non-insulin requiring, stable diabetes mellitus. Synonyms of this drug are diabinis, chloronas, and others. 

Insulin Exenatide is not a substitute for insulin in insulin-requiring patients. Do not use exenatide in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. The concurrent use of exenatide with insulin, thiazolidinediones, D-phenylalanine derivatives, meglitinides, or alpha-glucosidase inhibitors has not been studied. 

For chronic pancreatitis-associated diabetes insulin is required, but usually in quite modest doses. 

Care should be taken in treating diabetic patients, as insulin requirements are usually increased during administration of cortisone. The risk of peptic ulceration is real and caution is necessary when treating patients with past symptoms of peptic ulceration, as relapse and hemorrhage or perforation may occur. 

May decrease insulin requirement in insulin-requiring diabetics... 

However, short-acting, regular soluble insulin is the only type that should be administered intravenously because the dilution causes the hexameric insulin to immediately dissociate into monomers. It is particularly useful for intravenous therapy in the management of diabetic ketoacidosis and when the insulin requirement is changing rapidly, such as after surgery or during acute infections. 

Older data pointed to some reduction in insulin requirements when patients with diabetes mellitus received androgens, and it is wise to avoid these drugs altogether in patients with diabetes. 

Most studies of carbohydrate metabolism have shown little effect of progestogen-only contraceptives, but there is a suggestion of slight deterioration in glucose tolerance and raised plasma insulin concentrations. Women with diabetes mellitus can generally take pro-gestogen-only contraceptives without a change in insulin requirements. 

Johnston PS, Feig PU, Coniff RF, Krol A, Davidson JA, Haffner SM. Long-term titrated-dose alpha-glucosidase inhibition in non-insulin-requiring Hispanic NIDDM patients. Diabetes Care 1998 21(3) 409-15. 

In India, insulin antibodies have been investigated in 25 patients with type 1 diabetes, 19 patients with so-called malnutrition-related diabetes, and eight patients with fibrocalculous pancreatopathy, who used bovine insulin because it was cheaper (147). Antibodies appeared within 3 months of treatment. The development of antibodies was not related to the type of diabetes. There was a fall in antibody titer with increased duration of treatment. There was no correlation between daily insulin requirement and antibody titers. 

A 31-year-old man with a treatment-refractory psychiatric disorder without prior diabetes was given olanzapine 10 mg/day. After 3 months he developed hyperglycemia and an acidosis (pH 7.11). After treatment he needed at least 64 U/day of insulin, but 15 days after stopping olanzapine his insulin requirements fell and 15 days later insulin was withdrawn. 

Goswami R, Jaleel A, Kochupillai NP. Insulin antibody response to bovine insulin therapy functional significance among insulin requiring young diabetics in India. Diabetes Res Clin Pract 2000 49(1) 7-15. 

Darmon P, Curtillet C, Boullu S, Laugier A, Dutour A, Oliver C. Insulin analogue lispro decreases insulin resistance and improves glycemic control in an obese patient with insulin-requiring type 2 diabetes. Diabetes Care 1998 21(9) 1575. 

Yu JG, Kruszynska YT, Mulford MI, Olefsky JM. A comparison of troglitazone and metformin on insulin requirements in euglycemic intensively insulin-treated type 2 diabetic patients. Diabetes 1999 48(12) 2414-21. 

A 76-year-old woman with type 2 diabetes taking gemfibrozil for pronounced hypertriglyceridemia had recurrent episodes of hypoglycemia her insulin requirements fell by 65 % and her HbAic concentration fell from 9 to 6.5% over 5 months (7). 

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