CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.

Insulin produces capillary recruitment in skeletal muscle through a nitric oxide (NO)-dependent mechanism. Capillary recruitment is blunted in obese and diabetic subjects and contributes to impaired glucose uptake. This study's objective was to define whether inactivity, in the absence of obesity, leads to impaired capillary recruitment and contributes to insulin resistance (IR). A comprehensive metabolic and vascular assessment was performed on 19 adult male rhesus macaques ( Macaca mulatta) after sedation with ketamine and during maintenance anesthesia with isoflurane. Thirteen normal-activity (NA) and six activity-restricted (AR) primates underwent contrast-enhanced ultrasound to determine skeletal muscle capillary blood volume (CBV) during an intravenous glucose tolerance test (IVGTT) and during contractile exercise. NO bioactivity was assessed by flow-mediated vasodilation. Although there were no differences in weight, basal glucose, basal insulin, or truncal fat, AR primates were insulin resistant compared with NA primates during an IVGTT (2,225 ± 734 vs. 5,171 ± 3,431 μg·ml−1·min−1, P < 0.05). Peak CBV was lower in AR compared with NA primates during IVGTT (0.06 ± 0.01 vs. 0.12 ± 0.02 ml/g, P < 0.01) and exercise (0.10 ± 0.02 vs. 0.20 ± 0.02 ml/g, P < 0.01), resulting in a lower peak skeletal muscle blood flow in both circumstances. The insulin-mediated changes in CBV correlated inversely with the degree of IR and directly with activity. Flow-mediated dilation was lower in the AR primates (4.6 ± 1.0 vs. 9.8 ± 2.3%, P = 0.01). Thus, activity restriction produces impaired skeletal muscle capillary recruitment during a carbohydrate challenge and contributes to IR in the absence of obesity. Reduced NO bioactivity may be a pathological link between inactivity and impaired capillary function.

Although the data did not capture the glucose frequency comprehensively, it varied significantly by insulin types, and was higher than what is recommended in the guidelines for patients with type 2 diabetes.

Policy related to homelessness varies across federal, state, and local levels influencing access to health and social services among persons experiencing homelessness. With a diversity of community stakeholders comes a diversity of ideas about which health and social services to provide and prioritize. Despite the unique insights PEH are able to offer on their own situations, their voices often remain excluded from research and policy. The aim of the current study was to identify the basic needs and health and social service priorities of PEH, to incorporate these voices into policy decisions and prioritization. Fifteen participants age 18 and older who had any experience of homelessness in Salt Lake Countyparticipated in in-depth qualitative interviews between February and March 2020. Open-ended questions enabled the interviews to naturally progress and focus on what was most relevant to participants and their experience. Data were categorized into the services and supports identified as the most needed by PEH and to help lift people out of homelessness: 1) Housing and shelter, 2) Income and employment, 3) Transportation, 4) Food, 5) Physical and mental health services, and 6) Social support. We describe the needs, challenges, and solutions as identified and narrated by study participants. Findings offer critical insight into how the homelessness crisis should be approached by policymakers as the ways in which PEH understand and utilize the system of available resources and supports must align with their abilities and realities. Without these in-depth discussions with PEH about how they understand and meet their basic needs, there will be ongoing gaps in service delivery and mismatches in the attempts made to serve this population.

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