Glycemic Management in Adults With Type 1 Diabetes

McGibbon, Angela; Adams, Lenley; Ingersoll, Karen S.; Kader, Tina; Tugwell, Barna

doi:10.1016/j.jcjd.2017.10.012

Cited by 28 publications

(13 citation statements)

References 113 publications

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“…A 10–15 min delay in the postprandial glucose rise may also be useful in people with type 1 diabetes using subcutaneously administered insulin. Modern rapid-acting insulins begin to act 5–15 min after insulin administration [ 31 ]. Delaying meal consumption for 15 min after rapid-acting insulin administration reduced the glycemic response compared to eating the same meal immediately before or after insulin administration [ 32 , 33 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans

et al. 2020

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To see if the molecular weight (MW) and viscosity of oat β-glucan (OBG) when taken before eating determine its effect on postprandial glycemic responses (PPRG), healthy overnight-fasted subjects (n = 16) were studied on eight separate occasions. Subjects consumed 200 mL water alone (Control) or with 4 g OBG varying in MW and viscosity followed, 2–3 min later, by 113 g white-bread. Blood was taken fasting and at 15, 30, 45, 60, 90, and 120 min after starting to eat. None of the OBG treatments differed significantly from the Control for the a-priori primary endpoint of glucose peak-rise or secondary endpoint of incremental area-under-the-curve (iAUC) over 0–120 min. However, significant differences from the Control were seen for glucose iAUC over 0–45 min and time to peak (TTP) glucose. Lower log(MW) and log(viscosity) were associated with higher iAUC 0–45 (p < 0.001) and shorter TTP (p < 0.001). We conclude that when 4 g OBG is taken as a preload, reducing MW does not affect glucose peak rise or iAUC0-120, but rather accelerates the rise in blood glucose and reduces the time it takes glucose to reach the peak. However, this is based on post-hoc calculation of iAUC0-45 and TTP and needs to be confirmed in a subsequent study.

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Section: Discussionmentioning

confidence: 99%

Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans

et al. 2020

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“…In addition, although the mechanisms for kidney protection may overlap significantly in type 1 and type 2 diabetes, SGLT2is are not currently recommended in Canada for use in patients with type 1 diabetes due to concerns related to an increased risk of diabetic ketoacidosis (DKA) in this population. 18,19 Although SGLT2i use in patients with type 1 diabetes is approved in Europe and Japan, even in the hands of specialized endocrinology clinics, significant education is required to mitigate the risk of DKA, especially around ketone monitoring and sick day advice. 20-22…”

Section: Reviewmentioning

confidence: 99%

Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

Dubrofsky

Srivastava

Cherney

2020

Can J Kidney Health Dis

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Purpose of the review: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are recommended for eligible patients with type 2 diabetes for the secondary prevention of adverse cardiovascular and kidney disease outcomes. Patients with type 2 diabetes and albuminuric chronic kidney disease, a history of atherosclerotic cardiovascular disease, and/or heart failure with reduced ejection fraction should be assessed for the use of these therapies. Sources of information: The sources include published clinical trials with SGLT2is, with a focus on cardiovascular safety studies and kidney protection trials. Methods: Information was gathered via a review of relevant literature and clinical practice guidelines, incorporated with real-life clinical experience. Key findings: Clinicians prescribing these agents must be familiar with the benefits of SGLT2is on cardiovascular and renal endpoints, and with adverse effects of SGLT2is, including mycotic genital infections and diabetic ketoacidosis. Primary care physicians and specialists should know how to adjust antihypertensive, antiglycemic, and diuretic agents. With the results of completed cardiovascular outcome trials and the Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy trial, nephrologists specifically have a unique opportunity to impact the safe, effective, and equitable implementation of SGLT2is into clinical practice. Limitations: Further work is needed in specific patient subgroups, including patients with chronic kidney disease stages IV and V, patients with kidney disease but lower levels of albuminuria, and in patients without diabetes.

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“…In patients with newly diagnosed diabetes, basal–bolus analog insulin regimens using basal (glargine, detemir or degludec) and rapid-acting insulin (lispro, aspart or glulisine) insulin analogs are recommended. [ 63 64 ] The usual initial doses are at 0.5 units/kg body weight/day with half the dose prescribed as basal insulin and the other half as bolus (meal) insulin divided between three daily meals. Basal insulin is prescribed initially once daily, usually at bedtime, while the doses of meal insulin are divided according to the size of meals, for example, 50% of total dose at the main meal and 25% with each of the other two meals.…”

Section: Management After Resolution Of Diabetic Ketoacidosismentioning

confidence: 99%

Management of diabetic ketoacidosis in adults: A narrative review

Eledrisi

Elzouki

2020

Saudi J Med Med Sci

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Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus. DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.

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Glycemic Management in Adults With Type 1 Diabetes

Cited by 28 publications

References 113 publications

Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans

Effect of Varying Molecular Weight of Oat β-Glucan Taken just before Eating on Postprandial Glycemic Response in Healthy Humans

Sodium-Glucose Cotransporter-2 Inhibitors in Nephrology Practice: A Narrative Review

Management of diabetic ketoacidosis in adults: A narrative review

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