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The popular Type 2 medication is already being used off-label as an add-on to insulin therapy. Pharma companies are testing whether drugs designed for combatting Type 2 diabetes can be used to also treat Type 1 diabetes. There have been roughly 100 clinical trials involving SGLT2 drugs logged at the National Institutes of Health since researchers first began evaluating canagliflozin. In February 2016, Yale Medical School and the National Institutes of Diabetes and Digestive and Kidney Disease (NIDDK) filed for a 20-patient study to administer canagliflozin during interruptions in insulin therapy. In December 2015, diaTribe reported the launch of two one-year studies to test the administration of the SGLT2 drug empagliflozin in three different doses. Most recently, diaTribe reported on April 2, 2016 that Phase III international trials have begun to evaluate the SGLT2 drug dapagliflozin for uncontrolled Type 1 diabetes. These drugs suppress the SGLT2 protein’s ability to carry excess glucose back to the bloodstream.
The medication is currently not recommended for treating Type 1 diabetes, and its FDA label indicates that it should not be administered to patients suffering from or with histories of ketoacidosis. Recently, Type 2 Nation carried a story about legal claims lodged against a leading SGLT2 drugmaker based upon the drug’s reported role in the onset of DKA or kidney damage.
The pace of trials for SGLT2 drugs has picked up, and the FDA recently relaxed its protocol for when the drug therapy can be initiated. Researchers find many children with Type 1 had biological markers for the condition years before they became symptomatic.
How underground T1D tech programmers are using Nightscout and other apps to make all CGM readings wireless. Insulin Nation® delivers comprehensive information about the technology and science of diabetes therapy, and curates the best, most relevant news for the 6.5 million people in the US who take insulin – the “Citizens” of Insulin Nation. Topics covered include diabetes-specific technology and medicine, the science behind a potential cure, wearable and wireless health tech, the rich data produced by meters, pumps, and CGMs, and the people and organizations that impact the everyday lives of our readers. Insulin pump therapy and continuous glucose monitoring systems can be invaluable tools for patients with type 1 and type 2 diabetes.
The Diabetes Control and Complications Trial (DCCT) concluded that intensive insulin therapy was superior to conventional therapy in improving glycemic control and slowing the progression of retinopathy, nephropathy, and neuropathy in patients with type 1 diabetes.1 The study defined conventional therapy as 1 or 2 insulin injections daily. Currently, CGMs are starting to be used more and may be most valuable in patients with a history of severe hypoglycemia.
Although insulin reservoirs built for insulin pump therapy and the actual pumps are typically ordered directly from the manufacturer, pharmacists must keep abreast of these treatment regimens to provide optimal patient care. 13•A common feature in the control of hormone release is a feedback loop connecting the response to the initial stimulus.
The hypothalamic hormones are secreted into the blood and travel through a short circulatory vessel (the portal vessel) directly to the anterior pituitary or adenohypophysis.Here the tropic hormones regulate the release of other hormones from the pituitary into the general circulation. The latest attempt involves a class of of oral antidiabetics called SGLT2 inhibitors, first cleared by the Food and Drug Administration on March 29, 2013.
All but two have involved individuals with Type 2 diabetes or those who don’t have diabetes. Diabetic ketoacidosis (DKA), rare for people with Type 2, is much more common in people with Type 1.


Doctors often have the option to write off-label prescriptions if they think a therapy will benefit their patient.
Peters starts patients with a low dose, breaking pills into thirds or halves, and slowly adjusts the basal insulin dose downward as patients acclimate. Canagliflozin has been reportedly linked with cardiovascular and urinary tract complications and hospitalizations for ketosis and ketoacidosis in adverse event reports filed with the FDA. It’s not yet been possible to unearth whether patients who’ve initiated suits are in fact those with Type 1 who have been using the drug off-label, and to what extent, or whether the FDA adverse event reports came in from cases of acidosis or ketoacidosis unrelated to diabetic hyperglycemia. It seems very likely that we’ll be hearing more about this drug for Type 1 use in the future. Before turning to writing, he was a lawyer in government and private practice who focused on consumer protection and regulatory law.
Intensive insulin therapy was considered to be 3 or more insulin injections daily or the use of an insulin pump, which provides continuous subcutaneous insulin infusion. Choosing the appropriate regimen is usually dependent upon the patient’s preference, lifestyle, and self-care capabilities, as well as cost.
The reservoir is connected by narrow tubing to a plastic cannula (not a needle, but a soft, flexible tube) that lies under the skin. There are definitely times during which insulin pump therapy should be considered over multiple daily injections (Table 2). They can measure and record blood glucose levels continuously and can record up to 288 glucose measurements in a 24-hour period.
The caveats of CGMs are that they are expensive ($900 per 10 of the replaceable sensors) and they read blood glucose via the interstitial fluid, causing an approximately 20-minute delay in readings.
The rapid-acting insulin analogs, which currently most closely mimic a healthy postprandial pancreas’ response, are lispro, glulisine, and aspart. Pham is a diabetes pharmacist at the Mary & Dick Allen Diabetes Center at Hoag Hospital and assistant professor of pharmacy practice at Western University of Health Sciences, College of Pharmacy. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macro vascular and micro vascular complications in type 2 diabetes (UKPDS 38).
This loop is called _______, which regulates virtually all hormonal pathways and functions to maintain a “constant” internal environment. This hormone promotes the uptake of ______ and the synthesis of _______.A low level of blood glucose triggers_____(hormone) release from the ______(gland).
Insulin promotes the uptake of glucose and the synthesis of glycogen.A low level of blood glucose triggers glucagon release from the pancreas. 232 participants were enrolled to investigate whether 100 mg and 300 mg canagliflozin doses with insulin would help better control blood sugar levels than insulin alone. They are considered an add-on to more traditional oral diabetes medication regimes, and are available in a single pill that’s combined with metformin.
FDA regulators are examining these claims, and have put out a cautionary notice for doctors that the drug might cause some enhanced risk for amputation. As the claims proceed, it may be revealed that some patients were indeed clinical trial participants, or individuals with Type 1 who were prescribed the drug off label under physician supervision. Insulin is indicated for all patients with type 1 diabetes, most patients with gestational diabetes when diet is not enough to achieve control, and patients with T2DM who cannot control blood glucose levels with other forms of therapy.


A fine needle is used to help insert the cannula subcutaneously (usually around the abdomen, thigh, or upper buttocks), but the needle is removed once the cannula is placed.
As pump technology and insulin pharmacokinetics become more advanced, we may approach a clearer picture of which regimen is superior overall. These 3 agents have been shown to produce less hypoglycemia with a more favorable dosing timeframe than insulin regular. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the management of diabetes mellitus (AACE). Continuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with diabetes mellitus: systematic review and meta-analysis. Effect of insulin concentration, subcutaneous fat thickness and skin temperature on subcutaneous insulin absorption in healthy subjects.
Quality of life and treatment satisfaction in adults with type 1 diabetes: a comparison between continuous subcutaneous insulin infusion and multiple daily injections. Memory of insulin pumps and their record as a source of information about insulin therapy in children and adolescents with type 1 diabetes. Insulin pump therapy in preschool children with type 1 diabetes mellitus improves glycemic control and decreases glucose excursions and the risk of hypoglycemia. It can take up to 20 minutes for the readings compared to the traditional finger stick readings. Do sensor glucose levels accurately predict plasma glucose concentrations during hypoglycemia and hyperinsulinemia?
Phase II of this trial was completed in June 2015, and the study process came under some criticism, but full results have not been posted. As long as glucose and ketone levels remain in the safe range, she keeps patients on the therapy.
The cannula is replaced every 2 or 3 days; patients will only need to be punctured by a needle every 2 or 3 days compared with when insulin is used multiple times daily. Furthermore, the long-acting insulin analogs, such as glargine and detemir, have allowed for once-daily dosing (occasionally twice daily) of basal insulin compared with intermediate neutral protamine Hagedorn (NPH), which is usually administered twice daily. Iyer is an endocrinologist and medical director of the Mary & Dick Allen Diabetes Center at Hoag Hospital.
The pump is programmed to deliver a predetermined amount of basal insulin throughout the day. Woodring is a certified diabetes educator and nurse at the Mary & Dick Allen Diabetes Center at Hoag Hospital. Typical features include the ability to program and deliver different types of boluses and basal rates, as well as set alarms and reminders. McArthur are PharmD candidates at Western University of Health Sciences, College of Pharmacy.



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