Medications Most Commonly Associated with Emergency Admissions in Patients >65 Years of Age Budnitz et al. Hypoglycemia Accounts for Most Endocrine-related Emergency Hospital Admissions Budnitz et al.
ADVANCE: Severe Hypoglycemia is Associated with Increased Risk of Adverse Outcomes Zoungas at al. ACCORD: Severe Hypoglycemia is Associated with Increased Risk of Death Launer et al for the ACCORD Study Group.
Association of Hypoglycemia with Acute Cardiovascular Events in T2DM Retrospective, observational study (n=860,845) assessing association between hypoglycaemia and acute CV events 3.1% patients had a hypoglycemic event during evaluation period (1 year) Patients who experienced hypoglycemia had a 79% higher odds of an acute CV event than patients without hypoglycaemia Johnston et al. Severe Hypoglycemia Increases the Risk of CVD and Microvascular Complications in the Elderly Zhao et al. Risk of Severe Hypoglycemia Increases with Baseline Poor Cognitive Function: Importance of early recognition when starting insulin Launer et al for the ACCORD Study Group. Hypoglycemia is Frequently Unrecognized by Patients Many episodes are asymptomatic; CGMS data show that unrecognised hypoglycaemia is common in people with insulin- treated diabetes In one study, 63% of patients with type 1 diabetes and 47% of patients with type 2 diabetes had unrecognised hypoglycaemia as measured by CGMS (n=70) 1 In another study, 83% of hypoglycaemic episodes detected by CGMS were not detected by patients with type 2 diabetes (n=31) 2 CGMS, continuous glucose monitoring system 1. Risk of Hypoglycemia during Sleep No symptoms detectable during sleep Catecholamine responses are diminished 1 May not impair cognitive function the next day 2,3 Subjective well-being affected with greater fatigue during exercise 3 May induce impaired awareness of hypoglycaemia the next day 4 1. Beware of Patients with Hypoglycemia Unawareness Hypoglycemia unawareness affects 20–25% of adults T1DM 10% 1 insulin-treated T2DM Risk of severe hypoglycaemia is 3 to 6 fold greater 2 Broad spectrum of severity 1. International Shipping - items may be subject to customs processing depending on the item's declared value. Your country's customs office can offer more details, or visit eBay's page on international trade. Estimated delivery dates - opens in a new window or tab include seller's handling time, origin ZIP Code, destination ZIP Code and time of acceptance and will depend on shipping service selected and receipt of cleared payment - opens in a new window or tab.
This item will be shipped through the Global Shipping Program and includes international tracking. What's New: Learn all you need to know about Type 1 Diabetes in our brand new Type 1 Section.
Tresiba (degludec) is a new-generation basal insulin with an ultra-long duration of action of more than 42 hours as reported by the company.
Insulin degludec, a once daily subcutaneous injection,  is a modified insulin that has one single amino acid deleted in comparison to human insulin, and is conjugated to hexadecanedioic acid via gamma-L-glutamyl spacer at the amino acid lysine at position B29.
Tresiba is suitable for use in treating patients of ages 18 years and older with either type 1 diabetes or type 2 diabetes. Studies have shown that patients taking insulin degludec needed to take significantly smaller doses of basal insulin than those taking insulin glargine, while achieving similar blood glucose levels.
After 52 weeks, patients treated with insulin degludec produced  similar (noninferior) reduction in hemoglobin A1c (HbA1c) Vs. Rates of nocturnal hypoglycemia (between midnight and 6am) were 27% lower in patients treated with insulin degludec 3.91% vs. After 52 weeks, patients treated with insulin degludec produced similar ( noninferior)  reduction in HbA1c Vs. Other studies compared Tresiba with insulin glargine, insulin detemir or sitagliptin in addition to other diabetes medications or rapid-acting insulin at mealtimes if needed.

As a clinician, I often battle complaints of hypoglycemia during the day and night in addition to issues of non-adherence with insulin regimen. Improvement in compliance with insulin regimen will also be enhanced by the ability to mix this basal insulin with bolus insulin; thus, reducing the burden of injections. With the rising incidence of diabetes in India, it becomes particularly relevant to ascertain its prevalence in various ethnic groups. In the last two decades, type 2 DM is on the rise [1] , the degree of which differs between countries and among different ethnic groups within the individual country [2] .
Familial aggregation of type 2 (non-insulin dependent) diabetes mellitus in South India : absence of excess maternal transmission. Determination of blood glucose using an oxidase - peroxidase system with a non - carcinogenic chromogen.
Familial history of type 2 diabetes in patients from Southern Brazil and its influence on the clinical characteristics of this disease.
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This insulin product is already approved and launched in the European Union, Japan and other markets. It’s unique modification provides a duration of action that lasts longer compared with existing basal insulin product (18 to 26 hours provided by other marketed long-acting insulins such as insulin glargine and insulin detemir).
However, this insulin product  may not be suitable for people that experience reactions to glycerol, metacresol, phenol or zinc acetate. Insulin degludec also has the ability to be mixed with other insulins, which cannot be done using current basal insulins, thereby improving compliance with medication therapy. I believe that Tresiba will add benefit to our armament of insulin products once it comes on the market, especially for patients with significant insulin resistance. The objective of this study was to find out the presence of diabetes mellitus in the 'Dawoodi Bohra Youth Community' and also to assess the factors responsible for it. The World Health Organization (WHO) considers it to be a non-communicable epidemic and has projected that the global prevalence of type 2 DM will be more than double from 135 million in 1995 to 300 million by 2025 [3] . If you reside in an EU member state besides UK, import VAT on this purchase is not recoverable. Furthermore, Insulin degludec has an onset of action of 30–90 minutes (similar to insulin glargine and insulin detemir).
The double strength of Tresiba may be useful for people with stronger insulin resistance that require larger doses of insulin.
The increasing prevalence of this disease in the modern world has been attributed to an unmasking of genetic defects [4],[5] by environmental factors [6] brought about by changes in the lifestyle [1],[7] . One of the benefits of insulin degludec is that it’s longer duration of action allows doses to be taken at different times of day.
A questionnaire was given to each member and questions were also asked to test their level of awareness regarding diabetes which was graded on a 5-pointer scale where 1 meant 'very poor' and 5-'excellent'. Novo Nordisk is on track to conduct an interim analysis by the end of 2014, potentially allowing it to submit data to the FDA in the first half of 2015 and potentially launch the product in the U.S.
Diabetes was diagnosed using GOD-POD (oxidase-peroxidase) method according to the WHO criteria.

Individual predisposition to type 2 diabetes mellitus is governed by multiple factors but inherited factors seem predominant [9] . With the rising incidence of diabetes in India it becomes particularly relevant to ascertain its prevalence in various ethnic groups with different cultural and lifestyle practices [1] . The 'Dawoodi Bohra youth community' is a distinct subgroup amongst the Muslims and comprises approximately one million members worldwide. The highest prevalence was recorded in the age group of 65-69 yr (22.01%) and none had diabetes in the age group 11-24 yr. There are high incidences of consanguineous marriages in this community which help in understanding genetic linkage in the transmission of this disease. No research work on prevalence or familial aggregation of diabetes and transmission patterns of the disease in this community has been reported earlier. This cross-sectional study was undertaken to determine the presence of diabetes mellitus in the 'Dawoodi Bohra youth community' in Udaipur, Rajasthan, India, to assess the social or genetic factors responsible for its high incidence. Interpretation &conclusions : Our results indicated that the marital alliances, familial aggregation and lifestyle could be the major factors which enhanced the chances of diabetes in this community. The study was also aimed to find the level of awareness among people regarding their health. The total population of 'Dawoodi Bohra youth community' in this region is approximately 4000 and majority of them reside in Bohrawadi and Kharol Colony (Fatehpura) in Udaipur.
The total number of households was approximately 900, of which 505 households were covered and 2179 subjects were questioned eventually. The inclusion criterion was that the person questioned should belong to 'Dawoodi Bohra youth community' and children below 18 yr of age were excluded. Diabetes was diagnosed according to World Health Organization Criteria [10] in the Central Laboratory where Glucose Oxidase-peroxidase (GOD-POD) (oxidase- peroxidase) method [11] was used for estimating blood sugar after overnight fasting of 10-14 hours. The elderly who were unable to come to the hospital were tested by using a glucometer (Optium Omega Meter manufactured by Abbott Diabetes Care Limited, Range Road Witney, Oxon Ox29, OYL UK). This implies that these subjects developed diabetes in the most productive years of their life and both hereditary factors and lifestyle might have had a major role to play [1] . Maternal excess was also evident as 11 per cent of the diabetic subjects had a diabetic mother while 8.5 per cent had a diabetic father, which was in agreement with several other studies [5],[6],[7],[8],[12] .
The reason for this could be pregnancy, diabetic environment in utero, longer average life span or mitochondrial DNA mutations [5],[6],[8],[12] .
Though this fact has been contradicted by certain other studies [9] maternal transmission of type 2 diabetes remains debatable [12] .
This work also reflected poor awareness among the people of this community regarding their health related issues.

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