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Association between intensification of metformin treatment with insulin vs sulfonylureas and cardiovascular events and all-cause mortality among patients with diabetes. Most individuals are familiar with the importance of insulin in the treatment of diabetes, which is responsible for the lowering of blood sugar levels. Those unfamiliar with the specifics of diabetes may be unaware of the significance of hemoglobin A1c (HbA1c) levels.
The study consisted of 14,616 total patients after careful eligibility criteria were followed, 2,436 of which belonged to the metformin + insulin group and 12,180 patients in the metformin + sulfonylurea group. Diabetic patients receiving metformin who were additionally prescribed insulin had increased risk of cardiovascular events and death in comparison to those who received sulfonylureas as supplementary treatment to metformin. Furthermore, many patients want to delay their treatment due to a variety of personal anxieties. Tresiba (insulin degludec) is the first, long-acting, human insulin indicated for the treatment of Type 1 and Type 2 diabetes. The new drug application (NDA) of Tresiba as a once-daily, long-acting basal insulin was approved by the US Food and Drug Administration (FDA) in September 2015, making it the first basal insulin to be approved by the FDA in 10 years. Tresiba can be used alone or in combination with oral anti-diabetic medicines, or bolus insulin, and acts for more than 42 hours. Studies conducted on Tresiba demonstrated that even at lower doses, the drug achieved reduced long-term blood glucose levels (HbA1c) and greater fasting plasma glucose reduction.
Afrezza is a rapid-acting insulin therapy indicated for controlling hyperglycaemia in adult patients with type 1 and type 2 diabetes mellitus.
Diabetes mellitus is a condition, in which the body either doesn't produce enough insulin hormone, or is unable to use it properly. Chronic diabetes includes Type 1 and Type 2 diabetes, of which Type 2 is the most common and accounts for approximately 90% to 95% of all diabetes cases. Tresiba contains an active ingredient called insulin degludec, which, like any other insulin, regulates the glucose metabolism. When injected, insulin degludec forms stable depot of multi-hexamers in subcutaneous tissue.
The FDA-approval for Tresiba was based on the results from a clinical trial programme known as Begin, which included nine randomised, controlled, treat-to-target, open-label trials conducted on Type 1 and Type 2 diabetics from more than 40 countries.
The next six studies, D to I, also randomised, open-label, treat-to-target, active-controlled trials, were conducted on Type 2 diabetic patients. Results of all the nine studies demonstrated that patients treated with Tresiba achieved levels of glycemic control similar to those achieved through other insulin medications such as Lantus (insulin glargine) and Levemir (insulin detemir) and also achieved statistically-significant improvements compared to sitagliptin.
The common adverse reactions recorded during the studies were hypoglycemia, allergic reactions, injection site reactions, lipodystrophy, pruritus, rashes, oedema and weight gain. Headquartered in Denmark, Novo Nordisk has been into innovation and leadership in diabetes care for more than 90 years. Diabetes Mellitus is a condition, in which the body either doesn’t produce enough insulin hormone or is unable to use it properly.
Tresiba contains an active ingredient called insulin degludec, which regulates the body’s glucose metabolism. For patients eating substantial amounts of food, you can use that calculated amount as the total daily dose. Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement.
The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio.The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin.
The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Read some examples and therapeutic principles on how to calculate the carbohydrate coverage dose, high blood sugar correction dose and the total mealtime insulin dose.
CHO insulin dose =     Total grams of CHO in the meal ? grams of CHO disposed by 1 unit of insulin (the grams of CHO disposed of by 1 unit of insulin is the bottom number or denominator of the Insulin:CHO ratio). High blood sugar correction dose =      Difference between actual blood sugar and target blood sugar*? correction factor. This example above assumes that you have a constant response to insulin throughout the day.

Please keep in mind, the estimated insulin regimen is an initial “best guess” and the dose may need to be modified to keep your blood sugar on target. The use of incretin-based drugs is not associated with an increased risk of pancreatic cancer in patients with type 2 diabetes, according to a study published in the latest issue of the British Medical Journal (BMJ). Incretin-based drugs are widely used in the treatment of type 2 diabetes, but there have been concerns that their use may stimulate pancreatic duct cells in a way that might lead to pancreatic cancer.
To conduct the study, CNODES researchers from across Canada examined health records of patients in Canada, the United States, and the United Kingdom. Indiana University researchers have found that magnesium intake may be beneficial in preventing pancreatic cancer. Massachusetts General Hospital (MGH) investigators may have uncovered a novel mechanism behind the ability of the diabetes drug metformin to inhibit the progression of pancreatic cancer. Long-term use of liraglutide, a substance that helps to lower blood sugar levels in patients with type 2 diabetes, can have a deteriorating effect on insulin-producing beta cells, leading to an increase in blood sugar levels.
A drug used by people with type 2 diabetes to regulate blood sugar led to pancreatic beta cell burnout in mice exposed to high doses over a period of six months. Here's one more reason to consider cutting back on the soda: drinking too many sugary drinks on a daily basis has been linked to gallbladder cancer. Cancer is a disease of our genes - yet our understanding of how our genetic makeup affects our risk of cancer is still rudimentary. Scientists at Lancaster University have shed light on the metabolic switch observed in abnormal cells like cancer.
An insulin pump is a small computerized device used in the treatment of insulin-dependent diabetes. Pump users still need to test their blood sugar on a regular basis, usually 6-8 times a day. Basal rates deliver the specific amount of insulin needed at that moment, rather than having a long acting insulin peak, or deliver a flat amount if different amounts are needed for different times of day.
Because the insulin is based on what is being eaten, and when, the user has the ability to eat what and when they want. Pumps can be programmed to have alarms to remind the user to test their blood glucose or do some other task. Since pumps only use fast acting insulin, the amount of insulin in the body can be increased or decreased for exercise or other events that may require more or less insulin, and therefore, prevent low blood sugar episodes. Pumps eliminate the need for injections; the infusion set gets changed every 2-3 days instead. Pumps can give boluses over an extended period of time to accommodate food that digests slower, such as pizza.
Since only fast-acting insulin is used, blood glucose can rise quickly if delivery is stopped, and possibly lead to ketoacidosis.
Pumps need to be worn almost all the time, and may present an outward sign of the user's diabetes. However, many people are unfamiliar with the use and significance of sulfonylureas in treating diabetic patients. This result is substantiated by available clinical data of previous studies, several of which are mentioned in the original article. On the other hand, many physicians attempt to control diabetes as quickly as possible with the use of insulin or sulfonylurea therapy.
In addition, it is the first basal insulin that allows patients to dose at any time of the day.
It will be available in the FlexTouch device, a prefilled insulin pen, containing two concentrations of 80 units and 160 units per injection. As insulin plays a key role in controlling sugar levels in blood, irregular levels lead to excess build up of sugar. Diabetes is a serious health problem, affecting approximately 29 million people in the US alone.
It reduces the blood glucose levels by stimulating peripheral glucose uptake and controlling hepatic glucose production. From there, it is slowly absorbed into the systemic circulation resulting in a prolonged time action profile. Subjects in these randomised, open-label, treat-to-target, active-controlled, trials were treated once-daily with Tresiba in combination with mealtime insulin.

The subjects were administered with once-daily Tresiba in combination with mealtime insulin or common oral anti-diabetic. It employs approximately 39,000 people in 75 countries and markets its products in more than 180 countries. Between 40% and 50% of that total dose should be administered as basal, with the rest dosed out in nutritional boluses. You should give 50% of that total dose as basal insulin about four hours before patients’ IV insulin is turned off. This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Bear in mind, this may be too much insulin if you are newly diagnosed or still making a lot of insulin on your own. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team. The research was conducted by the Canadian Network for Observational Drug Effect Studies (CNODES), which used the health records of almost 1 million patients with types 2 diabetes. However, in this, the largest study conducted to date, the researchers found no association between these drugs and pancreatic cancer. As is its mandate, the network has the ability to analyze a large amount of anonymous patient data to assess questions of drug safety more reliably than would otherwise be possible in smaller trials or epidemiological studies. Pierre Ernst, senior author on this study and Professor of Medicine at McGill University, this type of study shows the importance of being able to access health data collected for administrative purposes while assuring that individual patients cannot be identified.
Incretin based drugs and the risk of pancreatic cancer: international multicentre cohort study, BMJ (2016). In other words, is the addition of insulin or sulfonylurea to patients receiving metformin more appropriate for the intensification of the treatment of type 2 diabetes? Sulfonylureas are drugs used in the management of diabetes mellitus type 2 that function by stimulating beta cells of the pancreas to increase insulin release. In other words, it provides physicians with insight into how well the patient has been controlling their diabetes over the past several weeks. There were also a variable number of comorbities in each of the study groups, as well as other potential areas of bias or study design concerns that can be reviewed in the original article. Insulin is a reliable form of treatment for patients with whom sulfonylureas are inadequate, but this study shows that insulin should be delayed if possible due to some additional risk.
Studies such as this one allow the practice of evidence-based medicine in order to obtain the best possible outcomes for patients. The company introduced pen needles for diabetes injectable therapies approximately 30 years ago. Once patients start eating, add the rest in bolus amounts.You should also take into account how well the patient’s glucose was controlled in the ICU on the preceding day. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times. Furthermore, this class of drugs constitutes one of the most commonly prescribed medications in the treatment of type 2 diabetes2.
Although the average non-diabetic individuals exhibit HbA1c levels between 4-5.6%, a patient with diabetes strives to maintain an HbA1c below 7%4. Further research is needed in order to substantiate the risks of insulin use compared to sulfonylureas.
Association Between Intensification of Metformin Treatment With Insulin vs Sulfonylureas and Cardiovascular Events and All-Cause Mortality Among Patients With Diabetes. For patients with poor control, consider factoring in another 10% to your total daily dose. Talk to your provider about the best insulin dose for you as this is a general formula and may not meet your individual needs. According to WebMD, sulfonylurea medications are able to lower hemoglobin A1c by as much as 1-2%.

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