ABSTRACT
Background: Locally, experienced dietitians have been teaching carbohydrate counting (CHOC) and associated insulin dose adjustment as per nationally recognised structured patient education programmes for people with type 1 diabetes since 2005. In 2007, the BDA suggested a protocol with organisational approval was best practice to ratify this extended role1. As organisations have a responsibility to ensure competency of staff there is sometimes, understandably, a reluctance to give local agreement without a legal framework to underpin this practice. Dietitians are currently not eligible to do the nonmedical prescribers course2. Methods: People with type 1 diabetes who do not wish to attend secondary care, sit within the level 3 diabetes service in primary care. Following completion of a CHOC workshop, they often opt for e-consultation. This involves submitting electronic charts detailing blood glucose (BG), carbohydrate (CHO) loads and insulin doses for advice. All insulin dose adjustment advice by a dietitian is cross-checked by a prescriber (Diabetes Specialist Nurse DSN) prior to email response. Three case reviews illustrate this process. Discussion: Waiting for a prescriber to okay insulin dose adjustment advice from the dietitian delays email response to patient by an average of 38 hours. A regulatory framework such as a patient group directive or protocol would enable a dietitian to provide this advice in a timely manner. Without organisational support locally, dietitians have been refused this mechanism. Conclusion: This brief abstract provides evidence of on-going safe working of a dietitian in an extended insulin dose adjustment role and reinforces the need for a legal framework to underpin this practice.
ABSTRACT
Objective To investigate the correlation between BMI and insulin dose in diabetic patients after short-term continuous subcutaneous insulin infusion (CSII). Methods Three hundred patients with type 2 diabetes mellitus (T2DM) were enrolled and randomized into the normal weight (BMI < 23 kg/m2) group, overweight (BMI 23 ~ 25 kg/m2) group and obesity (BMI≥25 kg/m2) group. The metabolic and anthropometric parameters of each group were compared and the related factors which may influence insulin dose were analyzed. Results The insulin dose per weight in the overweight group or in the obesity groups was significantly lower than that in the normal weight group. Weight and BMI were negatively correlated with the insulin dose per weigh. Conclusions Differences of glycemia level , β-cell function and insulin resistance exist in Chinese type 2 diabetes patients with different BMI. The stratification of BMI should be considered before estimating the insulin dose by body weight in CSII therapy.
ABSTRACT
Investigou-se o perfil de 80 pacientes diabéticos tipo 2 (PDT2), constituído de homens (45%) e mulheres (55%) com média de idade de 62,8 ± 8,5 anos, usuários de insulina NPH fornecida pela Secretaria Municipal de Saúde de Maringá, PR, Brasil. Obteve-se informações por meio de um questionário e pela medida do índice de massa corporal (IMC). Verificou-se que: 1) 72% apresentavam obesidade ou sobrepeso; 2) 67,5% utilizavam antihipertensivos dos quais os inibidores da enzima conversora (ECA) e os bloqueadores dos receptores de angiotensina (BRA) representavam 84%; 3) O IMC foi similar em PDT2 usuários ou não de agentes antihipertensivos; 4) 46% além da insulina utilizavam antidiabéticos orais; 5) a dose de insulina (unidades. kg-1. dia-1) foi inferior (p< 0,05) em usuários de antihipertensivos, sugerindo existir uma correlação entre terapia antihipertensiva e o uso de menores doses de insulina. Este efeito ocorreria de maneira independente do IMC ou da simultânea a terapia com antidiabéticos orais.
The profile of 80 type-2 diabetic patients (T2DP), male (45%) and female (55%), with mean age 62.8 ± 8.5 years old, receiving NPH insulin from the municipal health department of Maringa city, PR, Brazil, was investigated. Information about each volunteer was obtained using a questionnaire and an evaluation of body mass index (BMI). It was verified that: 1) 72% showed obesity or overweight; 2) 67.5% used antihypertensive drugs in which angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) were the main antihypertensive drugs (84%); 3) The BMI was similar in the T2DP with hypertension or without hypertension; 4) 46%, in addition to insulin therapy, also used antidiabetic drugs; 5) The daily dose of insulin (units. kg-1. day-1) in the group which received antihypertensive therapy was lower (p< 0.05), suggesting the presence of a relationship between antihypertensive treatment and lower doses of insulin. In addition, this relationship would occur independently of the influence of BMI or the simultaneous treatment with oral antidiabetic drugs.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Diabetes Mellitus , Hypertension , Insulin/administration & dosage , Insulin/therapeutic use , Antidepressive Agents/therapeutic useABSTRACT
PURPOSE: Leptin is a product of ob gene in adipose tissue. This is a important factor for regulation of body weight, especially body fat mass. So it is interested in correlation of leptin with obesity or various diseases related with obesity, particularly diabetes mellitus. It was demonstrated that leptin level was increased in type 2 diabetes and insulin was associated with increased leptin level. This study is to measure leptin levels in type 1 diabetes without insulin resistance, to validate whether insulin increases leptin level and to investigate correlation of leptin with degree of diabetic control and pubertal progression. METHODS: This study included 114 children(boys; 57, girls; 57) with type 1 diabetes, whose blood samples were taken to measure leptin level using RIA(radioimmunoassay). We observed the correlation of leptin with body mass index, HbA1c, insulin dose, duration of disease, and pubertal degree. RESULTS: Mean values of age, BMI, insulin dose, and HbA1c at the measurement of leptin were 13.0+/-5.04 years-old, 18.9+/-3.5kg/m2, 36U/day, and 8.9+/-2.1%, respectively. Thirty seven children were prepubertal and fifty seven children had pubertal characteristics and the rests were not confirmed. With increment of BMI, serum leptin levels were significantly increased in the all subjects, with the same correlation in pubertal female group, but not in pubertal male. There was a relatively weak correlation(r=0.29) of leptin levels with insulin doses. In prepubertal male, there was a significant positive correlation(r=0.55) of leptin with insulin dose, whereas in pubertal male there was shown negative correlation(r=-0.41). Female patients had a significantly higher leptin levels than male, irrespective of pubertal changes or BMI. There was not a significant correlation of leptin levels with duration of diabetes and HbA1c level. CONCLUSION: It is suggested that blood levels of insulin and sex hormones play an important roles in determining the levels of leptin.