Cuidados al adulto postoperado en la administración de insulina / Care for the postoperative adult in the administration of insulin

Introducción: Los pacientes adultos postoperados de cirugía cardiaca (POCC), con o sin diabetes mellitus tipo 2 (DM T2), comúnmente presentan descontrol glucémico, favoreciendo la presencia de complicaciones que aumentan la morbimortalidad. Objetivo: Describir cuidados de enfermería al paciente adulto POCC con o sin DM T2 en la administración de insulina. Metodología: Revisión sistematizada con metodología integradora. Pasos de la enfermería basada en la evidencia: pregunta clínica; descriptores en ciencias de la salud; atención de enfermería, administración y dosificación, insulina regular humana e insulina isófana humana en español, inglés y portugués; búsqueda de la evidencia científica (SciELO, CINAHL, PubMed, LILACS, CUIDEN), artículos en texto completo publicados del 1 enero 2012 a 31 marzo 2017; lectura y evaluación de la evidencia científica con tabla de evidencia; y análisis de contenido a profundidad para integración de la evidencia. Resultados: se encontraron 20 artículos que cumplieron con los criterios de inclusión. Prevalecieron los estudios con nivel de evidencia observacionales III/C, publicados en países anglosajones en inglés del área médica. Se identificaron cinco dimensiones: valoración de enfermería, medición de la glucosa en sangre, control glucémico, las complicaciones por hipoglucemia o hiperglucemia, y recomendaciones o seguimientos para enfermería. Conclusiones: los cuidados de enfermería basados en la evidencia, pueden mejorar el control metabólico y prevenir las complicaciones por hipoglucemia e hiperglucemia. Palabras clave: Atención de enfermería, administración y dosificación, insulina regular humana, insulina isófana humana, diabetes mellitus tipo 2, cirugía torácica.

Comparative study between two recombinant human NPH insulin formulations for the treatment of type 2 diabetes mellitus

ABSTRACT Objective To compare the effects of the neutral protamine Hagedorn (NPH) recombinant human insulin formulations Gansulin and Humulin N® on the glycemic control of patients with type 2 diabetes mellitus (T2DM). Subjects and methods Prospective, double-blind, randomized, parallel, single-center study of 37 individuals with T2DM treated with NPH insulin formulations. The Tukey-Kramer test for multiple comparisons, the Wilcoxon paired comparison test and the Chi-Square test were used for the statistical analyses. The significance level was set at 5% (p < 0.05). Results The NPH insulin formulations Humulin and Gansulin similarly reduced the HbA1c levels observed at the end of the study compared with the values obtained at the beginning of the study. In the Humulin group, the initial HbA1c value of 7.91% was reduced to 6.56% (p < 0.001), whereas in the Gansulin group, the reduction was from 8.18% to 6.65% (p < 0.001). At the end of the study, there was no significant difference between the levels of glycated hemoglobin (p = 0.2410), fasting plasma glucose (FG; p = 0.9257) and bedtime plasma glucose (BG; p = 0.3906) between the two insulin formulations. There was no nt difference in the number of hypoglycemic events between the two insulin formulations, and no severe hyp episodes were recorded. Conclusion This study demonstrated similar glycemic control by NPH insulin Gansulin compared with human insulin Humulin N® in patients with T2DM.

A case of anaphylaxis to human recombinant insulin treated by desensitization / 대한내과학회지

Allergic reaction to insulin is mediated by several mechanisms; differences in amino acid sequence of animal and human insulin, altered tertiary structure of insulin and the presence of non-insulin protein contaminants or pharmaceutical additives. Anaphylactic reactions to insulin only occur in 0.1 to 2% of patients who stopped insulin therapy and have then resumed treatment. We report a diabetic patient who suffered severe anaphylactic reactions to human recombinant insulin, successfully treated by desensitization. A 19-year-old man with type 1 diabetes receiving Insulatard HM(R) developed generalized urticaria and angioedema with progression to dyspnea, dizziness and syncope. Skin prick test to all kinds of human recombinant insulin products revealed immediate type hypersensitivity and the titer of insulin IgE was increased in serum. The desensitization trial with Velosulin HM(R) using modified desensitization method was performed. Six months after the desensitization he was taking Velosulin HM(R) as well as Insulatard HM(R) without any evidence of systemic allergic reactions.