PubMed · 10437561
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E Gil Zorzo. 1999. [Insulin therapy: basic concepts for care].. https://pubmed.ncbi.nlm.nih.gov/10437561/
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OBJECTIVE: To review performance characteristics of 12 insulin infusion protocols. RESEARCH DESIGN AND METHODS: We systematically identify and compare 12 protocols and then apply the protocols to generate insulin recommendations in the management of a patient with hyperglycemia. The main focus involves a comparison of insulin doses and patterns of insulin administration. RESULTS: There is great variability in protocols. Areas of variation include differences in initiation and titration of insulin, use of bolus dosing, requirements for calculation in adjustment of the insulin infusion, and method of insulin protocol adjustments. Insulin recommendations for a sample patient are calculated to highlight differences between protocols, including the patterns and ranges of insulin dose recommended (range 27-115 units [mean +/- SD 66.7 +/- 27.9]), amount recommended for glucose readings >200 mg/dl, and adjustments nearing target glucose. CONCLUSIONS: The lack of consensus in the delivery of intravenous insulin infusions is reflected in the wide variability of practice noted in this survey. This mandates close attention to the choice of a protocol. One protocol may not suffice for all patients.
Imprisonment often improves metabolic control in prisoners with type 2 diabetes; however, the reasons for this remain unclear. Here, we investigated the metabolic control of male prisoners with type 2 diabetes in Japan. Retrospective analysis of 4385 medical charts of male prisoners in Fukushima Prison from 1998 to 2004 revealed 109 prisoners (all Asian) with type 2 diabetes (mean+/-S.D.: 51+/-10 years). All were followed up during their imprisonment (14+/-10 months). During imprisonment, mean fasting plasma glucose and hemoglobin Alc (HbA1c) levels dramatically decreased from 184+/-74 to 113+/-38mg/dl (p<0.001) and 8.4+/-2.1 to 5.9+/-1.2% (p<0.001), respectively. In addition, 5 of 18 prisoners (28%) treated with insulin and 17 of 34 (50%) treated with oral hypoglycemic agents were able to discontinue their treatment and maintain good metabolic control. Most prisoners in Japanese prisons work 8h a day 5 days a week, consuming a high dietary fiber diet including boiled rice with barley, "Mugimeshi". These findings suggest that a well-regulated lifestyle and long-term intake of high dietary fiber may have beneficial effects on metabolic control in patients with type 2 diabetes.
CONTEXT: Intramuscular lipid content increases with aging and obesity and is directly related to impaired glucose tolerance and insulin resistance. OBJECTIVE: Our purpose was to determine the effects of aerobic exercise training (AEX) with and without weight loss (WL) on midthigh low-density muscle (LDM; a measure of im lipid) and whether changes in LDM impact glucose tolerance in sedentary older men. DESIGN: Forty-six men (60.4 +/- 1.1 yr) completed 6 months of AEX (n = 34) or AEX + WL (n = 12) and had oral glucose tolerance tests (OGTTs) and computed tomography measures of LDM and regional abdominal and thigh fat depot areas. RESULTS: At baseline, LDM area directly correlated with fasting plasma glucose (FPG), 120-min glucose (G(120)), and glucose area under the curve (G(AUC)) during an OGTT (r = 0.44, r = 0.51, and r = 0.54, respectively, P < 0.01). After the interventions, the AEX + WL group had greater decreases in LDM (-13.5 vs. +1.3%, respectively), FPG (-8.3 vs. +2.1%, respectively), G(120) (-22.5 vs. -3.6%, respectively), and G(AUC) (-17.3 vs. - 3.1%, respectively) than the AEX group. In the entire sample, the decreases in LDM correlated with reductions in FPG, G(120), and G(AUC) during an OGTT (r = 0.31, r = 0.34, and r = 0.41, P < 0.05). Changes in other regional fat depots did not independently correlate with glucose tolerance or insulin responses. CONCLUSION: AEX + WL is more efficacious than AEX for reducing LDM and glucose tolerance. The improvement in glucose tolerance may be partially mediated by decreases in LDM in older men.