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1
Fernando, Ricardo E. "Diet therapy among young diabetics in the Philippines." Indian Journal of Pediatrics 56, S1 (January 1989): S67—S70. http://dx.doi.org/10.1007/bf02776467.
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Evseev, A. "Sweeteners in Diabetes Mellitus Diet." Bulletin of Science and Practice 6, no. 9 (September 15, 2020): 192–97. http://dx.doi.org/10.33619/2414-2948/58/18.
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According to the statistics submitted by the World Health Organization, sugar consumption has been constantly increasing worldwide. Craving for sugary foods is a fairly common form of addiction. Poor nutrition, caused by external and internal factors, provokes an increase in the incidence of obesity, arterial hypertension, and diabetes mellitus. This deadly triad annually takes hundreds of thousands of lives across the globe, since the pathologies listed above often go hand in hand, being interconnected. The article discusses the problem of using artificial and natural sweeteners in diet therapy for diabetes mellitus. Nutritionists around the world are concerned about how to preserve the usual sweet taste of dishes and drinks for patients with diabetes, on the one hand, yet avoiding additional harm to their health, and possibly improving the quality of diabetic life, on the other. The author summarized the materials on recent clinical studies on the subject discussed. The article analyses the four sweeteners most commonly used by diabetics: fructose, sorbitol, xylitol and honey stevia (Stevia rebaudiana Bertoni) leaf powder. Considerable attention is paid to the history of the appearance of each of the substances and medicinal raw materials studied. The author indicates their safe properties and possible disadvantages of use, as well as side effects.
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Bellmann, O. "Therapy of gestational diabetes." Acta Endocrinologica 113, no. 3_Suppl (August 1986): S50—S55. http://dx.doi.org/10.1530/acta.0.111s0050.
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Abstract. Even minor abnormalities of maternal carbohydrate metabolism may influence foetal development. This study aimed at examining the relations between impaired glucose tolerance and blood glucose behavior under a standardized diet in late pregnancy and at looking for the obstetrical and neonatal outcome after normalization of blood glucose profiles in gestational diabetics. The study included 97 women in the second half of pregnancy. Severely abnormal blood glucose profiles were observed in most patients with impaired glucose tolerance who had a fasting capillary blood glucose concentration above 4.7 mmol/l. Normalization could usually only be achieved by combining a strict dietary regimen with insulin treatment. The obstetrical and neonatal outcome in the group of patients treated with diet plus insulin was similar to that in the group of patients treated with diet alone.
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Kavula, Michael P. "Diet and Exercise in the Management of Diabetes." Journal of Pharmacy Practice 5, no. 5 (October 1992): 254–59. http://dx.doi.org/10.1177/089719009200500504.
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Insulin-dependent diabetes mellitus (IDDM) individuals can benefit from using current nutritional concepts to control their intake of carbohydrates, protein, fats, and other nutrients to aid in the control of blood glucose and lipid levels by building consistency of meal times and injections of insulin into their overall program. The NIDDM patient, on the other hand, will need a diet that offers appropriate calories to sustain daily activities, but also promote weight loss. Exercise has important physiological and psychological benefits for all individuals including diabetics. Exercise programs need to be designed for the individual's ability and used as adjunctive therapy to improve glucose control and reduce cardiovascular risk factors.
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Davì, Giovanni, Mario Belvedere, Sergio Vingneri, Isabella Catalano, Carlo Giammarresi, Salvatore Roccaforte, Agostino Consoil, and Andrea Mezzetti. "Influence of Metabolic Control on Thromboxane Biosynthesis and Plasma Plasminogen Activator Inhibitor Type-1 in Non-insulin-dependent Diabetes mellitus." Thrombosis and Haemostasis 76, no. 01 (1996): 034–37. http://dx.doi.org/10.1055/s-0038-1650518.
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SummaryWe have previously shown that tight metabolic control by insulin therapy reduced thromboxane-dependent platelet activation in noninsulin-dependent diabetes mellitus (NIDDM) patients. The present study was undertaken to determine whether a similar effect could be obtained without switching diabetics in secondary failure to insulin treatment. For this purpose, we gave strict diet and exercise advise program and adjusted on a weekly basis the oral antidiabetic therapy (glipizide) that 26 patients with NIDDM had been given over the previous months.Basal measurements of urinary ll-dehydro-TXB2 and PAI-1 confirmed previous findings of enhanced levels of these parameters in NIDDM patients with macrovascular disease in comparison to age-and sex-matched controls. After 2-6 weeks, 16 patients achieved tight metabolic control associated with significant reduction of both thromboxane biosynthesis and PAI-1 levels; 10 patients remained in poor control and no significant decrease of both parameters was observed.We conclude that reduction of in-vivo platelet activation and PAI-1 antigen levels after metabolic improvement obtained by frequent reassessment of sulphonylurea therapy together with strict diet and exercise programs may have beneficial effects on the progression of diabetic micro- and macrovascular disease.
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Akhtar, Sakina, and Mushtaq Ahmad. "Myths About Medical nutrition therapy (MNT) in Kashmiri diabetics." JMS SKIMS 20, no. 2 (December 9, 2017): 69–72. http://dx.doi.org/10.33883/jms.v20i2.29.
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Methods:- 50 patients of diabetes who were attending OPD Endocrinology Department were taken randomly over 3 months in the study. patients were enquired about the diet they were avoiding or taking with the belief of Glycaemic control.
Result:- Of the 50 patients of the study 17 were males and 33 females.32 belonged to rural and 18 urban areas. 32 were illiterate and only 18 were literate.43(80%) patients were avoiding sweet fruits like Banana, Mango and Apple. 42 (84%)were found avoiding underground vegetables like Potato, Turnip, Radish, Carrots and Onions. 17 (34%)were taking unlimited rice. 22(44%) were consuming refined oils.22 (44%) had tried bitter gourd for glycaemic control. 12(24%)had tried Fenugreek seeds for Glycaemic control.22 (44%) were avoiding lunch. 45(90%) were avoiding Dhals like Rajma. 11(22%) were having Miscellaneous beliefs. JMS 2017;20(2):69-72
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Arshad, Shoaib, Amreen Khan, Veena Melwani, Soumitra Sethia, Angelin Priya, and Satish Melwani. "A study to assess the efficacy of medical nutritional therapy in reducing blood sugar level in type 2 diabetic patients." International Journal Of Community Medicine And Public Health 5, no. 7 (June 22, 2018): 2901. http://dx.doi.org/10.18203/2394-6040.ijcmph20182619.
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Background: Physicians in India have less time for Diet consultation, despite the fact that diet planning plays an important role in management of diabetes mellitus type II. Medical nutritional therapy is defined as Nutritional diagnostic therapy, and counseling services for the purpose of disease management. The objective of the study was to study the efficacy of medical nutrition therapy in type 2 diabetics.Methods: A study was done on residents of Fatehgarh and Shaheed Nagar area of Bhopal. 44 patients with known history of diabetes with age 45 years or above were selected by house to house visit using purposive sampling. Subjects were divided in 2 groups. 1. Intervention group- known cases of diabetes mellitus type 2 with medical nutritional therapy. 2. Non Intervention group- known cases of diabetes mellitus type 2 without medical nutritional therapy. Diet plan according to the calorie requirement on the basis of the desired body weight was prepared and prescribed to the subjects of group 1. Monthly home visits for blood glucose monitoring was done.Results: The mean RBS of group 1 was 200mg and of group 2 was 194. The mean RBS of group 1 decreased by 6.5% in second reading and 8.2% in third reading.Conclusions: Only 19 out of 22 Diabetics belonging to intervention group adhered to the prescribed medical nutrition therapy. The reason being poor patient compliance because of casual attitude towards health. Better results could be obtained if the study duration was longer and HbA1c was considered.
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Wiasa, I. Wayan. "Yoga Theraphy Untuk Penyakit Diabetes Melitus." JURNAL YOGA DAN KESEHATAN 1, no. 1 (July 7, 2020): 65. http://dx.doi.org/10.25078/jyk.v1i1.1545.
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Diabetes Mellitus disease or abbreviated as DM is one of the chronic diseases caused by carbohydrate, protein and fat metabolism abnormalities and the development of macrovascular and neurological complications. The disease is characterized by elevated blood glucose levels (hyperglycemia) and allows for a decrease in the ability to respond to insulin or decrease insulin formation by the pancreas. DM can attack anyone from adolescence to adulthood. This disease becomes one of the categories of diseases that are dangerous, because it becomes one of the causes of disability, chronic complications that can spread to the heart, blood vessels, kidneys, eyes and nerves, even this disease can lead to death. If not prevented as early as possible, people with Diabetes Mellitus will continue to increase throughout the year, especially with a fast-paced and instant life, causing a variety of stress and prolonged stress that also trigger the emergence of this disease. Various alternative healing options for patients such as a healthy diet, exercise, until the consumption of drugs. Among the ways of treatment, exercise or exercise is still in demand by most people, one of which is often incorporated yoga practice with meditation so-called yoga theraphy is a special yoga therapy for diabetics. Some studies reveal that the movements in yoga can overcome the problems experienced by diabetics, of course, through regular exercise and balanced with a healthy diet.<br /><br />
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Gyldenkerne, Christine, Kevin Kris Warnakula Olesen, Morten Madsen, Troels Thim, Lisette Okkels Jensen, Bent Raungaard, Henrik Toft Sørensen, Hans Erik Bøtker, and Michael Maeng. "Association between anti-diabetes treatments and cardiovascular risk in diabetes patients with and without coronary artery disease." Diabetes and Vascular Disease Research 16, no. 4 (April 3, 2019): 351–59. http://dx.doi.org/10.1177/1479164119836227.
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Objective: We examined the risk of myocardial infarction associated with glucose-lowering therapy among diabetes patients with and without obstructive coronary artery disease. Methods: A cohort of patients with type 1 or type 2 diabetes (n = 12,030), who underwent coronary angiography from 2004 to 2012, were stratified by presence of obstructive (any stenosis ⩾50%) coronary artery disease and by type of diabetes treatment: diet, non-insulin treatment and insulin (±oral anti-diabetics). The primary endpoint was myocardial infarction. Adjusted hazard ratios were calculated using diet-treated patients without coronary artery disease as reference. Results: In patients without coronary artery disease, risk of myocardial infarction was similar in patients treated with non-insulin medication (adjusted hazard ratio 0.70, 95% confidence interval 0.27–1.81) and insulin (adjusted hazard ratio 0.76, 95% confidence interval 0.27–2.08) as compared to diet only. In patients with coronary artery disease, the risk of myocardial infarction was higher than in the reference group and an incremental risk was observed being lowest in patients treated with diet (adjusted hazard ratio 3.79, 95% confidence interval 1.61–8.88), followed by non-insulin medication (adjusted hazard ratio 5.42, 95% confidence interval 2.40–12.22), and highest in insulin-treated patients (adjusted hazard ratio 7.91, 95% confidence interval 3.51–17.82). Conclusion: The presence of obstructive coronary artery disease defines the risk of myocardial infarction in diabetes patients. Glucose-lowering therapy, in particular insulin, was associated with risk of myocardial infarction only in the presence of coronary artery disease.
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Setyaji, Diyan Yunanto, and Fransisca Shinta Maharini. "Ganyong-kelor snack bar's glycemic index as a diet for diabetics." Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition) 9, no. 2 (June 30, 2021): 105–10. http://dx.doi.org/10.14710/jgi.9.2.105-110.
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Background: Lack of insulin or the inability of cells to respond to insulin causes high blood glucose levels or hyperglycemia, a hallmark of diabetes. Consumption of foods with a low glycemic index and high fiber has been shown to provide the same benefits as pharmacological therapy in the control of postprandial hyperglycemia and can prevent the incidence of hypoglycemia in people with diabetes. Ganyong (Canna edulis) is a food source of carbohydrates and fiber. Kelor (Moringa oliefera) contains protein and some phytochemical compounds which have a hypoglycemic effect.Objectives: The objective of the study was to analyze the glycemic index of ganyong-kelor snack bars as a diet for diabetics.Materials and Methods: Ten respondents fasted for 10 hours and checked their fasting blood glucose levels, then consumed 105 grams of bread as the reference food. Every 30 minutes after eating, the blood glucose levels were checked. In the following week, after fasted, all respondents consumed 157 grams of a ganyong-kelor snack bar and checked their blood glucose levels every 30 minutes.Results: Every 100 grams of ganyong-kelor snack bar contains 230.13 kcal, 31.97 grams of carbohydrates, 9.25 grams of fat, and 4.75 grams of protein. In this study, bread was used as a reference food. If bread was corrected with glucose as a reference food, the glycemic index of the ganyong-kelor snack bar was 38.08. The calculation of the glycemic load used the converted-glycemic index and the total carbohydrates contained in 100 grams of the food. Ganyong-kelor snack bar had a glycemic load value of 12.10.Conclusions: Ganyong-kelor snack bar had good nutritional content and was categorized as food with a low glycemic index. The hypoglycemic effect of the ganyong-kelor snack bar came from its high fiber content. Ganyong-kelor snack bar can be consumed as a healthy snack for diabetic people.
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Porrata-Maury, Carmen, Manuel Hernández-Triana, Eduardo Rodríguez-Sotero, Raúl Vilá-Dacosta-Calheiros, Héctor Hernández-Hernández, Mayelín Mirabal-Sosa, Concepción Campa-Huergo, and Mario Pianesi. "Medium- and Short-Term Interventions with Ma-Pi 2 Macrobiotic Diet in Type 2 Diabetic Adults of Bauta, Havana." Journal of Nutrition and Metabolism 2012 (2012): 1–10. http://dx.doi.org/10.1155/2012/856342.
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Background.In Cuba, the Ma-Pi 2 macrobiotic diet has shown positive results in 6-month assays with type 2 diabetic patients. The objective of this study was to assess the influence of this diet at short and medium terms.Methods.Sixty-five type 2 diabetic volunteers were included for dietary intervention, institutionally based for 21 days and followed later at home, until completing 3 months. 54 of them stayed until assay end. Before intervention, and after both assay periods, they were submitted to anthropometric records, body composition analyses and measurements of serum biochemical indicators, glycemic profile in capillary blood, blood pressure, and medication consumption; food intake was evaluated by the 3-day dietary recall.Results.During the intervention, the energy intake was 200 kcal higher at instance of more complex carbohydrates and dietary fiber and despite less fat and protein. Blood pressure and serum biochemical indicators decreased significantly in both periods; the safety nutritional indicators (hemoglobin, serum total proteins, and albumin) showed no variations. The global cardiovascular risk decreased and insulin consumption dropped by 46% and 64%, in both periods, respectively.Conclusions.The Ma-Pi 2 macrobiotic diet was a successful therapy at short term and after 3-month home-based intervention, for type 2 diabetics.
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Siringo-ringo, Magda, and Pomarida Simbolon. "Progressive Muscle Relaxatation Terhadap Kualitas Tidur Dan Kadar Gula Darah Pada Diabetes Di Desa Hulu Wilayah Kerja Puskesmas Pancur Batu Kecamatan Pancur Batu Kabupaten Deli Serdang Tahun 2019." Elisabeth Health Jurnal 5, no. 1 (June 18, 2020): 19–35. http://dx.doi.org/10.52317/ehj.v5i1.277.
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Introduction..Diabetes erupts relative to the production of insuline deficits which results in an uncontrolled control mechanism of the level of glucose in the body, giving rise to potential complications of hyperglycemia and hypoglycemia. These conditions make diabetic patients diabetes stress, great anxiety dangerous to increase blood glucose levels in the body, this is as a management recommended complementary therapy using progressive Muscle Relaxations .. The purpose of this study was to determine the effect of Progressive Muscle Relaxation on sleep quality and blood glucose levels in diabetMethod. The design of this study was quasi-experimental with pre and post with control groups, for each group consisting of 32 samples with consecutive sampling techniques. Data were analyzed by statistical tests used by the Wilcoxon Sign Range Test and Mann WhitneyU Result. The influence of Progressive Muscle Relaxation on improving sleep quality was very significant there was a difference in intervention 1 in diabets with p = 0.695 (<0.05) and diabetic intervention group p = 0.00 (p = <0.05). and the effect of progressive muscle relaxation on decreasing blood glucose with found differences before and after intervention I in diabetics p = 0.627 (p> 0.05), with differences in intervention group II diabetes p = 0.00 (p <0.05) showed a significant relationshipDuscussion. There is an autogenic relaxation effect on decreasing blood glucose levels in patients with diabetes mellitus type. Suggestions for Diabetes Progressive Muscle Relaxitation can control the prevention of complications of lowering / stabilizing blood glucose levels, because muscle relaxation is a simple, easy, economical implementation, not a special tutorial room, it just needs intention , the spirit of optimism to be healthy happy future. Hopefully, people with diabetes are always active in implementing progressive, regular muscle relaxation. And the efforts to remain obedient to control blood sugar while balanced a healthy balanced diet. For the Development of Health Sciences / Researchers The results of this study are expected to be used as a reference for data information in finding alternative therapies to control diabetes complications. It is suggested that further research the number of samples is greater in knowing the factors causing comorbidities. Other modifications to complement therapy such as combining music therapy, measuring stress levels, depression, examination (ABI), HBA1C examination
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Roszkowski, A., K. Kulesza, M. Cybulski, and A. M. Witkowska. "Physical activity in type 1 diabetic young and early adults treated with insulin pump therapy. A preliminary report." Progress in Health Sciences 1 (June 11, 2019): 13–21. http://dx.doi.org/10.5604/01.3001.0013.3689.
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<b>Purpose:</b> To determine the level of physical activity in young and early adults with type 1 diabetes in comparison with their healthy counterparts and to determine whether the use of insulin pump facilitates physical activity. <br/><b>Materials and methods:</b> This study included 40 type 1 diabetes (T1D) subjects of both sexes treated with a personal insulin pump therapy, and 30 healthy controls. The diagnostic survey included questions about nutrition, knowledge about the disease and whether the patient can control diabetes through physical activity, diet and self-monitoring. The International Physical Activity Questionnaire – long form (IPAQ-L), was used to assess the level of physical activity of both diabetic and control individuals. <br/><b>Results:</b> 87.5% T1D subjects believe that using an insulin pump facilitates their physical activity. The level of physical activity associated with cycling (p=0.038) and vigorous physical activity (p=0.008) was higher in T1D than in the control group. Statistically significant differences (p=0.043) were found for total physical activity. The total mean activity was higher in participants with T1D (8147.70 MET-min/week) compared to the control group (5857.55 MET-min/week). <br/><b>Conclusions:</b> Young and early adults with type 1 diabetes may be more physically active than their healthy counterparts, mainly in their leisure time. The use of a personal insulin pump facilitates physical activity, but most diabetics experience episodes of hypoglycemia after physical activity.
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Smelser, Woodson, Vassili Glazyrine, Brian Barnes, Abigail Stanley, Misty Bechtel, Carrie Michel, Jeffrey M. Holzbeierlein, Jill Hamilton-Reeves, and Eugene Lee. "The DEAL trial: A diet and exercise intervention in (pre)-diabetics during treatment for non-muscle invasive bladder cancer." Journal of Clinical Oncology 36, no. 6_suppl (February 20, 2018): 473. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.473.
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473 Background: Patients with diabetes are at greater risk for bladder cancer (BC) as well as disease recurrence and progression. Even after controlling for clinical and pathologic risk factors, DM confers a 2x greater risk of recurrence and 9x greater risk of progression. We hypothesize that utilizing a carbohydrate restricted (CR) diet ( < 130 grams/day) to decrease the bioavailability of glucose in patients with DM and BC, a “Warburg-like” tumor, has potential therapeutic benefit. We designed a study to assess the feasibility of a CR diet in patients with (pre)diabetes and non-muscle invasive bladder cancer receiving BCG therapy. Methods: This is a pilot study of 5 (pre)diabetic patients (defined as HgbA1c > 5.7) with NMIBC receiving BCG and maintenance. A CR diet ( < 130 g/day) was supplied for the first 12 weeks through a meal delivery service. Patients received weekly coaching with a nutritionist for 6 weeks during induction BCG and at the 3 month surveillance cystoscopy with dietary and activity goals implemented. Patients had laboratory evaluation at baseline and at 3 month intervals. Patients tracked their diet. Two (1 weekday, 1 weekend day) unannounced 24 hour diet recalls were obtained to monitor compliance. Dietary compliance was defined as < 130 grams/day of carbohydrate intake. Results: Between 09/2016 and 05/2017, 5 patients were enrolled. Mean age was 66.2 years (Range 59-74). Three patients had diabetes and two patients had pre-diabetes. Two patients had CIS, 1 patient had high-grade Ta, and 2 patients had high-grade T1 disease. Mean baseline hemoglobin A1c was 7.6% (Range 5.9-11.8). Mean bodyweight and BMI were 92 kg (Range 66-105) and 28.2 (Range 23.1- 31.3) respectively. Regarding compliance, 4/5 (80%) patients completed dietary logs and weekly labs. Three patients (60%) achieved their goal of < 130 grams carbohydrates/day on 24-hour dietary recall. Average 3-month HbA1c improved from 7.6% to 6.6% (Range 5.6-7.9). Conclusions: Eighty percent of patients completed dietary logs for the first three months of the trial; 60% achieved compliance with the CR diet. These data demonstrate the feasibility of a dietary intervention utilizing CR in patients with high-grade NMIBC undergoing BCG. Clinical trial information: NCT02716623.
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Ishrat, Shabzain, Talea Hoor, Muhammad Sajid Abbas Jaffri, Shizma Junejo, and Mehreen Lateef. "Impact of Vitamin C as an Adjuvant Agent on Glycemic Indices in Type 2 Diabetes Mellitus: Randomized Clinical Trial." Journal of Bahria University Medical and Dental College 11, no. 03 (July 1, 2021): 102–6. http://dx.doi.org/10.51985/mydd5410.
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Objectives: To evaluate the effects of adjuvant vitamin C therapy with oral hypoglycemic on FBS, RBS and HbA1c and to find out the correlation of Vitamin C with glycemic indices. Study Design & Settings: This randomized open label clinical trial was conducted at Bahria University Medical & Dental College (BUMDC) in collaboration with NMC, Karachi from October 2018 to April 2019. Methodology: A total of 160 known type -2 males and females, uncomplicated diabetics, aged 40-65 years with FBS= 200 mg/dl, HbA1c = 8.5% and diabetes duration > 5years were enrolled from diabetic clinic of NMC after written informed consent. They were divided into control group and treatment group by sealed envelope technique. Control group received oral hypoglycemic drugs while treatment group received vitamin C 500 mg per orally BD with oral hypoglycemic drugs with advice of diet control and daily exercise. Patients were subjected to FBS, RBS and HbA1c at baseline and at the end of 90 days. SPSS version 23.0 was used for data analysis. The results were expressed as mean ± standard deviation (SD). P value<0.05 was considered as statistically significant. Results: In control group FBS and RBS reduced by1mg /dl and 7mg/dl from day-0 to 90. In treatment group FBS reduced by 14mg/dl and RBS reduced by 21mg/dl from day-0 to 90. HbA1c increased by 0.7% in control group and decreased by 0.4 % in treatment group at the end of 90 days. Negative correlation is observed between Vitamin C and glycemic indices. Conclusion: Adjuvant vitamin C therapy with oral hypoglycemic drugs in type-2 diabetics reduced FBS, RBS and HbA1c and exhibited negative correlation with glycemic parameters.
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Hassannezhad, Reshad. "Hyperketonemia: Clinical features and diagnosis of Diabetic Ketoacidosis." Endocrinology and Disorders 2, no. 5 (August 27, 2018): 01–04. http://dx.doi.org/10.31579/2640-1045/033.
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Diets that boost ketone production are increasingly used for treating several neurological disorders. Elevation in ketones in most cases is considered favorable, as they provide energy and are efficient in fueling the body's energy needs.Several physiological and pathological triggers, such as fasting, ketogenic diet, and diabetes cause an accumulation and elevation of circulating ketones. Complications of the brain, kidney, liver, and microvasculature were found to be elevated in diabetic patients who had elevated ketones compared to those diabetics with normal ketone levels. Diabetic ketoacidosis is an acute metabolic complication of diabetes characterized by hyperglycemia, hyperketonemia, and metabolic acidosis. Hyperglycemia causes an osmotic diuresis with significant fluid and electrolyte loss. DKA occurs mostly in type 1 diabetes mellitus (DM). It causes nausea, vomiting, and abdominal pain and can progress to cerebral edema, coma, and death. DKA is diagnosed by detection of hyperketonemia and anion gap metabolic acidosis in the presence of hyperglycemia. Treatment involves volume expansion, insulin replacement, and prevention of hypokalemia. Diabetic ketoacidosis (DKA) is a rare yet potentially fatal hyperglycemic crisis that can occur in patients with both type 1 and 2 diabetes mellitus. Due to its increasing incidence and economic impact related to the treatment and associated morbidity, effective management and prevention is key. Elements of management include making the appropriate diagnosis using current laboratory tools and clinical criteria and coordinating fluid resuscitation, insulin therapy, and electrolyte replacement through feedback obtained from timely patient monitoring and knowledge of resolution criteria. In addition, awareness of special populations such as patients with renal disease presenting with DKA is important. During the DKA therapy, complications may arise and appropriate strategies to prevent these complications are required. DKA prevention strategies including patient and provider education are important. This review aims to provide a brief overview of DKA from its pathophysiology to clinical presentation with in depth focus on up-to-date therapeutic management.
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Maletkovic, Jelena. "Selecting Patients at Risk of Developing DKA on Gliflozins." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A399. http://dx.doi.org/10.1210/jendso/bvab048.811.
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Abstract Background: Since the introduction of gliflozins less than a decade ago we have witnessed how these medications are changing our approach to treating patients with type 2 diabetes mellitus. While recognizing tremendous benefits from these medication we are aware of potentially fatal risks. We present three cases of diabetic keto-acidosis in patients with type 2 diabetes mellitus and no prior history of diabetic emergencies while on SGLT2 inhibitors. Cases: A 58 year old woman with history of type 2 diabetes mellitus for 8 years and history of bulimia was treated with an SGLT2 Inhibitor for 12 months with stable control of diabetes mellitus. After an episode of very low calorie diet for 30 hours the patient was admitted to ICU with findings of diabetic ketoacidosis. She was critically ill but responded to treatment and needed only oral medication for future diabetic control. The second patient was a 49 year old man with type 2 diabetes mellitus and obesity who has been treated with oral antidiabetics for 7 years prior to requiring MDI insulin regimen in the past 3 years. The patient was well controlled in the past one year since introduction of SGLT2 inhibitors to his therapy. After a 2 day episode of eating carb heavy diet and using about 20% of prescribed insulin the patient developed DKA and was admitted to ICU where he needed to be intubated but improved and stabilized over the next few days. The third patient was a 52 year old man with history of type 2 DM for 13 years, well controlled in the past 3 years since SGLT2Is were added to his oral antidiabetic therapy. After one night of binge drinking alcohol with poor calorie intake the patient was diagnosed with DKA. After successful treatment this patient remains on oral antidiabetic medications. Conclusion: SGLT2Is have been prescribed in our clinic with great success since the first introduction of these medications. These are the only three patients who developed DKA on SGLT2 inhibitors in the past 6 years to our knowledge. All three patient had risk factors that were recognized but likely not enough emphasized. The first patient developed DKA during a “starvation phase” of eating disorder, the second one during a short episode of non-compliance with insulin while on a high carb diet and the third one after one episode of binging on alcoholic drinks. When prescribing SGLT2 inhibitors we are turning some patients with classical type 2 DM into ketosis prone diabetics. Eating disorders, extremely low or heavy carbohydrate intake, alcohol consumption and non-compliance with other antidiabetic medications should be subjects that we discuss when starting gliflozins in order to avoid significant risks. While using impressive benefits of these medications we should be aware of their side effects and recognize those that are at risk of serious side effects.
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Fata, Ulfa Husnul. "Overview of Ankle Brachial Index (ABI) Values on Diabetes Mellitus Type 2 in Blitar." Jurnal Ners dan Kebidanan (Journal of Ners and Midwifery) 4, no. 3 (December 1, 2017): 254–59. http://dx.doi.org/10.26699/jnk.v4i3.art.p254-259.
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Examination of foot vascularization often used for patients with DM who have Perypheral Arterial Disease (PAD) is to measure the value of Ankle Brachial Index (ABI). ABI examination is a non-invasive gold standard measurement to detect vascular disorders of the peripheral arteries and is recommended as part of the assessment process to help formulate the diagnosis in at-risk individuals. The purpose of this study is to provide an overview of the value of ABI in people with diabetes mellitus type 2 in Village ofKepanjenKidul and Village KarangsariBlitar City. The method in this research is descriptive with respondent of type 2 diabetes mellitus which counted 32 respondents. Methods of data collection with check list and ABI score. The results of this study indicate that the value of ABI in people with type 2 diabetes with ABI value right and left extremities borderline and abnormal categories at most are female gender, abnormal value many in diabetics who do not routinely consume anti diabetic drugs, abnormal ABI value many in patients who do not exercise regularly, abnormally abnormal ABI values in patients who have never performed foot therapy, and abnormal ABI values are many in patients who do not implement the diet. Therefore, foot examination is very important to be done regularly to reduce the risk of foot ulcers in patients with diabetes mellitus.
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Widowati, Sri, Made Astawan, Deddy Muchtadi, and Tutik Wresdiyati. "HYPOGLYCEMIC ACTIVITY OF SOME INDONESIAN RICE VARIETIES AND THEIR PHYSICOCHEMICAL PROPERTIES." Indonesian Journal of Agricultural Science 7, no. 2 (October 25, 2016): 57. http://dx.doi.org/10.21082/ijas.v7n2.2006.57-66.
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Diabetes mellitus is a spectrum of inherited and acquired disorders characterized by elevating blood glucose levels. Diabetes is an abnormal carbohydrate metabolism, therefore, diet therapy for diabetics plays a key role in the management of the disease. Most Indonesian people consume rice as source of energy and protein. Generally, diabetics consume very limited rice because they believe that rice is the one of hyperglycemic food, even though different rice varieties have large range of glycemic index. The study aimed to evaluate hypoglycemic properties by using rat assay and chemical characteristics of 10 Indonesian rice varieties, i.e. Pandan Wangi, Rojolele, Bengawan Solo, Cenana Bali, Memberamo, Celebes, Ciherang, Batang Piaman, Cisokan, and Lusi. Taj Mahal, an herbal ponni imported rice, was used as a comparison. Male Sprague Dawley rats (150- 200 g body weight) were used for hypoglycemic assay. The rats were fasted overnight before the blood glucose was measured in the morning. The rats were then feed with 4.5 g rice per kg body weight by oral administration, followed by 1 ml of 10% glucose solution in the next 30 minutes. The blood glucose was measured for the next 30, 60, 90, and 120 minutes. Changes in blood glucose concentrations (mg dl-1) before and after the oral administrations were calculated for each rice variety tested. Results showed that Cisokan and Batang Piaman were categorized as low glycemic responses and Ciherang as high glycemic response, while the other varieties (Memberamo, Cenana Bali, Lusi, Bengawan Solo, Pandan Wangi, Celebes, and Rojo Lele) showed moderate glycemic responses. As the best hypoglycemic activity, Cisokan contained high amylose (27.6%), fat (0.87%), total dietary fiber (6.24%), resistant starch (2.02%), and lowest starch digestibility (52.2%), which are ideal for diabetic’s consumption. Ciherang as the worst hypoglycemic activity had low resistant starch (1.78%), low total dietary fiber (4.52%), and medium amylose (23.0%). This study implies that Cisokan variety is suitable for diabetic’s consumption.
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Widowati, Sri, Made Astawan, Deddy Muchtadi, and Tutik Wresdiyati. "HYPOGLYCEMIC ACTIVITY OF SOME INDONESIAN RICE VARIETIES AND THEIR PHYSICOCHEMICAL PROPERTIES." Indonesian Journal of Agricultural Science 7, no. 2 (October 25, 2016): 57. http://dx.doi.org/10.21082/ijas.v7n2.2006.p57-66.
Full textAbstract:
Diabetes mellitus is a spectrum of inherited and acquired disorders characterized by elevating blood glucose levels. Diabetes is an abnormal carbohydrate metabolism, therefore, diet therapy for diabetics plays a key role in the management of the disease. Most Indonesian people consume rice as source of energy and protein. Generally, diabetics consume very limited rice because they believe that rice is the one of hyperglycemic food, even though different rice varieties have large range of glycemic index. The study aimed to evaluate hypoglycemic properties by using rat assay and chemical characteristics of 10 Indonesian rice varieties, i.e. Pandan Wangi, Rojolele, Bengawan Solo, Cenana Bali, Memberamo, Celebes, Ciherang, Batang Piaman, Cisokan, and Lusi. Taj Mahal, an herbal ponni imported rice, was used as a comparison. Male Sprague Dawley rats (150- 200 g body weight) were used for hypoglycemic assay. The rats were fasted overnight before the blood glucose was measured in the morning. The rats were then feed with 4.5 g rice per kg body weight by oral administration, followed by 1 ml of 10% glucose solution in the next 30 minutes. The blood glucose was measured for the next 30, 60, 90, and 120 minutes. Changes in blood glucose concentrations (mg dl-1) before and after the oral administrations were calculated for each rice variety tested. Results showed that Cisokan and Batang Piaman were categorized as low glycemic responses and Ciherang as high glycemic response, while the other varieties (Memberamo, Cenana Bali, Lusi, Bengawan Solo, Pandan Wangi, Celebes, and Rojo Lele) showed moderate glycemic responses. As the best hypoglycemic activity, Cisokan contained high amylose (27.6%), fat (0.87%), total dietary fiber (6.24%), resistant starch (2.02%), and lowest starch digestibility (52.2%), which are ideal for diabetic’s consumption. Ciherang as the worst hypoglycemic activity had low resistant starch (1.78%), low total dietary fiber (4.52%), and medium amylose (23.0%). This study implies that Cisokan variety is suitable for diabetic’s consumption.
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Miyahara, Randell K. "Pharmacotherapy of Oral Hypoglycemic Agents." Journal of Pharmacy Practice 5, no. 5 (October 1992): 271–79. http://dx.doi.org/10.1177/089719009200500506.
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The use of sulfonylurea in conjunction with a diet and exercise regimen continues to be the primary treatment modality for obese type II diabetics in the United States. These agents work to lower plasma glucose by several proposed mechanisms. Pancreatic mechanisms of action improve efficiency of the islet beta cells, and extrapancreatic mechanisms of action increase peripheral insulin-receptor sensitivity. Sulfonylureas are extensively metabolized in the liver. Depending on the specific agent, renally excreted metabolites with hypoglycemic activity may be produced and pose a threat to patients with impaired renal function. Accumulation of these metabolites can result in hypoglycemia, a common adverse reaction seen with the sulfonylurea. Other adverse reactions and their prevalence, presentation, and treatment are also presented. Clinically significant drug interactions of the sulfonylurea are tabulated and discussed. Because the sulfonlyureas have equivalent efficacy to each other, proper agent selection must be based on the metabolism and excretion characteristics, adverse reaction potential, and concurrent drug profile of the patient for whom the sulfonylurea is being selected. In patients who have not achieved adequate blood glucose control, combination therapy is sometimes initiated. Sulfonylurea-sulfonylurea and various sulfonylurea-insulin regimens are discussed. The importance of diabetic patient education is reviewed, including some basic instructions pharmacists can give to diabetics. The investigation of other oral hypoglycemic agents continues. Information of selected agents undergoing clinical trials in the United States is also reviewed.
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Nallu, Ravali, Misbah Azmath, Hassaan Aftab, and Vitaly Kantorovich. "A Case of Euglycemic DKA With SGLT 2 Inhibitor Use- A Diagnostic and Therapeutic Dilemma." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A358—A359. http://dx.doi.org/10.1210/jendso/bvab048.730.
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Abstract Background: The increasing use of SGLT-2 inhibitors driven by the apparent renal and cardiovascular benefits has been associated with increased incidence of euglycemic diabetic ketoacidosis (DKA), we present a case of euglycemic DKA following bariatric surgery in a patient on SGLT-2 inhibitors. Case: 32 year old female with history of diabetes mellitus, obesity, hypertension, and triglyceride induced pancreatitis was admitted for an elective gastric sleeve procedure. She was diagnosed with type 2 diabetes after birth of her first child. Prior to the surgery she was treated with metformin 1000 mg twice daily, Empagliflozin 25 mg once daily, Tresiba 46 units and Humalog 12–15 units with each meal. She was placed on a strict calorie restricted diet leading up to the surgery. Empagliflozin and metformin were held 1 day prior to the surgery, insulin was decreased. Patient’s laparoscopic surgery was complicated by bleeding and hypotension and had to be converted to open surgery. Post operatively labs showed metabolic acidosis with bicarbonate level of 13 mmol/l (22–33), anion gap of 22 (7–17) and arterial pH of 7.29. Serum glucose of 223 mg/dl (65- 99), AST 541 u/l (10–50) ALT 580 u/l (10–50), beta hydroxy butyrate 5.89 mmol/l (< 0.28), serum osmolality 305. Urinalysis showed a glucose of 500 mg /dl with the presence of large ketones. She was started on an insulin infusion and transferred to the ICU for close monitoring and management of euglycemic DKA. She was eventually transitioned to a basal bolus regimen of insulin at discharge with discontinuation of SGLT - 2 inhibitor therapy. Later, it was revealed that the patient had history of EDKA while on SGLT2 inhibitors, which was not reported to her new endocrinologist and hence she was re-initiated on them a year ago. Discussion: Euglycemic DKA [EDKA] in the setting of SGLT- 2 inhibitor use has been associated with Type I diabetes with an incidence of 9.4 % whereas in type II at a rate of 0.2 %. In type 2 diabetics, it is more common in patients with beta cell insufficiency and may predict risk of developing type 1 diabetics which is likely the case in our patient. SGLT2 inhibitors act by promoting glucosuria, which in turn promotes sodium and ketone body reabsorption and increased ketone body production because of increased glucagon to insulin ratio. (1) Most patients with DKA while on SGLT 2 inhibitor have a precipitating event like dehydration, infection, surgery or change in insulin dose. We propose that strict carbohydrate diet and continuation of SGLT2 inhibitors before bariatric surgery resulted in EDKA. It led to complications peri-operatively. In conclusion, despite the increasing benefits of SGLT2 inhibitors in type 2 diabetics, one must be cognizant of its limitations and in particular association with EDKA. This especially holds true for patients suspected to have beta cell dysfunction or ketosis prone diabetes and patients on strict/low carbohydrate diets.
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Djindjic, Boris, Goran Rankovic, Misko Zivic, Todorka Savic, Mirjana Spasic, and Maja Bubanj. "Gender difference in hipolipemic and anti-inflammatory effects of statins in diabetics with coronary artery disease." Vojnosanitetski pregled 66, no. 12 (2009): 966–72. http://dx.doi.org/10.2298/vsp0912966d.
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Background/Aim. Statins produce hipolipemic and pleotropic effects on markers of inflammation with stabilization of atheromatous plaque. The aim of this paper was to examine gender difference in hipolipemic and antiinflammatory effects of statins in patients with diabetes mellitus (DM) type 2 with coronary artery disease (CAD). Methods. Sixty dyslipidemic patients with DM type 2 were analyzed. Lifestyle modification and hipolipemic diet were applied in all patients divided into two groups: 30 patients with statins therapy (20 mg of simvastatin or equivalent dose of some other statins, during 3 months) and 30 patients without statins therapy. Estimation of obesity, quality of glicoregulation, and determination of inflammatory parameters: Creactive protein (CRP), fibrinogen, total and differential leukocyte count, intracellular adhesive molecules (ICAM-1), vascular adhesive molecule-(VCAM-1) and lipid profile (total cholesterol - TC, LDL-C, HDL-C, triglicerides - TG) were done. Results. Women with DM type 2 were more obese and had significant disturbances in lipid profiles, glicoregulation and inflammatory markers compared to men. Statins therapy significantly improved all lipid parameters and quality of glicoregulation in women, while there were only significant reduction of LDL-C and nonHDL-C in males. There were more significant reductions of inflammatory markers in women as compared to men with statins therapy. In the group without statins there was not such significant reduction. Concentration of ICAM-1 was the lowest in men on statins therapy, while there were no significant variability of VCAM-1 values between groups and genders. Conclusion. Women with DM type 2 and CAD have more prominent lipoprotein disorders and impaired glicoregulation with expression of enhanced proinflamatory state which could not be seen in men. Statins therapy exerts more favorable effects in women leading to stabilization of lipoprotein profiles, improvement of glicoregulation and reduction of inflammatory markers. More superior antiinflammatory effects of statins therapy in men were registered only in significant ICAM-1 reduction.
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Remely, M., E. Aumueller, D. Jahn, B. Hippe, H. Brath, and A. G. Haslberger. "Microbiota and epigenetic regulation of inflammatory mediators in type 2 diabetes and obesity." Beneficial Microbes 5, no. 1 (March 1, 2014): 33–43. http://dx.doi.org/10.3920/bm2013.006.
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Metabolic syndrome is associated with alterations in the structure of the gut microbiota leading to low-grade inflammatory responses. An increased penetration of the impaired gut membrane by bacterial components is believed to induce this inflammation, possibly involving epigenetic alteration of inflammatory molecules such as Toll-like receptors (TLRs). We evaluated changes of the gut microbiota and epigenetic DNA methylation of TLR2 and TLR4 in three groups of subjects: type 2 diabetics under glucagon-like peptide-1 agonist therapy, obese individuals without established insulin resistance, and a lean control group. Clostridium cluster IV, Clostridium cluster XIVa, lactic acid bacteria, Faecalibacterium prausnitzii and Bacteroidetes abundances were analysed by PCR and 454 high-throughput sequencing. The epigenetic methylation in the regulatory region of TLR4 and TLR2 was analysed using bisulfite conversion and pyrosequencing. We observed a significantly higher ratio of Firmicutes/ Bacteroidetes in type 2 diabetics compared to lean controls and obese. Major differences were shown in lactic acid bacteria, with the highest abundance in type 2 diabetics, followed by obese and lean participants. In comparison, F. prausnitzii was least abundant in type 2 diabetics, and most abundant in lean controls. Methylation analysis of four CpGs in the first exon of TLR4 showed significantly lower methylation in obese individuals, but no significant difference between type 2 diabetics and lean controls. Methylation of seven CpGs in the promoter region of TLR2 was significantly lower in type 2 diabetics compared to obese subjects and lean controls. The methylation levels of both TLRs were significantly correlated with body mass index. Our data suggest that changes in gut microbiota and thus cell wall components are involved in the epigenetic regulation of inflammatory reactions. An improved diet targeted to induce gut microbial balance and in the following even epigenetic changes of pro-inflammatory genes may be effective in the prevention of metabolic syndrome.
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A. Alduraywish, Abdulrahman. "Case Report: Diabetic urinary auto-brewery and review of literature." F1000Research 10 (May 20, 2021): 407. http://dx.doi.org/10.12688/f1000research.52461.1.
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Background: Although candiduria is an expected encounter and should not be surprising in uncontrolled diabetes with glucose-enriched urine, urinary auto-brewery is rarely thought of by diabetologists. Moreover, endogenous ethanol production in humans from gut microbiome, urinary tract fungi and bacteria, and intermediary metabolism, has been reported for a long time, particularly in diabetics. Case description: To alert physicians to the overlooked implication of endogenously produced ethanol both as a biomarker for poor control of diabetes and as a complicating factor, we report this case of an elderly male smoker alcohol-abstinent insulin-dependent Type 2 diabetic patient. Because of circumstantial treatment and incompliance for one week, he developed endogenously produced alcohol intoxication. We proposed candidal urinary auto-brewery evidence sourced from the case history, urinalysis, and culture/identification tests - without excluding other sources. Fortunately, his diet and glycemic control were fairly controlled and, liver and kidney functions were almost normal. Amphotericin B I/V for five days, insulin, and a fluid therapy regimen greatly improved the case and cleared both the candiduria and ethanol from the urine and blood and the patient regained his base-line normal life. Conclusion: Symptoms of alcohol intoxication should be expected in patients with uncontrolled diabetes that most often correlates with candiduria and/or constipation. These symptoms can be exaggerated in those already suffering a degree of dementia and/or comorbid psychiatric/neurologic affections. Direct wet mount examination of urine under phase contrast microscopy would show the budding yeast cells. Appropriate antifungal, insulin and fluid therapies regained the base-line norms.
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Muhammed, Dauda, Yetunde H. Adebiyi, Bernard O. Odey, Jonathan Ibrahim, Opeyemi N. Hassan, Peter I. Ugwunnaji, and Eustace B. Berinyuy. "Nutritional Management of Diabetes Mellitus: An appraisal of the role of Medicinal plants." AROC in Natural Products Research 01, no. 01 (July 24, 2021): 01–27. http://dx.doi.org/10.53858/arocnpr01010127.
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Diabetes mellitus is a heterogeneous metabolic syndrome characterized by chronic hyperglycemia with partial or total lack of insulin secretion and insulin resistance. The most common symptoms are polydipsia, polyuria, blurred vision, slow healing sore, nerve damage. Diabetes, being a metabolic, endocrine disorder is directly connected to carbohydrates, lipid, and protein metabolism. As a result, nutrition therapy forms an integral part of diabetes management. Daily caloric intake of 50% - 55% carbohydrates is recommended. Carbohydrate with low glycaemic index is preferred to those with high glycaemic index. Nonnutritive sweeteners are also encouraged for people with diabetes to add increased variety to their food choices. The protein requirement for persons with diabetes is not different from the general population, 15-20 % of total caloric intake. Both soluble and insoluble fibers are encouraged in amounts similar to the recommendations for the general population (20–35 g). Fibers are useful as they prolong gastric emptying, prevent constipation, lower serum cholesterol level, and reduce nutrients diffusion rates, thus reducing blood glucose response. A low-fat diet is advisable for diabetics in order to reach and maintain good weight and health. As part of a healthy diet, 30% of daily calories should come from fats, and of these less than 10% should be saturated fat, less than 10% polyunsaturated fat and 10- 15% monounsaturated fat. As the general population, people with diabetes have no need for vitamin and mineral supplementation when the dietary intake is adequate. Despite much research on nutritional factors in the etiology and management of diabetes, the risk associated with several individual nutrients is not entirely clear. In order to achieve maximum benefit from nutritional interventions in the management of diabetes changes in government policies and legislation will be needed in addition to individual and community-based programs.
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Prastuti, Betty, and Sunarti Sunarti. "Pengendalian Superoxide Dismutase (SOD) dan Nitrit Oxide(NO) pada penderita DMT2 dengan emping garut (Maranta arundinacea Linn) sebagai makanan selingan." Jurnal Gizi Klinik Indonesia 8, no. 3 (January 1, 2012): 118. http://dx.doi.org/10.22146/ijcn.18207.
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Background: Hyperglycemia in diabetes mellitus increases the production of superoxide that cause oxidative stress and decrease the activity of superoxide dismutase (SOD). SOD enzyme reduces superoxide to hydrogen peroxide to lessen the reaction between superoxide and nitric oxide (NO). To reduce hyperglycemia in diabetes mellitus, diabetics are encouraged to consume diet with low glycemic index. Arrowroot chips is a product commonly used by the community as a snack. Arrowroot has low glycemic index (glycemic index = 14) so it can be used as an alternative snack for diabetics.Objective: The aim of this study is to determine the beneficial effects of arrowroot chips to help controlling the blood glucose level, SOD activity and NO concentration in type 2 diabetes. Method: This is a quasi-experimental research with a one group pre test - post test. Subjects were 14 patients with type 2 diabetes mellitus who regularly visited endocrine polyclinic of RSUP.Dr. Sardjito Yogyakarta. The inclusion criteria were: aged 35-60 years, had suffered from diabetes mellitus for at least one year and currently on insulin injection therapy. The subjects were given 20 grams/day arrowroot chips to be consumed as a snack for four weeks. The blood samples were drawn before and after treatment. Glucose level were analyzed by GOD-PAP method, SOD activity was determined by Ransod kits and NO concentration was analyzed by colorimetric Gies reagent system. Finally, data were analyzed by paired t-test and correlation regression test.Result: There was an increased glucose level from 124,43 ± 33,56 to 139,00 ± 67,96 mg/dl after treatment (p=0,551), SOD activity decreased from 77,09 + 19,33 to 43,99 + 17,45 unit/ml whole blood after treatment (p=0,000), decreased NO concentration from 1,28 + 1,32 to 1,15 + 0,577 µM after treatment (p=0,875), and a positive correlation between SOD activity and NO concentration (p=0,151; r=0,405; R2=0,164).Conclusion: Arrowroot chips consumption as a snack for 4 weeks was unable to help controlling the fasting plasma glucose level, SOD activity and NO concentration in type 2 diabetics.
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Mavrogiannaki, A. N., and I. N. Migdalis. "Nonalcoholic Fatty Liver Disease, Diabetes Mellitus and Cardiovascular Disease: Newer Data." International Journal of Endocrinology 2013 (2013): 1–8. http://dx.doi.org/10.1155/2013/450639.
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Nonalcoholic fatty liver disease (NAFLD) is the most common, chronic liver disease worldwide. Within this spectrum, steatosis alone is apparently benign, while nonalcoholic steatohepatitis may progress to cirrhosis and hepatocellular carcinoma. NAFLD is strongly associated with obesity, dyslipidemia, type 2 diabetes mellitus, and cardiovascular disease. The pathogenesis of hepatic steatosis is not clearly known, but its main characteristics are considered insulin resistance, mitochondrial dysfunction, increased free fatty acids reflux from adipose tissue to the liver, hepatocyte lipotoxicity, stimulation of chronic necroinflammation, and fibrogenic response. With recent advances in technology, advanced imaging techniques provide important information for diagnosis. There is a significant research effort in developing noninvasive monitoring of disease progression to fibrosis and response to therapy with potential novel biomarkers, in order to facilitate diagnosis for the detection of advanced cirrhosis and to minimize the need of liver biopsy. The identification of NAFLD should be sought as part of the routine assessment of type 2 diabetics, as sought the microvascular complications and cardiovascular disease, because it is essential for the early diagnosis and proper intervention. Diet, exercise training, and weight loss provide significant clinical benefits and must be considered of first line for treating NAFLD.
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Almeida, Josiane Monteiro, and Lucas Lima de Carvalho. "Indicadores de variabilidade glicêmica e mortalidade em pacientes críticos com terapia nutricional." Braspen Journal 34, no. 4 (January 20, 2020): 355–60. http://dx.doi.org/10.37111/braspenj.2019344008.
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Introduction: Glycemic variability (GV) has been associated with mortality in critically ill patients. Several methods have been used to measure it, but no guideline has so far proposed a gold standard. The aim of this study was to associate different GV measurement methods with mortality in patients in an intensive care unit (ICU) under nutrition therapy (NT). Methods: Retrospective longitudinal study conducted between April and September 2018, in which 82 patients were enrolled in intensive care, with more than 48 hours of hospitalization and using NT. Demographic data, clinical data and all blood glucose values measured during hospitalization were collected. The GV was evaluated through three indicators: standard deviation (SD), coefficient of variation (CV) and glycemic mean (MGL). Statistical analysis was performed using Whitney and Pearson Chi-square tests, univariate and multiple logistic regression, and odds ratio. The analyzes were processed and evaluated using the Statistical Data Analysis software version 12.0. Results: 11,676 blood glucose levels were measured. Most of the sample received enteral diet. Mortality was 42.7%. A total of 36.58% of the patients had a previous diagnosis of diabetes mellitus (DM) and these presented higher values for all evaluated parameters of VG compared to non-diabetics. CV, SD and MGL values were higher among the patients who died. Univariate logistic regression analysis showed that the variables CV, SD and MGL were significantly associated with mortality. However, based on the multivariate logistic regression model, only PD maintained a relationship with mortality. Conclusion: The SD is an indicator of GV is independently associated with increased mortality in a cohort of heterogeneous patients on TN in the ICU.
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Cho, Jae Won. "Diet Therapy for Diabetic Nephropathy." Korean Clinical Diabetes 10, no. 1 (2009): 45. http://dx.doi.org/10.4093/kcd.2009.10.1.45.
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Villareal, Roland. "The Effect Of Diet Composition On Weight Gain in Obese, Type 2 Diabetes Patients Receiving Intensive Insulin Therapy." American Journal of Health Sciences (AJHS) 6, no. 2 (December 30, 2015): 111–16. http://dx.doi.org/10.19030/ajhs.v6i2.9579.
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This study was conducted to contribute to the limiting existing body of literature about diet and prevention of weight gain when administering intensive insulin therapy. The effects of a high- monounsaturated fatty acid (MUFA) diet compared with a conventional diabetic diet have not been studied in insulin treated patients. A growing body of evidence assessed that diets rich in high-MUFA foods had similar glycemic results, as do low-fat, high carbohydrate diets. However, a high-MUFA diet did not raise triglycerides as suspected. Ros (2003) stated that high-MUFA energy controlled diets do not promote weight gain and are more acceptable for weight loss and/or maintenance. A MUFA diet can be used as an alternate to the conventional American Diabetic Association (ADA) diet when managing obese type 2 diabetes patients treated with intensive insulin therapy. Dietary restriction to 1600 calories in diabetes patients on intensive insulin therapy decreased the A1C value by 1.3 points in the ADA group and 1.5 points in the MUFA group without weight gain and without additional insulin required. In conclusion the total calorie count was more important for preventing weight gain and reducing the A1C in patients on intensive insulin therapy than was dietary composition.
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Manjula, Suri, Mamta Bhardwaj, Kapur Punam, and Pathak Ashok. "An Overview of Dietary Approaches to Prevent the Development of Diabetic Retinopathy." Indian Journal of Nutrition and Dietetics 55, no. 3 (July 5, 2018): 367. http://dx.doi.org/10.21048/ijnd.2018.55.3.18193.
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Various researchers suggest that in up to 50% of patients with type 1 diabetes and 30% of those with type II diabetes, potentially vision-threatening retinal changes develop over time. Diabetic retinopathy is a common micro-vascular complication of diabetes mellitus. The present review outlines the dietary strategies to manage these complications of diabetes mellitus and studies the relationship between diet and retinopathy-associated risk factors in the development and progression of diabetic retinopathy. Though retinopathy therapy is currently limited to invasive procedures like laser photocoagulation and vitrectomy but there is a paradigm shift in favor of a preventive and protective, natural and safe dietary approach which can be used in treatment or prevention of diabetic retinopathy. Dietary carbohydrates, fats, proteins, dietary fibers, vitamins, antioxidants, minerals, phyto-estrogens, exogenous advanced glycation end-products, herbs, spices and protective dietary approaches play a role in development of diabetic retinopathy. This rationale can be applied to food interventions e.g. changing the composition of diet which favors metabolic improvements in type II diabetes and diabetic retinopathy. The ophthalmologists should encourage an interdisciplinary approach with endocrinologists and dietitian for optimal care of diabetic patient so as to prevent the development of diabetic retinopathy.
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Marenych, Nadiia, and Janice L. Gilden. "A Case Report of Euglycemic Diabetic Ketoacidosis in the Setting of Keto Diet and SGLT-2 Inhibitors." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A360. http://dx.doi.org/10.1210/jendso/bvab048.733.
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Abstract Background: Euglycemic diabetic ketoacidosis is relatively uncommon. Studies of SGLT inhibitors, when added to either insulin pumps or multiple daily injections have shown glycemic benefit in type 1 diabetes mellitus (DM), with reductions of Hba1c, body weight, glucose variability, without increased hypoglycemia, but with increase of DKA. We report a case of euglycemic diabetic ketoacidosis in a patient with type 1 DM, precipitated by keto diet and SGLT-2 inhibitor use. Clinical Case: A 24 year-old female with 17 years of type 1DM, using insulin pump therapy and empagliflozin, started a keto diet, then stopped meal time boluses, and eventually turned off her pump. Urine ketones were high. After 12 hours, she developed fatigue, nausea, abdominal pain, and shortness of breath, and presented to the emergency room. She was afebrile with BP 112/68, HR 123 beats/minute, respiratory rate 18, and oxygen saturation on room air 99%. Physical exam: anxious in mild distress, abdomen was diffusely tender without guarding. Laboratory results: sodium 141 mmol/L, potassium 5.3 mmol/L, chloride 103 mmol/L, CO2 8 mmol/L, Anion gap 30 mmol/L, with blood glucose of 201 mg/dL,and BUN 22 mg/dL, creatinine 1.55 mg/dL, GFR 41 ml/min/1.73m, Hba1c 7.2%, Normal thyroid tests, WBC 23.1 10x3/ul, Hgb 16.6 g/dl, HCT 53.3%, normal differential, Urine: ketones >=80 mg/dl, Protein 30 mg/dl, urine glucose >500 mg/dl. CT abdomen and pelvis with contrast: questionable regional colitis of ascending colon with prominent distended stomach, and possible functional obstruction, such as diabetic gastroparesis, and fatty infiltration of liver. An insulin infusion per DKA protocol was started. Over the next few days, she continued with high anion gap and low CO2; requiring bicarbonate drip. By day 3, laboratory results finally improved. Symptoms completely resolved, and the patient was started on a carbohydrate restricted diet with insulin pump therapy, and discharged home after intensive education by the diabetes team. Discussion: Euglycemic diabetic ketoacidosis is a rare, but serious complication of DM, characterized by glucose values ≤200 mg/L, ketosis and metabolic acidosis. Possible risk factors include decreased caloric intake, keto diet, heavy alcohol consumption, change in insulin regimen, chronic liver disease, pregnancy, and sodium glucose cotransporter 2 (SGLT2) inhibitors. This case highlights the complex interplay between type 1 DM, a keto diet, in combination with SGLT-2 inhibitor therapy, which may result in euglycemic diabetic ketoacidosis, and also demonstrates the importance of patient education regarding risks of ketoacidosis in the setting of SGLT-2 inhibitor therapy, in conjunction with low calorie intake and diets, such as the keto diet. Reference: (1) Julio Rosenstock, et al. Empagliflozin as Adjunctive to Insulin Therapy in Type 1 Diabetes: The EASE Trials. Diabetes Care 2018 Dec; 41(12): 2560–2569.
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Jain, Sushil K. "L-Cysteine supplementation as an adjuvant therapy for type-2 diabetes." Canadian Journal of Physiology and Pharmacology 90, no. 8 (August 2012): 1061–64. http://dx.doi.org/10.1139/y2012-087.
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Diabetes remains a major public health issue. According to the American Diabetes Association, 23.5 million, or 10.7% of people in the USA aged 20 years and older, have diabetes. Type-2 diabetes is treated both by controlling the diet and with oral hypoglycemic drugs. However, for many patients, achieving a tight control of glucose is difficult with current regimens. This chapter discusses a relatively low-cost dietary supplement that could be used as an adjuvant therapy for type-2 diabetes. A review of the literature indicates that cysteine-rich whey protein improves glucose metabolism in diabetic animals and type-2 diabetic patients. Similarly, in animal studies, improvement in glucose metabolism is observed after supplementation with L-cysteine, or molecules containing a cysteine moiety. This chapter discusses the biochemical mechanisms by which L-cysteine can upregulate the insulin-dependent signaling cascades of glucose metabolism. Further studies are needed to examine whether clinical interventions using L-cysteine as an adjuvant therapy indeed help to control glycemia and vascular inflammation in the diabetic patient population.
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Kim, Ji-Youn. "Diet Therapy in Patients of Diabetic Nephropathy." Journal of Korean Diabetes 14, no. 1 (2013): 27. http://dx.doi.org/10.4093/jkd.2013.14.1.27.
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Filippi, Alexandru, Alina Constantin, Nicoleta Alexandru, Geanina Voicu, Cristina Ana Constantinescu, Daniela Rebleanu, Madalina Fenyo, et al. "Integrins α4β1 and αVβ3 are Reduced in Endothelial Progenitor Cells from Diabetic Dyslipidemic Mice and May Represent New Targets for Therapy in Aortic Valve Disease." Cell Transplantation 29 (January 1, 2020): 096368972094627. http://dx.doi.org/10.1177/0963689720946277.
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Diabetes reduces the number and induces dysfunction in circulating endothelial progenitor cells (EPCs) by mechanisms that are still uncovered. This study aims to evaluate the number, viability, phenotype, and function of EPCs in dyslipidemic mice with early diabetes mellitus and EPC infiltration in the aortic valve in order to identify possible therapeutic targets in diabetes-associated cardiovascular disease. A streptozotocin-induced diabetic apolipoprotein E knock-out (ApoE−/−) mouse model was used to identify the early and progressive changes, at 4 or 7 days on atherogenic diet after the last streptozotocin or citrate buffer injection. Blood and aortic valves from diabetic or nondiabetic ApoE−/− animals were collected. EPCs were identified as CD34 and vascular endothelial growth factor receptor 2 positive monocytes, and the expression levels of α4β1, αVβ3, αVβ5, β1, αLβ2, α5 integrins, and C-X-C chemokine receptor type 4 chemokine receptor on EPC surface were assessed by flow cytometry. The number of CD34 positive cells in the aortic valve, previously found to be recruited progenitor cells, was measured by fluorescence microscopy. Our results show that aortic valves from mice fed 7 days with atherogenic diet presented a significantly higher number of CD34 positive cells compared with mice fed only 4 days with the same diet, and diabetes reversed this finding. We also show a reduction of circulatory EPC numbers in diabetic mice caused by cell senescence and lower mobilization. Dyslipidemia induced EPC death through apoptosis regardless of the presence of diabetes, as shown by the higher percent of propidium iodide positive cells and higher cleaved caspase-3 levels. EPCs from diabetic mice expressed α4β1 and αVβ3 integrins at a lower level, while the rest of the integrins tested were unaffected by diabetes or diet. In conclusion, reduced EPC number and expression of α4β1 and αVβ3 integrins on EPCs at 4 and 7 days after diabetes induction in atherosclerosis-prone mice have resulted in lower recruitment of EPCs in the aortic valve.
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Nezhinskaya-Astapenko, Z. P., T. V. Sekret, and M. V. Vlasenko. "PREVALENCE OF DIABETIC KETOACIDOSIS AND ITS ETIOLOGICAL FACTORS IN THE PODILLYA REGION OF UKRAINE." Актуальні проблеми сучасної медицини: Вісник Української медичної стоматологічної академії 18, no. 4 (December 20, 2018): 33–40. http://dx.doi.org/10.31718/2077-1096.18.4.33.
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The diabetes mellitus is one of the most common diseases of the world. It is characterized by a large number of complications, including ketoacidosis and its severe form known as ketoacidosis diabetic coma. The aim was to estimate the causes of the development of diabetic ketoacidosis and the duration of treatment of an acute state in different age groups. Materials and methods. The random sampling of patients included 55 individuals with diabetes mellitus admitted to intensive care unit of the Vinnytsia Regional Highly Specialized Endocrinological Center aged from 9 up to 70 years in an emergency condition of diabetic ketoacidosis during 2009-2014. Average age of patients was 31,58 ± 17,18 years. Patients were divided into 3 clinical groups depending on their age. Diagnosis of diabetic ketoacidosis was made on the basis of the order of the Ministry of Public Health of Ukraine No. 254, 27.04.06. The results obtained were statistically processed by the Russian-language "Statistica 6.1" StatSoft, 1995. Results. In the most of the cases (27,2%) the acute condition was caused by improper diet. Insulin therapy disturbance ranked the 2nd place and made up 21,8% of all cases. 20 % of ketoacidosis cases were a disease debut in first diagnosed diabetes mellitus. An average duration of hospital staying ranged from 2,33 to 3,09 days and depended on clinical form of diabetic ketoacidosis. Conclusions. The commonest causes resulting in the emergency of diabetic ketoacidosis were improper diet, non-compliance with insulin therapy, and first diagnosed diabetes mellitus. The duration of the hospital treatment did not depend on age of patients, however considerably differed according to clinical form of diabetic ketoacidosis.
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Bosy-Westphal, Anja, Friederike Fieres-Keller, and Manfred Müller. "Ernährungstherapie bei Diabetes." Diabetologie und Stoffwechsel 12, no. 03 (June 2017): 187–205. http://dx.doi.org/10.1055/s-0043-112278.
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AbstractNutritional therapy of patients with type 1 or type 2 diabetes is based on a healthy balanced diet that is complemented by evidenced based guidelines for nutritional counselling of comorbidities like obesity, hypertension and dyslipidemia. Dietary recommendations are further individualized based on medication (i. e. for prevention of hypoglycemia) and according to personal preferences (e. g. regarding macronutrient composition). Avoidance of long-term complications and improvement of prognosis are main objectives of nutritional therapy in the vulnerable group of patients with diabetes. In normal weight patients with type 1 diabetes, optimal glycemic control is the major target of counselling. In patients with type 2 diabetes, reduction of cardiovascular risk is also in the focus of therapy. In contrast to non-diabetic patients the treatment of dyslipidemia in type 2 diabetes not only requires lowering of LDL cholesterol by limitation of saturated fat intake but also needs a strategy for reduction of triglyceride levels. Both therapeutic aims can be best achieved by a high fiber low glycemic load diet with a high proportion of oleic acid.
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Cunha, F. M., P. Lourenço, M. Couto, P. Tavares, S. Silva, J. T. Guimarães, and P. Bettencourt. "Is the Blood Pressure Paradox Observed in All Heart Failure Patients?" BioMed Research International 2013 (2013): 1–7. http://dx.doi.org/10.1155/2013/350289.
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Background.Heart failure (HF) patients with higher systolic blood pressure (SBP) survive longer. Diabetes mellitus (DM) is a frequent comorbidity in HF. We evaluated the prognostic significance of low SBP according to DM in acute HF.Methods.We prospectively recruited 589 patients admitted with acute HF. DM was defined according to the 2011 American Diabetes Association recommendations. Patients were followed for 6 months and HF-death was the endpoint. A multivariate Cox-regression model was used to assess the prognostic impact of SBP. A stratified analysis according to DM was performed.Results.Median patients’ age was 79 years and DM was present in 50.8%. Ischemic aetiology HF and hypertension history were more common in diabetics. Diabetic patients had worse renal function and lower total cholesterol and were more often discharged with antiplatelet therapy and statin. During followup, 89 patients died due to HF. The multivariate-adjusted HR for the 6-month HF death in non-diabetic patients with an admission SBP < 115 mmHg (1st quartile) was 2.94 (95% CI: 1.49–5.79), while lower admission SBP was not associated with HF mortality in diabetics.Conclusions.The blood pressure paradox in HF is only observed in non-diabetic HF patients. Diabetic patients seem to be a particular subgroup of HF patients.
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Gargouri, Manel, Houda Hamed, Amel Akrouti, Xavier Dauvergne, Christian Magné, and Abdelfattah El Feki. "Effects ofSpirulina platensison lipid peroxidation, antioxidant defenses, and tissue damage in kidney of alloxan-induced diabetic rats." Applied Physiology, Nutrition, and Metabolism 43, no. 4 (April 2018): 345–54. http://dx.doi.org/10.1139/apnm-2017-0461.
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Chronic hyperglycemia in diabetes causes free radicals overproduction, which contributes to the development of diabetic nephropathy. In modern medicine, no satisfactory therapy is available to cure diabetes mellitus. In that context, we investigated the potential therapeutic action of spirulina-enriched diet on renal impairment and oxidative stress in diabetic rats. Diabetes was induced by a single subcutaneous injection of alloxan (120 mg·kg−1) in rats. Following alloxan treatment, male Wistar rats were fed daily with 5% spirulina-enriched diet or treated with insulin (0.5 IU·rat−1) for 3 weeks. Diabetes was associated with hyperglycemia, increase in renal oxidative parameters (lipid peroxidation, thiobarbituric-acid reactive substances, protein carbonyl and advanced oxidation protein products levels, changes in antioxidant enzyme activities), and nephropathology markers. The renal injury induced by alloxan was confirmed by histological study of the diabetic rat kidney. Treatment with spirulina or insulin significantly ameliorated renal dysfunction by reducing oxidative stress, while rats recovered normal kidney histology. Overall, this study indicates that spirulina is efficient in inhibiting hyperglycemia and oxidative stress induced by diabetes, and suggests that the administration of this alga may be helpful in the prevention of diabetic complications. This amelioration was even more pronounced than that caused by insulin injection.
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Cannata, Francesca, Gianluca Vadalà, Fabrizio Russo, Rocco Papalia, Nicola Napoli, and Paolo Pozzilli. "Beneficial Effects of Physical Activity in Diabetic Patients." Journal of Functional Morphology and Kinesiology 5, no. 3 (September 4, 2020): 70. http://dx.doi.org/10.3390/jfmk5030070.
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One of the main goals of diabetic therapy is to achieve the best metabolic control to prevent the development and progression of potential complications. A multidisciplinary approach characterized by the combination of diet, physical activity (PA) and drug therapy with oral and injectable (non-insulin) pharmacological agents, is desirable to optimize metabolic control. The aim of this review is to explain the contribution of PA and its beneficial effects on patients affected by type 1 (T1D) and type 2 diabetes (T2D). We provide an overview of evidence on the effects of PA for the main two types of diabetes mellitus (DM) to identify the right level of PA to be recommended. We discuss the physiological and clinical role of PA in people with DM. It can be concluded that the objective of antidiabetic therapy should be the achievement and optimization of metabolic control through a multidisciplinary approach involving non-pharmacological therapy such as diet and PA, which has a crucial role.
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Ishida, Hitoshi. "12. Diet Therapy Suitable for Japanese Diabetic Patients." Nihon Naika Gakkai Zasshi 104, Suppl (2015): 124a. http://dx.doi.org/10.2169/naika.104.124a.
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Ishida, Hitoshi. "12. Diet Therapy Suitable for Japanese Diabetic Patients." Nihon Naika Gakkai Zasshi 104, no. 9 (2015): 1993–2000. http://dx.doi.org/10.2169/naika.104.1993.
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Kanazawa, Yoshie, and Toshiyuki Nakao. "Studies on diet therapy in diabetic dialysis patients." Journal of Japanese Society for Dialysis Therapy 21, no. 9 (1988): 825–30. http://dx.doi.org/10.4009/jsdt1985.21.825.
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Gross, Benjamin. "Clinical Pearls for Initiating and Utilizing Liraglutide in Patients With Type 2 Diabetes." Journal of Pharmacy Practice 26, no. 2 (December 2, 2012): 144–50. http://dx.doi.org/10.1177/0897190012465985.
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This review presents clinical pearls for initiating liraglutide (Victoza®, Novo Nordisk Inc) therapy for the management of type 2 diabetes and selecting patients who will benefit from liraglutide therapy. Liraglutide, a once-daily glucagon-like peptide 1 receptor agonist, is Food and Drug Administration approved as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes. Liraglutide is effective for reducing hemoglobin A1c levels by 0.8% to 1.5% in patients with type 2 diabetes as monotherapy or in combination with other diabetic medications (such as metformin, sulfonylureas, rosiglitazone, or basal insulin) when compared with placebo and these other diabetic medications, including exenatide. Overweight or obese patients with type 2 diabetes or those with insulin resistance are good candidates for liraglutide therapy because liraglutide use is associated with weight loss (about 2%-4% of initial body weight) and improved β-cell function. The incidence of hypoglycemia with liraglutide is low; therefore, liraglutide would be a safe therapy choice for patients at risk or with a history of symptomatic or severe hypoglycemia. Nausea seems to be the most problematic adverse effect associated with liraglutide therapy, but it is usually transient and is minimized with dose titration.
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Arbatskaya, Natalia Yuryevna, Nadezhda Gennadjevna Ignatova, Marina Vladislavovna Moldovanova, Elena Petrovna Melnikova, and Violetta Vladimirovna Kandalina. "The role of dietotherapy in prevention of a diabetic fetopathy at women with gestational diabetes mellitus." Journal of obstetrics and women's diseases 62, no. 3 (June 15, 2013): 9–15. http://dx.doi.org/10.17816/jowd6239-15.
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The Gestational Diabetes Mellitus (GDM) is the disease, being characterized a hyperglycemia for the first time revealed during pregnancy. The main method of GDM treatment is diet. During our research we compared efficiency of different recommendations about a diet therapy in prevention of macrosomia, the birth with large gestation age (LGA) and other diabetic fetopathy (DF) manifestations. Our results showed that a diet with a low and medium glycemic index of products, a fractional food taking into account physiological secretion of insulin and insulinoresistance during pregnancy allows to achieve a target values of glucose from pregnant women with GDM, decrease the frequency of purpose of insulin therapy because of pre-natal manifestations of DF, decrease the risk of macrosomia development and frequency of cesarean section in connection with the LGA a fetus.
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Razak, Adil, and Abdul Aziez Isaacs. "Implementation and evaluation of a weight-reduction programme for diabetic patients at a primary health care facility in the Western Cape: a pilot study." South African Family Practice 59, no. 2 (December 5, 2017): 34. http://dx.doi.org/10.4102/safp.v59i6.4637.
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Background: Diabetes is a common non-communicable disease and complications are resulting in increased disability, reduced life expectancy and enormous health costs for virtually every society. Medical Nutrition Therapy is important for the prevention, treatment, and self-management of diabetes, and the prevention or delay in onset of diabetes-related complications. The current nutritional guidelines for diabetes state that carbohydrates should comprise 45–60% of the total nutritional intake and that lowcarbohydrate or high-protein diets offer no long-term success over healthy eating plans. Recent studies suggest that there may be merit in using low-carbohydrate diets in diabetic patients for weight reduction and improved cardiovascular markers. This study aimed to implement and evaluate a pilot programme for weight loss in diabetes mellitus type 2 patients by comparing a low-carbohydrate diet with the conventional low-fat diet.
Methods: The study design was that of a two-group parallel design, with one group following a low-fat diet and the other a low-carbohydrate diet. Diabetic patients attending the Mitchell’s Plain Community Health Centre in Cape Town were recruited, with 10 participants in each group. Both groups received similar advice on exercise and behaviour change. Changes in weight, waist circumference, blood pressure and blood parameters (creatinine, lipids and HbA1c) were recorded at baseline and again after 12 weeks.
Results: There were reductions in weight (1.85 kg vs. 0.1 kg gain) and HbA1c (1.72 vs. 0.32) in the low-carbohydrate diet group when compared with the low-fat diet group. No significant change was seen in other parameters including BP, total cholesterol and serum creatinine for either group.
Conclusion: Low-carbohydrate diets may be effective in promoting weight loss and improving glucose control in diabetic patients. Implementation of this programme would require a paradigm shift for staff and further studies to assess its acceptability for patients.
(Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1329490
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Petrėtis, Vilius, Jonas Činčikas, and Audrius Gradauskas. "Diabetinės pėdos gydymo patirtis Vilniaus miesto universitetinės ligoninės bendrosios chirurgijos skyriuose." Lietuvos chirurgija 1, no. 4 (January 1, 2003): 0. http://dx.doi.org/10.15388/lietchirur.2003.4.2392.
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Vilius Petrėtis1, Jonas Činčikas1, Audrius Gradauskas21 Vilniaus miesto universitetinės ligoninės Chirurgijos klinikaAntakalnio g. 57, LT-2040 Vilnius2 Vilniaus universiteto Medicinos fakultetoBendrosios medicinos praktikos ir slaugos katedraVilniaus miesto universitetinės ligoninės Chirurgijos klinikaAntakalnio g. 57, Vilnius, LT-2040 VilniusEl paštas: wiliux@vlk.lt Įvadas / tikslai Daugiau nei 60% kojų amputacijų priežastis – cukrinis diabetas. Mirštamumas po amputacijų Lietuvos ligoninėse svyruoja nuo 5 iki 37%. Pagrindinė invalidumo ir mirštamumo priežastis – pėdos infekcija, gangrena, sepsis, širdies ir plaučių komplikacijos. Periferinės neuropatijos, neuroischemijos ir infekcijos derinys skatina diabetinių opų raidą, o uždelsus padidėja gangrenos ir amputacijos tikimybė. Vis dėlto dažnai pėdos opų ir apatinės galūnės amputacijos būtų galima išvengti. Diabetinės pėdos profilaktika turėtų būti pradėta iškart diagnozavus cukrinį diabetą. Klinikiniais tyrimais įrodyta, kad įvairių specialistų gebėjimas kartu gydyti diabetinės pėdos sindromą yra viena svarbiausių sąlygų sumažinti apatinių galūnių amputacijų skaičių. Kompleksinė daugiaprofilinė pagalba yra veiksmingas diabetinės opos gydymo metodas. Todėl pacientams, kuriems labiau nei kitiems gresia diabetinės pėdos sindromas, būtinos kraujagyslių chirurgų, endokrinologų, bendrosios chirurgijos bei diabetinės pėdos specialistų konsultacijos ir nuolatinė kontrolė. Mes šią problemą norime panagrinėti bendrosios chirurgijos aspektu. Tyrimo tikslas: panagrinėti diabetinės pėdos gydymo taktiką, veiksnius, skatinančius apatinės galūnės gangreną esant diabetinei pėdai, vyraujančius mikroorganizmus ir jų jautrumą antibiotikams. Metodai 1992–2002 metais Vilniaus miesto universitetinės ligoninės (VMUL) bendrosios chirurgijos skyriuose buvo hospitalizuotas 441 ligonis, sergantis diabetinės pėdos sindromu. Duomenys rinkti pildant specialiai sudarytas anketas. Rezultatai Pagrindinis diabetinės pėdos sindromo gydymo tikslas – išsaugoti galūnę, o išplitus infekcijai – išgelbėti ligonio gyvybę. Dėl diabetinės pėdos sindromo hospitalizuotų ligonių gydymas galėtų būti skirstomas į bendrąjį ir vietinį. Bendrajam diabetinės pėdos sindromo gydymui priskirtina visų pirma glikemijos kontrolė, o prisidėjus infekcijai – antibakterinis gydymas. Esant išplitusiai infekcijai, sepsiui, gelbstint ligonio gyvybę atliekama radikali chirurginė operacija – galūnės amputacija. Vietiniam diabetinės pėdos sindromo gydymui priskirtume pėdos chirurgiją ir infekuotos diabetinės pėdos drenavimą, plovimą, negyvybingų audinių šalinimą. Bendrosios chirurgijos skyriuose taikomos ir kitos, pagalbinės, gydymo priemonės, pavyzdžiui, hiperbarinė oksigenoterapija. Nustatėme, kad VMUL bendrosios chirurgijos skyriuose iš 441 hospitalizuoto ligonio 71,7% buvo operuoti. Vidutiniškai vienam dėl diabetinės pėdos sindromo hospitalizuotam ligoniui tenka 1,07 operacijos, arba vienam nuo diabetinės pėdos sindromo operuotam pacientui tenka 1,5 operacijos. Nagrinėjant mikroorganizmų paplitimą diabetinės pėdos žaizdose paaiškėjo, kad tik iš 46% diabetinių žaizdų buvo imtas pasėlis mikroorganizmams nustatyti. Iš viso išaugintos 323 mikroorganizmų kolonijos. Vienas sukėlėjas nustatytas 54,5% pasėlių, du mikroorganizmai – 29,6%, trys – 11,1%, keturi ir daugiau – 4,8% pasėlių. Vyrauja gramteigiami aerobai, sudarantys 61,9% visų pasėlių. Iš jų dažniausiai pasitaiko Staphylococcus aureus (36,2%), o 12% atvejų išauginti meticilinui atsparūs stafilokokai (MRSA). Nustatyta, kad vidutiniškai iki 31,1% ligonių anksčiau buvo hospitalizuoti dėl diabetinės pėdos sindromo komplikacijų. VMUL bendrosios chirurgijos skyriuose 7,7% hospitalizuotų ligonių atlikta amputacija virš kelio, 23,4% – žemiau kelio sąnario. 59,6% ligonių išgydyti. Hospitalizavimo metu mirė 9,3% ligonių. Trys pagrindinės mirties priežastys: sepsis ir septicemija, miokardo infarktas, širdies veiklos nepakankamumas. Kitos mirties priežastys: plaučių arterijos trombembolija, terminalinis inkstų funkcijos nepakankamumas, hipoglikeminė koma, prakiurusi dvylikapirštės žarnos opa. Vidutinis mirusių pacientų amžius – 68,4 metų. Paaiškėjo, kad diabetinės pėdos sindromo baigtis nepriklauso nuo cukrinio diabeto tipo. Išvados Kasmet vidutiniškai 0,5% pacientų hospitalizuojama dėl diabetinės pėdos sindromo VMUL bendrosios chirurgijos skyriuose. Apie 60% šių pacientų pavyksta išgydyti, tačiau nemaža dalis netenka galūnės (7,7%) aukščiau kelio sąnario ar miršta (9,3%) hospitalizavimo metu. Vienuolikos pacientų mirties priežastys buvo tiesiogiai susijusios su diabetinės pėdos sindromu (sepsis, septicemija), vieno – su pačiu diabetu (hipoglikeminė koma). Kitų pacientų mirties priežastys – gretutinės ligos. Tik glaudus ir darnus endokrinologų, kraujagyslių ir bendrosios chirurgijos specialistų darbas galėtų sumažinti amputacijų ir mirčių nuo diabetinės pėdos sindromo skaičių. Diabetinės pėdos opose vyrauja polimikrobinė flora. Dažniausias infekcijos sukėlėjas – St.aureus, kuris buvo jautriausias oksacilinui, gentamicinui, eritromicinui, cefazolinui. Meticilinui atsparus stafilokokas nustatytas 12% atvejų. Prasminai žodžiai: cukrinis diabetas, diabetinė pėda, gydymo patirtis, baigtys Experience of treatment of diabetic foot at Vilnius City University Hospital departments of general surgery Vilius Petrėtis1, Jonas Činčikas1, Audrius Gradauskas2 Background / objective More than 60% of lower extremity amputations are due to diabetes mellitus. In Lithuania, in-hospital mortality after amputations varies from 5 to 37%. The main causes of invalidity and mortality are foot infection or gangrene, sepsis and complications of the heart and lungs. A combination of peripheral neuropathy, ischemic vascular disease and infection facilitate diabetic ulcer development, which can lead to gangrene and amputation. However, in many cases foot ulcers and amputation can be prevented. The work of prevention begins with the initial diagnosis of diabetes. Attempts to reduce the incidence of lower extremity amputations have shown that multi-disciplinary team management is one of the more effective means of accomplishing this goal. A complex multi-disciplinary team, including vascular surgeon, endocrinologist, general surgeon, podiatrist consultations and continuous control are vital for patients with diabetic foot syndrome. The topics were analyzed from general surgeon's point of view. The objective of this analysis was to find the experience of treatment of diabetic foot syndrome, factors inducing gangrene of lower extremity, dominant microorganisms and their susceptibility to antibiotics in diabetic foot wounds. Methods At Vilnius City University Hospital departments of general surgery, from 1992 to 2002 441 patients with diabetic foot syndrome were hospitalized. The data were collected by filling in a questionnaire. Results The main goal in the treatment of diabetic foot syndrome is to save the extremity or in the case of life-threatening infection to save the patient's life. Treatment of diabetic foot syndrome could be categorized into general and local. For the general treatment of diabetic foot we resort first of all to glycemic control and in the case of infection to antibiotic therapy. If a life-threatening infection, sepsis occurs, radical surgical intervention – amputation of lower extremity – is performed. For the local treatment of diabetic foot we resort to foot surgery including dreinage, lavage and debridement. Also other therapies such as adjuvant means of treatment, e.g., hyperbaric oxygen therapy, are applied at Vilnius City University Hospital departments of general surgery. Of all the patients hospitalized for diabetic foot syndrome 71.7% were operated on. We analyzed the prevalence of microorganisms in diabetic foot wounds. Microbiological tests were taken only from 46% of all diabetic wounds. In total, 323 pathogens were isolated. One pathogen was found in 54.5%, two in 29.6%, three in 11.1%, four and more in 4.8% of all swabs. According to the data, in almost half of all swabs two or more pathogens were found. The most common species were Staphylococcus, Proteus, Streptococcus and Enterococcus. The predominant pathogenic organisms were Gram-positive aerobes found in 61.9% of swabs. Of the Gram-positive aerobes, St. aureus was found most frequently (36.2% of all swabs), and 12% were MRSA. We analyzed the outcomes of diabetic foot syndrome. Of all hospitalized patients, 31.1% had been ill with diabetic foot complications before hospitalization. At the departments of general surgery, 7.7% of hospitalized patients' extremities were amputated above the knee and 23.4% below the knee; 59.6% of patients were cured. We found that 9.3% of patients died during hospitalization; their mean age was 68.4 years. Three main causes of the lethal outcome were sepsis and septicemia, myocardial infarction and heart failure. Other causes were lung artery embolism, terminal insufficiency of renal function, hypoglycemic coma, perforated ulcer of the duodenum. Conclusions Approximately 0.5% of all patients of Vilnius City University Hospital departments of general surgery are hospitalized with diabetic foot syndrome every year. About 60% of patients were cured, but some patients were not: their extremities were amputated above the knee in 7.7% and 9.3% of patients died during hospitalization. Eleven cases of lethal outcome were directly associated with diabetic foot syndrome (sepsis, septicemia), one case with diabetes mellitus (hypoglycemic coma), and the other cases with concomitant and conterminous diseases. Only a multi-disciplinary team (including endocrinologists, vascular and general surgeons) applying a combined management of diabetic foot syndrome can reduce the prevalence of amputations and mortality in diabetic foot patients. In diabetic foot wounds polymicrobic flora was dominant. St.aureus was the sole pathogen most sensitive to oxaciline, gentamycine, erythromycine, cefazoline and 12% were MRSA. Keywords: diabetes mellitus, diabetic foot, experience of treatment, outcomes
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Lariviere, F., D. B. Kupranycz, J. L. Chiasson, and L. J. Hoffer. "Plasma leucine kinetics and urinary nitrogen excretion in intensively treated diabetes mellitus." American Journal of Physiology-Endocrinology and Metabolism 263, no. 1 (July 1, 1992): E173—E179. http://dx.doi.org/10.1152/ajpendo.1992.263.1.e173.
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It is well known that inadequate insulin therapy stimulates body protein loss in insulin-dependent diabetes mellitus (IDDM). It is less well known, however, that accelerated body protein loss (as indicated by increased leucine oxidation) occurs in IDDM even during conventional glycemic control. It is not known whether intensified insulin therapy fully normalizes protein oxidation or, more importantly, whether such therapy is sufficient to allow the adaptive decrease of protein oxidation that normally occurs when protein intake is restricted below the customary surfeit level. We used two measures of protein oxidation [daily urinary nitrogen (N) excretion over several days of intensive insulin therapy and plasma [1-13C]leucine oxidation during short-term strict euglycemia] to assess the response of 7 men with IDDM and 12 normal men after adaptation first to a control diet providing maintenance energy and conventional (surfeit) protein then to an isoenergetic protein-free diet. After adaptation to the protein-free diet and during short-term strict euglycemia achieved using intravenous insulin, leucine turnover and oxidation decreased equivalently in normal and diabetic subjects. However, daily urinary obligatory N excretion, which indicated the effect of the low-protein diet and intensive subcutaneous insulin therapy over several days, was increased by 18% in the diabetic group (P less than 0.05). Even mildly elevated average blood glucose values well within the guidelines for intensive therapy were strongly correlated with high rates of urinary N excretion (r = 0.97, P = 0.0002). Thus insulin therapy of IDDM that imposes strict euglycemia is compatible with a normal ability to diminish body protein oxidation in response to protein restriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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Akinnuga, Akinjide M., Olubayode Bamidele, and Anthony J. Adewumi. "Evaluation of Kidney Function Parameters in Diabetic Rats Following Virgin Coconut Oil Diet." Folia Medica 61, no. 2 (June 1, 2019): 249–57. http://dx.doi.org/10.2478/folmed-2018-0083.
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Abstract Background: Diabetes mellitus (DM) leads to disruption of kidney function parameters (KFPs) which are markers of kidney diseases, especially nephropathy. Virgin coconut oil (VCO) has been implicated in playing a significant role in DM management. However, its role on KFPs in DM is scarce. Aim: To evaluate the kidney function parameters following VCO diet in diabetic rats. Materials and methods: : Twenty-five (25) male rats of 150 – 200 g were divided into 5 groups (n=5): Non-diabetic control (Group 1), diabetes control (Group 2), diabetes + metformin (Group 3), diabetes + 10% VCO (Group 4) and diabetes + 20% VCO (Group 5). Apart from Group 1, other groups were given intraperitone-ally 50 mg/kg of streptozotocin to induce diabetes mellitus. After 72 hours, fasting hyperglycaemia was confirmed by glucose oxidase method. All the rats were fed normal rat chow for 8 weeks. At 8th week, serum and urine samples were analysed for biochemical analysis. After 8 weeks, Group 1 and Group 2 continued to be fed on normal rat chow while other groups were treated with diets (VCO) or drug (metformin) for 4 weeks. At 12th week, urine samples were collected for biochemical analysis, the rats were sacrificed, and blood samples were collected by cardiac puncture. Results: There were significant differences in some KFPs in diabetes control (Group 2) compared to other experimental groups. However, there was no significant difference in glomerular filtration rate (GFR) and serum sodium in all the groups. Conclusion: VCO supplementary diet improved the altered KFPs and could be a therapy for kidney problems.