In subjects with type 2 diabetes inadequately controlled with oral antidiabetic agents （OADs）, insulin therapy is usually started to improve glycaemic control after failure of diet, exercise and OADs.1 Although ther...In subjects with type 2 diabetes inadequately controlled with oral antidiabetic agents （OADs）, insulin therapy is usually started to improve glycaemic control after failure of diet, exercise and OADs.1 Although there is no standard way to introduce insulin treatment, premixed formulations are a popular option. They offer an alternative to basal-bolus therapy and provide basal and prandial coverage with a single injection. Indeed, Koivisto et al2 in 1999 reported that 39% of patients with type 2 diabetes worldwide used premixed insulin as part of their therapeutic regimen, The modern premixed insulins, such as biphasic insulin aspart 30 （BIAsp 30） are most frequently prescribed twice-daily （BID） in clinical practice. However,展开更多
The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and...The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and fatty acids generates metabolic coupling factors(such as ATP, NADPH, glutamate, long chain acyl-CoA and diacylglycerol) which trigger insulin secretion. The observation of protein induced hypoglycaemia in patients with mutations in GLUD1 gene, encoding the enzyme glutamate dehydrogenase(GDH) and HADH gene, encoding for the enzyme short-chain 3-hydroxyacyl-CoA dehydrogenase has provided new mechanistic insights into the regulation of insulin secretion by amino acid and fatty acid metabolism. Metabolic signals arising from amino acid and fatty acid metabolism converge on the enzyme GDH which integrates both signals from both pathways and controls insulin secretion. Hence GDH seems to play a pivotal role in regulating both amino acid and fatty acid metabolism.展开更多
Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.L...Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.展开更多
Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication ...Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication with limited study of its burden, knowledge, determinants and preventive measures adopted by type 2 diabetics. Methods: Patients with type 2 diabetes who presented at Diabetes Clinic of a University teaching hospital and fulfilled selection criteria were recruited. The information obtained included sociodemographic, clinical details with hypoglycaemic symptoms and laboratory measurements. Results: There were 113 participants with a mean age of 60.94 ± 11.95 years. The majority of the patients had fair knowledge of hypoglycaemic symptoms and also knew what actions to take to ameliorate the symptoms when it occurs. The incidence of hypoglycaemia was 45.1% and most commonly occurred in the afternoon before lunch. The commonest symptoms reported by patients were shivering (76.1%), hunger (71.7%) sweatiness (71.5%) and weakness (69.9%). Almost one-fifth (19.6%) of those who reported hypoglycaemia had severe symptoms, of which 16.1% had hospital admission for its management. Use of insulin, duration of diabetes, age and possession of glucometers were some of the determinants of hypoglycaemic symptoms. Conclusions:?The burden of reported hypoglycaemia among type 2 diabetics is significant. Hence, diabetics at risk should always be asked about symptoms at each clinic visit. Early recognition of hypoglycaemia risks, self-monitoring of blood glucose (SMBG), appropriate education programs for both health care providers and patients with diabetes are the major ways to minimize risks of hypoglycaemia.展开更多
文摘In subjects with type 2 diabetes inadequately controlled with oral antidiabetic agents （OADs）, insulin therapy is usually started to improve glycaemic control after failure of diet, exercise and OADs.1 Although there is no standard way to introduce insulin treatment, premixed formulations are a popular option. They offer an alternative to basal-bolus therapy and provide basal and prandial coverage with a single injection. Indeed, Koivisto et al2 in 1999 reported that 39% of patients with type 2 diabetes worldwide used premixed insulin as part of their therapeutic regimen, The modern premixed insulins, such as biphasic insulin aspart 30 （BIAsp 30） are most frequently prescribed twice-daily （BID） in clinical practice. However,
文摘The interplay between glucose metabolism and that of the two other primary nutrient classes, amino acids and fatty acids is critical for regulated insulin secretion. Mitochondrial metabolism of glucose, amino acid and fatty acids generates metabolic coupling factors(such as ATP, NADPH, glutamate, long chain acyl-CoA and diacylglycerol) which trigger insulin secretion. The observation of protein induced hypoglycaemia in patients with mutations in GLUD1 gene, encoding the enzyme glutamate dehydrogenase(GDH) and HADH gene, encoding for the enzyme short-chain 3-hydroxyacyl-CoA dehydrogenase has provided new mechanistic insights into the regulation of insulin secretion by amino acid and fatty acid metabolism. Metabolic signals arising from amino acid and fatty acid metabolism converge on the enzyme GDH which integrates both signals from both pathways and controls insulin secretion. Hence GDH seems to play a pivotal role in regulating both amino acid and fatty acid metabolism.
文摘Maternal hypoglycemia,a condition characterized by lower than normal blood glucose levels in pregnant women,has been increasingly associated with adverse pregnancy outcomes,including low birth weight(LBW)in neonates.LBW,defined as a birth weight of less than 2500 g,can result from various factors,including maternal nutrition,health status,and metabolic conditions like hypoglycemia.Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus,leading to restricted fetal development and growth.This condition poses significant risks not only during pregnancy but also for the long-term health of the child,increasing the likelihood of developmental delays,health issues,and chronic conditions later in life.Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development,with studies suggesting that alterations in placental blood flow and nutrient transport,as well as direct effects on fetal insulin levels and metabolism,may play a role.Given the potential impact of maternal hypoglycemia on neonatal health outcomes,early detection and management are crucial to minimize risks for LBW and its associated complications.Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth,as well as to develop targeted interventions to support the health of both mother and child.Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.
文摘Introduction: Hypoglycaemia is a frequent and serious adverse effect of anti-diabetic therapy associated with both immediate and delayed adverse clinical outcomes. However, it continues to be a neglected complication with limited study of its burden, knowledge, determinants and preventive measures adopted by type 2 diabetics. Methods: Patients with type 2 diabetes who presented at Diabetes Clinic of a University teaching hospital and fulfilled selection criteria were recruited. The information obtained included sociodemographic, clinical details with hypoglycaemic symptoms and laboratory measurements. Results: There were 113 participants with a mean age of 60.94 ± 11.95 years. The majority of the patients had fair knowledge of hypoglycaemic symptoms and also knew what actions to take to ameliorate the symptoms when it occurs. The incidence of hypoglycaemia was 45.1% and most commonly occurred in the afternoon before lunch. The commonest symptoms reported by patients were shivering (76.1%), hunger (71.7%) sweatiness (71.5%) and weakness (69.9%). Almost one-fifth (19.6%) of those who reported hypoglycaemia had severe symptoms, of which 16.1% had hospital admission for its management. Use of insulin, duration of diabetes, age and possession of glucometers were some of the determinants of hypoglycaemic symptoms. Conclusions:?The burden of reported hypoglycaemia among type 2 diabetics is significant. Hence, diabetics at risk should always be asked about symptoms at each clinic visit. Early recognition of hypoglycaemia risks, self-monitoring of blood glucose (SMBG), appropriate education programs for both health care providers and patients with diabetes are the major ways to minimize risks of hypoglycaemia.
