Insulin-induced lypodistrophy in hemodialyzed patients: a new challenge for nephrologists?

Publication date: Available online 14 November 2019Source: Diabetes &Metabolic Syndrome: Clinical Research &ReviewsAuthor(s): S. Gentile, F. Strollo, E. Satta, T. Della-Corte, C. Romano, G. Guarino, Nefrocenter Research Study Group: Nephrologists, Diabetologists, NursesSummaryDiabetes Mellitus (DM) is the most common cause of renal failure and ESRD all over the world, and often requires an individualized insulin treatment regimen. Malnutrition, depression-related eating behavior changes, high on-off-dialysis day-to-day glycemic variability and frequent hypoglycemic events occurring during or immediately after dialysis make it hard to identify best insulin dosage in hemodialyzed patients. This suggests a prudent attitude including non-stringent control, despite which repeated hypoglycemia quite often occurs in such patients. When looking for possible sources of hypoglycemia, health professionals too often overlook the identification of skin lipodystrophy (LD) due to an incorrect insulin injection technique. This mini-review focuses on the high frequency (57%) of LD in a cohort of 1004 insulin-treated people with DM on dialysis consecutively referring to our joint medical centers, and on its relationship with hypoglycemia and glycemic control/variability. When taking on such patients, care team members accept to face a complex disease burdened with several risk factors requiring high professional skills, and have to keep in mind also the possible presence of any LD area...
Source: Diabetes and Metabolic Syndrome: Clinical Research and Reviews - Category: Endocrinology Source Type: research

Related Links:

Conclusion: Experiencing defibrillator shocks was associated with psychological distress in ICD recipients; the relationship was fully mediated by ICD-related concerns and perceived control. These results suggest that clinicians should routinely assess ICD-related concerns and perceived control in patients with ICD. Research is needed to develop and test interventions to decrease emotional distress related to the ICD shock experience.
Source: Journal of Cardiovascular Nursing - Category: Nursing Tags: ARTICLES: Cardiovascular Disease Source Type: research
Dexcom Learns a Valuable Lesson  A major server outage rattled Dexcom customers – particularly parents of diabetic children – over the U.S. Thanksgiving holiday weekend. But most were not as mad about the technology glitch as they were about the company's lack of communication about the issue. Dexcom has since fixed the problem and promised to communicate better with customers going forward.   Vicarious Surgical Scores Breakthrough Designation for Surgical Robot Vicarious Surgical is now the first to receive a breakthrough device designatio...
Source: MDDI - Category: Medical Devices Authors: Tags: Business Source Type: news
Authors: Fang L, Xu Z, Lu J, Hong L, Qiao S, Liu L, An J Abstract Hypothyroidism is associated with profound left ventricular dysfunction. Triiodothyronine (T3) supplementation may improve cardiac function after ischemic reperfusion (I/R) injury. In the present study, the effect of T3 on major calcium cycling proteins and high-energy phosphate content during I/R was evaluated. Isolated perfused rat hearts were divided into 5 groups: Sham Control (Sham, n=10), Control (n=8), T3 10 nM (T3-10, n=10), T3 25 nM (T3-25, n=10) and T3 50 nM (T3-50, n=10). T3 was administrated for 60 min before 30 min of ischemia and 120 mi...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
Authors: Wang W, Zhang L, Wang X, Lin D, Pan Q, Guo L Abstract Pioglitazone, a type of insulin sensitizer, serves as an effective anti-hyperglycemic drug. The mechanism of action of pioglitazone is through the activation of the peroxisome proliferator-activated receptor (PPAR), which results in enhanced insulin sensitivity of peripheral tissues and the liver, causing a reduction in the production and output of liver sugar. It has been reported that pioglitazone increases the risk of bladder cancer, but the underlying mechanisms have remained elusive. It was hypothesized that modulation of pioglitazone activity may ...
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
Conclusions: Knowledge of HIV status, be it positive or negative, was significantly associated with a decrease in depressive symptoms in 2 FSW populations. The expansion of HIV testing programs may have mental health benefits for FSWs.
Source: JAIDS Journal of Acquired Immune Deficiency Syndromes - Category: Infectious Diseases Tags: Prevention Research Source Type: research
Conclusions: Steato-ELSA is an accurate and inexpensive tool that uses simple parameters to identify individuals at high risk of liver steatosis.
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: ONLINE ARTICLE: Original Article Source Type: research
Conclusions: Our estimated rates of prevalence of GP in T1DM and T2DM indicate that GP is not a common clinical complication in these populations. Majority of EMRs that indicated a diagnosis of GP did not include any documentation of definitive diagnostic testing (EGD and/or GES).
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: ALIMENTARY TRACT: Original Articles Source Type: research
Background and Aims: Gender disparities exist in outcomes among patients with cirrhosis. We sought to evaluate the role of gender on hospital course and in-hospital outcomes in patients with cirrhosis to help better understand these disparities. Study: We analyzed data from the National Inpatient Sample (NIS), years 2009 to 2013, to identify patients with any diagnosis of cirrhosis. We calculated demographic and clinical characteristics by gender, as well as cirrhosis complications. Our primary outcome was inpatient mortality. We used logistic regression to associate baseline characteristics and cirrhosis complication...
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: LIVER, PANCREAS & BILIARY TRACT: Original Articles Source Type: research
CONCLUSIONS: Comorbidities play an important role in the hospital management of COPD exacerbation, increasing health care costs related to this disease. PMID: 28925473 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
In conclusion, documentation is important, a critical part of advocacy and the development process at the larger scale. It isn't just words, but rather a vital structural flow of information from one part of the larger community to another, necessary to sustain progress in any complex field. We would all do well to remember this - and to see that building this documentation is an activity in which we can all pitch in to help. Evidence Suggests that, at Least in Earlier Stages, Alzheimer's Disease Blocks Rather than Destroys Memories
Source: Fight Aging! - Category: Research Authors: Tags: Newsletters Source Type: blogs
More News: Depression | Diabetes | Dialysis | Education | Endocrinology | Insulin | Metabolic Syndrome | Nursing | Renal Failure | Skin | Study | Urology & Nephrology