Portable inhalation systemfor a dosed insulin supply

Интенсивная инсулинотерапия необходима для контроля состояния пациентов с диабетом.Несмотря на постоянное усовершенствование инсулинотерапии, все ещ? существует проблема неудобства режимов многократных инъекций инсулина. Целью данной работы является создание системы, позволяющей осуществлять ингаляцию инсулина.Intensive insulin therapy is necessary for the control of a condition diabetic patients. Despite the constant improvement of insulin therapy, there is still the problem of discomfort repeated regimes of insulin injections. The objective of this work is to create a system that allows the inhalation of insulin

Portable inhalation systemfor a dosed insulin supply

Интенсивная инсулинотерапия необходима для контроля состояния пациентов с диабетом.Несмотря на постоянное усовершенствование инсулинотерапии, все ещ? существует проблема неудобства режимов многократных инъекций инсулина. Целью данной работы является создание системы, позволяющей осуществлять ингаляцию инсулина.Intensive insulin therapy is necessary for the control of a condition diabetic patients. Despite the constant improvement of insulin therapy, there is still the problem of discomfort repeated regimes of insulin injections. The objective of this work is to create a system that allows the inhalation of insulin

The Effects of Exercise Training on Insulin Supply and Demand in Breast Cancer Survivors

Elevated insulin concentrations may influence cancer and cardiometabolic disease onset and prognosis, and lower insulin levels after exercise may contribute to disease prevention and overall health. The effect of exercise training on systemic and tissue-specific insulin supply and demand in breast cancer survivors and adults at risk for cardiometabolic disease is unclear. The objective of this dissertation was to evaluate the effects of exercise training on postmeal insulin concentrations in breast cancer survivors, and identify mechanisms responsible for changes to insulin supply and demand following exercise training in breast cancer survivors and adults at risk for cardiometabolic disease. Study 1 investigated differences between systemic and tissue-specific responses to exercise training and/or the anti-diabetes drug metformin in adults with prediabetes. Fasting proinsulin concentrations were lower following combined exercise and metformin (-24%), and insulin clearance was higher in the metformin and combined exercise and metformin groups (+19% and +17%). There were no differences in the exercise or placebo group, and taken together with previous work from our lab, suggests that exercise regulates insulin supply and demand systemically, while pharmacological adaptations may be tissue-specific. Study 2 evaluated the effects of physical activity on postmeal insulin concentrations in breast cancer survivors. Fifteen women completed 12 weeks of exercise training with pre- and post-intervention oral glucose tolerance testing. Insulin concentrations 120 minutes following glucose ingestion decreased (68.8±34.5 vs. 56.2±31.9 uU/ml, p Study 3 assessed the specific components of insulin supply and demand that may contribute to the blunted or absent postmeal insulin response observed in study 2. There was a significant increase in estimated skeletal muscle glucose uptake following exercise training (5.7±1.8 vs. 7.2 ±1.8, mmo*pmol*kg/m2

Optimal Regulation of Blood Glucose Level in Type I Diabetes using Insulin and Glucagon

The Glucose-Insulin-Glucagon nonlinear model [1-4] accurately describes how the body responds to exogenously supplied insulin and glucagon in patients affected by Type I diabetes. Based on this model, we design infusion rates of either insulin (monotherapy) or insulin and glucagon (dual therapy) that can optimally maintain the blood glucose level within desired limits after consumption of a meal and prevent the onset of both hypoglycemia and hyperglycemia. This problem is formulated as a nonlinear optimal control problem, which we solve using the numerical optimal control package PSOPT. Interestingly, in the case of monotherapy, we find the optimal solution is close to the standard method of insulin based glucose regulation, which is to assume a variable amount of insulin half an hour before each meal. We also find that the optimal dual therapy (that uses both insulin and glucagon) is better able to regulate glucose as compared to using insulin alone. We also propose an ad-hoc rule for both the dosage and the time of delivery of insulin and glucagon.Comment: Accepted for publication in PLOS ON

Assessing health systems for type 1 diabetes in sub-Saharan Africa: developing a 'Rapid Assessment Protocol for Insulin Access'

BACKGROUND: In order to improve the health of people with Type 1 diabetes in developing countries, a clear analysis of the constraints to insulin access and diabetes care is needed. We developed a Rapid Assessment Protocol for Insulin Access, comprising a series of questionnaires as well as a protocol for the gathering of other data through site visits, discussions, and document reviews. METHODS: The Rapid Assessment Protocol for Insulin Access draws on the principles of Rapid Assessment Protocols which have been developed and implemented in several different areas. This protocol was adapted through a thorough literature review on diabetes, chronic condition management and medicine supply in developing countries. A visit to three countries in sub-Saharan Africa and meetings with different experts in the field of diabetes helped refine the questionnaires. Following the development of the questionnaires these were tested with various people familiar with diabetes and/or healthcare in developing countries. The Protocol was piloted in Mozambique then refined and had two further iterations in Zambia and Mali. Translations of questionnaires were made into local languages when necessary, with back translation to ensure precision. RESULTS: In each country the protocol was implemented in 3 areas – the capital city, a large urban centre and a predominantly rural area and their respective surroundings. Interviews were carried out by local teams trained on how to use the tool. Data was then collected and entered into a database for analysis. CONCLUSION: The Rapid Assessment Protocol for Insulin Access was developed to provide a situational analysis of Type 1 diabetes, in order to make recommendations to the national Ministries of Health and Diabetes Associations. It provided valuable information on patients' access to insulin, syringes, monitoring and care. It was thus able to sketch a picture of the health care system with regards to its ability to care for people with diabetes. In all countries where this tool was used the involvement of local stakeholders resulted in the process acting as a catalyst in bringing diabetes to the attention of the health authorities

Diabetes in Sub Saharan Africa 1999-2011: Epidemiology and Public Health Implications. A Systematic Review.

Diabetes prevalence is increasing globally, and Sub-Saharan Africa is no exception. With diverse health challenges, health authorities in Sub-Saharan Africa and international donors need robust data on the epidemiology and impact of diabetes in order to plan and prioritise their health programmes. This paper aims to provide a comprehensive and up-to-date review of the epidemiological trends and public health implications of diabetes in Sub-Saharan Africa. We conducted a systematic literature review of papers published on diabetes in Sub-Saharan Africa 1999-March 2011, providing data on diabetes prevalence, outcomes (chronic complications, infections, and mortality), access to diagnosis and care and economic impact. Type 2 diabetes accounts for well over 90% of diabetes in Sub-Saharan Africa, and population prevalence proportions ranged from 1% in rural Uganda to 12% in urban Kenya. Reported type 1 diabetes prevalence was low and ranged from 4 per 100,000 in Mozambique to 12 per 100,000 in Zambia. Gestational diabetes prevalence varied from 0% in Tanzania to 9% in Ethiopia. Proportions of patients with diabetic complications ranged from 7-63% for retinopathy, 27-66% for neuropathy, and 10-83% for microalbuminuria. Diabetes is likely to increase the risk of several important infections in the region, including tuberculosis, pneumonia and sepsis. Meanwhile, antiviral treatment for HIV increases the risk of obesity and insulin resistance. Five-year mortality proportions of patients with diabetes varied from 4-57%. Screening studies identified high proportions (> 40%) with previously undiagnosed diabetes, and low levels of adequate glucose control among previously diagnosed diabetics. Barriers to accessing diagnosis and treatment included a lack of diagnostic tools and glucose monitoring equipment and high cost of diabetes treatment. The total annual cost of diabetes in the region was estimated at US$67.03 billion, or US$8836 per diabetic patient. Diabetes exerts a significant burden in the region, and this is expected to increase. Many diabetic patients face significant challenges accessing diagnosis and treatment, which contributes to the high mortality and prevalence of complications observed. The significant interactions between diabetes and important infectious diseases highlight the need and opportunity for health planners to develop integrated responses to communicable and non-communicable diseases

Insulin Injections Promote the Growth of Aberrant Crypt Foci in the Colon of Rats

The main objective of the present study was to test the hypothesis that exogenous insulin would enhance colon carcinogenesis. Thirty-six female F344 rats, fed ad libitum a low fat rodent chow, received a single azoxymethane injection (20 mg/kg), and were randomized a week later to two groups. Control rats were given 5 days a week a s.c. saline injection, and experimental rats were given ultralente bovine insulin, 20 U/kg. The promoting effect of insulin injections was assessed by the multiplicity (number of crypts) of aberrant crypt foci after 100 d of treatment (72 injections). The rats given insulin ate more and were heavier than controls (215 ± 11 vs. 182 ± 7 g, p<0.001). Insulin injections also increased the amount of abdominal fat, the plasma triglycerides, and the insulinemia, and decreased blood glucose (all p<0.05). The number of aberrant crypt foci was the same in both groups, but their multiplicity was significantly increased by the insulin injections (2.8 ± 0.3 vs. 2.5 ± 0.2 crypt/focus in controls, p=0.007). Besides, the proportion of sialomucin producing foci was higher in insulin injected rats than in controls (p=0.04). These data show that exogenous insulin can promote colon carcinogenesis in rats, and suggest that lifestyle and diets leading to low blood insulin might protect humans against colorectal cancer

A Survey of Insulin-Dependent Diabetes—Part II: Control Methods

We survey blood glucose control schemes for insulin-dependent diabetes therapies and systems. These schemes largely rely on mathematical models of the insulin-glucose relations, and these models are typically derived in an empirical or fundamental way. In an empirical way, the experimental insulin inputs and resulting blood-glucose outputs are used to generate a mathematical model, which includes a couple of equations approximating a very complex system. On the other hand, the insulin-glucose relation is also explained from the well-known facts of other biological mechanisms. Since these mechanisms are more or less related with each other, a mathematical model of the insulin-glucose system can be derived from these surrounding relations. This kind of method of the mathematical model derivation is called a fundamental method. Along with several mathematical models, researchers develop autonomous systems whether they involve medical devices or not to compensate metabolic disorders and these autonomous systems employ their own control methods. Basically, in insulin-dependent diabetes therapies, control methods are classified into three categories: open-loop, closed-loop, and partially closed-loop controls. The main difference among these methods is how much the systems are open to the outside people

Establishment of Structured Care Program for Children with Type 1 Diabetes in Low Income Countries: Integrated Management of Diabetes in Children (IMDC) Project in Sudan.

he Integrated Management of Diabetes in children (IMDC) is a program established to provide astructured care for children with type 1 diabetes in Gezira State, Sudan. It is a result of partnership between Faculty of Medicine –University of Gezira, World Diabetes Foundation and State Ministry of Health. This project has adopted a collaborative structure of providing care in health facilities, school and with the families. Partnership development with relevant sectors involved in diabetes care is one of the crucial strategies adopted to achieve the objectives. IMDC project develop the first management guidelines, train health personnel and teachers in schools and empower children and their families, produce  local education materials, and the establish reference laboratory and satellite clinics for diabetes care. In conclusion the care of children with diabetes needs collaboration between the health system, families and the schools. Partnership is crucial to implement programmes aiming at improving the care given to children with diabetes as each partner has a role in diabetes care continuum. Keywords: Diabete type 1, Sudan, Management, Childre