Continuous Subcutaneous Insulin Infusion: From 1 Different Sources
the administration of insulin by continuous infusion into the subcutaneous tissue via a small pump worn under the clothing and connected to the skin by a tube and a fine needle. The insulin is delivered at a precalculated background rate, but patient-activated *boluses can be administered at meal times. This method is particularly appropriate (as an alternative to regular injections) for patients with repeated or unpredictable episodes of hypoglycaemia.
An aqueous extract of one or a few herbs ; a common method for preparing tea (té); typically 2 teaspoons of dried plant material (1/4 cup if fresh) in 1 cup of hot (boiling) water, infused for 10-15 minutes; technically, an infusion is not boiled, whereas when making a decoction, the herbs are boiled in water. Most Dominican herbal remedies are prepared as decoctions.... infusion
Below the surface of the skin, but probably above the following term...well anyway, definitely lower than the TOP of the skin... subcutaneous
A POLYPEPTIDE hormone (see HORMONES) produced in the PANCREAS by the beta cells of the ISLETS OF LANGERHANS. It plays a key role in the body’s regulation of CARBOHYDRATE, FAT, and PROTEIN, and its de?ciency leads to DIABETES MELLITUS. Diabetic patients are described as type 1 (insulin dependent), or type 2 (non-insulin dependent), although many of the latter may need insulin later on, in order to maintain good control.
Insulin is extracted mainly from pork pancreas and puri?ed by crystallisation; it may be made biosynthetically by recombinant DNA technology using Escherichia coli, or semisynthetically by enzymatic modi?cation of porcine insulin to produce human insulin. The latter is the form now generally used, although some patients ?nd it unsuitable and have to return to porcine insulin.
The hormone acts by enabling the muscles and other tissues requiring sugar for their activity to take up this substance from the blood. All insulin preparations are to a greater or lesser extent immunogenic in humans, but immunological resistance to insulin action is uncommon.
Previously available in three strengths, of 20, 40, and 80 units per millilitre (U/ml), these have now largely been replaced by a standard strength of 100 U/ml (U100). Numerous different insulin preparations are listed; these differ in their speed of onset and duration of action, and hence vary in their suitability for individual patients.
Insulin is inactivated by gastrointestinal enzymes and is therefore generally given by subcutaneous injection, usually into the upper arms, thighs, buttocks, or abdomen. Some insulins are also available in cartridge form, which may be administered by injection devices (‘pens’). The absorption may vary from di?erent sites and with strenuous activity. About 25 per cent of diabetics require insulin treatment: most children from the onset, and all patients presenting with ketoacidosis. Insulin is also often needed by those with a rapid onset of symptoms such as weight loss, weakness, and sometimes vomiting, often associated with ketonuria.
The aim of treatment is to maintain good control of blood glucose concentration, while avoiding severe HYPOGLYCAEMIA; this is usually achieved by a regimen of preprandial injections of short-acting insulin (often with a bedtime injection of long-acting insulin). Insulin may also be given by continuous subcutaneous infusion with an infusion pump. This technique has many disadvantages: patients must be well motivated and able to monitor their own blood glucose, with access to expert advice both day and night; it is therefore rarely used.
Hypoglycaemia is a potential hazard for many patients converting from porcine to human insulin, because human insulin may result in them being unaware of classical hypoglycaemic warning symptoms. Drivers must be particularly careful, and individuals may be forbidden to drive if they have frequent or severe hypoglycaemic attacks. For this reason, insurance companies should be warned, and diabetics should – after taking appropriate medical advice – either return to porcine insulin or consider stopping driving.... insulin
A method for treating babies who suffer from alveolar collapse in the lung as a result of HYALINE MEMBRANE DISEASE (see also RESPIRATORY DISTRESS SYNDROME).... continuous positive airways pressure
A disorder in which the body produces excess INSULIN, which then reduces the amount of glucose in the blood (HYPOGLYCAEMIA). Treatment is with glucose or GLUCAGON. Untreated, the patient goes into a COMA and dies.... insulin shock
See TRANSFUSION.... continuous autologous transfusion
See “data”.... continuous data (variable)
Also called Juvenile-onset Diabetes, IDDM (Insulin-Dependent Diabetes) and Type I, it is a deficiency condition wherein the pancreas does not manufacture enough insulin or what it makes is formed improperly. It is usually inherited, although it may not surface until pregnancy, recovering from a life-threatening illness, boot camp or some other profound metabolic stress. It can have a not-hereditary source, since it seems to enigmatically follow after a viral disorder, and can occur spontaneously as an auto-immune condition. The percentage of folks with non-hereditary Type I diabetes is constantly increasing (or the other group is stable, but total numbers are increasing). Radical environmentalists and tree-hugging Gaiaist Pagans (I’m using the dialectic current to the pro-business backlash of the 1990s, when Green is out, and White-With-Green i$ in) claim this is another aspect of massive though subtle pollution from organochemical soup, which even some Real Doctors admit can cause increased auto-immune disease. (SOMETHING is causing it, at any rate, not simply cola drinks.)... insulin-dependent diabetes
The sum of all the activities which create desired change in quality. In the health care setting, quality improvement requires a feedback loop which involves the identification of patterns of the care of individuals (or of the performance of other systems involved in care), the analysis of those patterns in order to identify opportunities for improvement (or instances of departure from standards of care), and then action to improve the quality of care for future patients. An effective quality improvement system results in step-by-step increases in quality of care.... quality improvement / continuous quality improvement
See intravenous infusion.... infusion, intravenous
Also called NIDDM (Non-Insulin-Dependent Diabetes) and Type II (Type II), it generally means you make your own insulin, you eat too many calories, your storage cells are filled and are taking no more fuel, your liver is stuck in a rut and keeps making more glucose out of everything you eat, your brain has no control over its consumption of glucose, but you have run out of places to put it so you pee it out, sweat it out, etc. etc. Also called Adult-onset Diabetes. An Internist may cry out in dismay at this simplification, and there are many subtle distinctions between the various types, as well as a number of distinct hereditary considerations. This, however, is the glossary of an herbalist, and this is the common picture of the Type II person that herbs will help.... insulin-resistant diabetes
A machine that is used for the administration of a continuous, controlled amount of a drug or other fluid. The fluid is delivered through a needle that is inserted into a vein or under the skin.... pump, infusion
the route that a patient takes through the health-care system, from first admission to a hospital or treatment centre to final discharge. This may consist of one or more *spells in particular hospitals and one or more *finished consultant episodes. For example, a patient admitted to a district general hospital, transferred to a tertiary hospital for a specialist procedure, and then transferred back to the district general hospital for recovery would experience one continuous patient pathway but three spells.... continuous patient pathway
a group of synthetic human insulins with specific alterations in their amino-acid sequences designed to modify their rate of absorption from the subcutaneous injection site. Some are absorbed more rapidly and have a shorter duration of action than conventional short-acting human insulin; others are absorbed more slowly at a more consistent rate than conventional medium-acting *isophane insulin to give a more sustained control of fasting and premeal blood glucose levels and therefore a reduced risk of *hypoglycaemia. These analogues include the short-acting insulin aspart, insulin glulisine, and insulin lispro; the long-acting insulin detemir and insulin glargine; and the ultra-long-acting insulin degludec.... insulin analogues
a user-friendly penlike device designed to inject a measured dose of insulin, typically containing 3 ml insulin (300 units in total) in a cartridge chamber. For each injection a new disposable needle is applied to the device. The insulin dose is then ‘dialled up’ and safely injected subcutaneously. The pen can be capped off and easily stored in a pocket or small bag; some types are disposable when the cartridge is empty, while others can be refilled with a new cartridge.... insulin pen
diminution in the response of the body’s tissues to insulin, so that higher concentrations of serum insulin are required to maintain normal circulating glucose levels. Eventually the islet cells can no longer produce adequate amounts of insulin for effective glucose lowering, resulting in hyperglycaemia. Insulin resistance is one of the risk factors for cardiovascular disease. See also diabetes mellitus; metabolic syndrome.... insulin resistance
an important but potentially dangerous test of anterior pituitary function involving the deliberate induction of a hypoglycaemic episode with injected insulin and the subsequent measurement of plasma cortisol and growth hormone at regular intervals over the next three hours. The stress of the hypoglycaemia should induce a rise in the levels of these hormones unless the anterior pituitary or the adrenal glands are diseased. The test can induce epileptic seizures or angina in those with a predisposition and should not be performed in susceptible individuals. It is often combined with the thyrotrophin-releasing hormone (TRH) test and the gonadotrophin-releasing hormone (GnRH) test in what is known as the triple test (or dynamic pituitary function test).... insulin stress test
(SIS) see sonohysterography.... saline infusion sonohysterography
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