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In brief

Companies fined for supplying defective prefilled syringes: The company Fresenius Kabi has been fined £500 000 (€695 000; $775 000) plus £5900 in costs and Calea UK £50 000 with £5900 costs for supplying hospitals with defective prefilled syringes that contributed to the death of a patient with diabetes. Neil Judge developed multiorgan failure after being treated with a batch of intravenous insulin syringes that contained no insulin. The faulty syringes were supplied to Sheffield Teaching Hospitals NHS Foundation Trust by Fresenius Kabi as a licensed wholesaler for Calea UK, the manufacturer.  
feeds.bmj.com
over 4 years ago
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2

In brief

Companies fined for supplying defective prefilled syringes: The company Fresenius Kabi has been fined £500 000 (€695 000; $775 000) plus £5900 in costs and Calea UK £50 000 with £5900 costs for supplying hospitals with defective prefilled syringes that contributed to the death of a patient with diabetes. Neil Judge developed multiorgan failure after being treated with a batch of intravenous insulin syringes that contained no insulin. The faulty syringes were supplied to Sheffield Teaching Hospitals NHS Foundation Trust by Fresenius Kabi as a licensed wholesaler for Calea UK, the manufacturer.  
feeds.bmj.com
over 4 years ago
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19

Falsely elevated capillary glucose and ketone levels and use of skin lightening creams

Hyperglycaemia associated with ketosis reflects severe insulin deficiency that mandates immediate insulin therapy. Point-of-care devices to measure capillary glucose have become essential in diabetes management.1 Management of hyperglycaemic crisis has also been improved by the measurement of β-hydroxybutyrate in a fingerprick blood specimen. The method is quick, accurate, and reliable,2 3 4 and recommended to medical care providers and patients.2 5 6 Here we report two cases of misleadingly high capillary glucose and ketone measurements that could have been prevented by careful hand washing. We also identify the chemical compound, hydroquinone, that interferes with capillary results.  
feeds.bmj.com
over 4 years ago
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A patient request for some “deprescribing”

A 52 year old man with a history of type 2 diabetes for 14 years and hypertension for nine years presented to his general practitioner. He was a non-smoker with an alcohol intake of eight units a week. He had been experiencing bloating, abdominal pains, and erratic motions for more than a year. Because he drove about 12 000 miles a year for his job he found the loose motions “a real worry.” He wondered whether any of his problems might be caused by his drugs and asked if he could cut down on any if they weren’t all needed. He admitted to being afraid that his diabetic control might deteriorate and that he might need insulin, like some of his relatives who also had diabetes.  
feeds.bmj.com
over 4 years ago
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Critical Care

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.  
ccforum.com
over 4 years ago
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7

Type 1 Diabetes Mellitus Differential Diagnoses

Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Onset most often occurs in childhood, but the disease can also develop in adults in their late 30s and early 40s.  
emedicine.medscape.com
over 4 years ago
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45

Anna Gloyn: Genetics and Diabetes - Nuffield Department of Medicine

The research undertaken by Professor Anna Gloyn focuses on using naturally genetic variants identified in humans as tools to identify critical regulatory pathways for insulin secretion and action. Current research projects are focused on the translation of genetic association signals for type 2 diabetes and glycaemic traits into molecular mechanisms for diabetes and clinically useful tools.  
ndm.ox.ac.uk
over 4 years ago
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Hyperkalemia Treatment Explained Clearly

Dr. Seheult explains hyperkalemia treatment. Includes illustrations on the use of calcium, beta agonists, bicarbonate, insulin, normal saline IV fluids, diur...  
youtube.com
over 4 years ago
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Tandem t:slim G4 Insulin Pump with Dexcom CGM Integration Approved by FDA |

Tandem Diabetes Care won FDA approval to introduce its t:slim G4 insulin pump, a device that is a hybrid of the popular t:slim insulin pump and Dexcom G4 P  
medgadget.com
over 4 years ago
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FDA Approves New Insulin Pump-Continuous Sensor Combo

Tandem's system is the first insulin pump/continuous glucose monitor combination with a touch screen display of both glucose trend and insulin delivery information.  
medscape.com
over 4 years ago
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Insulin Degludec Distribution to Cease in Germany

As a result of a price dispute, Novo Nordisk is withdrawing Tresibia from Germany. Reactions are mixed.  
medscape.com
over 4 years ago
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Diabetes: Pocket-sized device to allow control over insulin intake - BBC News

A tiny, pocket-sized device is set to transform how diabetics in Northern Ireland regulate their insulin dosage.  
bbc.co.uk
over 4 years ago
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Fibromyalgia Linked to Deficiencies in RBC Magnesium, IGF-1

A small study shows deficiencies in red blood cell magnesium and insulin-like growth factor 1 in patients with fibromyalgia and reflects growing interest in the role of hormones and endocrine factors in chronic pain.  
medscape.com
over 4 years ago
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Emerging Basal Insulins for Diabetes: Looking to the Future for Advances in Care CME/CE

The goal of this activity is to improve the management of diabetes through a better understanding of new safety and efficacy data of emerging basal insulin analogs and how they differ from older basal insulin products.  
medscape.org
over 4 years ago
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FDA Approves Long-Lasting Insulin Drugs Tresiba and Ryzodeg

Both drugs for patients with diabetes contain insulin degludec, which possesses a half-life of 25 hours and acts for at least 42 hours.  
medscape.com
over 4 years ago
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Insulin Pumps Help Some Type 2 Diabetes Patients for 5 Years

A small case series is the longest reported experience to date of insulin-pump therapy for type 2 diabetes patients who don't meet glycemic goals despite multiple daily insulin injections.  
medscape.com
over 4 years ago
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Medtronic MiniMed Connect Monitor for Insulin Pumps and Glucometers Coming to U.S. Market |

Medtronic is releasing its MiniMed Connect wireless device to keep a close eye on insulin pumps and continuous glucometers. It connects to Medtronic's Mini  
medgadget.com
over 4 years ago
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US Medicaid Reimbursements for All Insulins Have Skyrocketed

Rising reimbursement for all types of insulins in the US, regardless of patent protection, suggests a lack of competition, with the result that many diabetes patients cannot afford their insulin.  
medscape.com
over 4 years ago
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Hyperkalaemia on the surgical ward

A 56 year old woman was admitted with an infected stump wound at the site of a below the knee amputation. Her medical history included type 2 diabetes, diabetic foot ulcer, and painful peripheral neuropathy. Her regular drugs were metformin, amitriptyline, lansoprazole, Humulin I and Novorapid SC insulin, aspirin, paracetamol, morphine sulfate, gabapentin, and carbamazepine. In hospital, she was also prescribed dalteparin 5000 units subcutaneously once daily, intravenous benzylpenicillin, and flucloxacillin.  
feeds.bmj.com
over 4 years ago
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Hyperkalaemia on the surgical ward

A 56 year old woman was admitted with an infected stump wound at the site of a below the knee amputation. Her medical history included type 2 diabetes, diabetic foot ulcer, and painful peripheral neuropathy. Her regular drugs were metformin, amitriptyline, lansoprazole, Humulin I and Novorapid SC insulin, aspirin, paracetamol, morphine sulfate, gabapentin, and carbamazepine. In hospital, she was also prescribed dalteparin 5000 units subcutaneously once daily, intravenous benzylpenicillin, and flucloxacillin.  
feeds.bmj.com
over 4 years ago