Hypertriglyceridemia-induced pancreatitis is a relatively common form of acute pancreatitis that may represent up to 10% of all etiologies of this condition. Due to its specific pathogenic mechanisms related to high serum triglyceride levels, different treatment options have been proposed, including insulin perfusion, heparin perfusion, and plasmapheresis. Although the superiority of plasmapheresis in this clinical setting has not been demonstrated in randomized clinical trials, many centers have reported its effectiveness and considered this as a possible alternative according to the current guidelines. We report a case of a young patient diagnosed with hypertriglyceridemia-induced pancreatitis that was successfully treated with plasmapheresis. Since complications associated with plasmapheresis are rare and other therapeutic options may not be so effective or safe, we believe that this should be a valid alternative treatment that may be offered to these patients. More studies are still needed to further evaluate its effectiveness and to elucidate if there is a subset of patients in whom treatment with plasmapheresis may be more beneficial.

BACKGROUND: Patients with diabetes mellitus for whom premixed insulin preparations (PMIPs) are ordered in the hospital setting may be at risk of hypoglycemia if the PMIP is incorrectly administered at bedtime (instead of suppertime).
OBJECTIVE: The primary objective was to determine, retrospectively, the incidence of bedtime administration of PMIPs at a tertiary teaching hospital. The secondary objective was to investigate whether bedtime administration of PMIPs led to an increase in nocturnal hypoglycemia.
METHODS: Inpatient PMIP orders for the period April 1, 2013, to March 31, 2017, were extracted from the pharmacy information system of the Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia. Two hundred randomly selected inpatient admissions were audited, and instances of PMIP administration after 2000 (8 pm) were recorded. Data from an additional random sample of inpatient admissions, from January 1, 2016, to December 31, 2017, were reviewed to determine whether bedtime administration of PMIPs was associated with increased incidence of nocturnal hypoglycemia, relative to suppertime administration.
RESULTS: In the randomly selected sample of 200 inpatient admissions, a PMIP was administered at bedtime at least once during 47 admissions (24%). In the additional sample of 123 inpatient admissions during which a PMIP had been administered, the mean nocturnal hypoglycemia rate was 4.15% for suppertime administration and 14.85% for bedtime administration (p = 0.13).
CONCLUSIONS: For a substantial proportion of patients, PMIPs were inappropriately ordered and administered at bedtime in this hospital setting and may have been associated with nocturnal hypoglycemic events. Recommendations to reduce this practice include ongoing education and a review of preprinted order sets.
BACKGROUND: Les patients atteints de diabète sucré pour lesquels des préparations d’insuline prémélangées (PIPM) sont commandées en milieu hospitalier peuvent présenter un risque d’hypoglycémie si elles sont administrées à tort au coucher (au lieu de l’heure du souper).
OBJECTIVE: L’objectif principal visait à déterminer, rétrospectivement, l’incidence de l’administration des PIPM au coucher dans un hôpital d’enseignement tertiaire. L’objectif secondaire visait quant à lui à déterminer si l’administration au coucher entraînait (ou non) une augmentation de l’hypoglycémie nocturne.
UNASSIGNED: Les données relatives aux commandes de PIPM pour les patients hospitalisés pendant la période du 1er avril 2013 au 31 mars 2017 ont été extraites du système d’information pharmaceutique du QEII Health Sciences Centre à Halifax (N.-É.). Deux cents admissions de patients hospitalisés sélectionnées au hasard ont été vérifiées et les cas d’administration des PIPM après 2000 (20 h) ont été enregistrés. Les données d’un échantillon aléatoire supplémentaire d’admissions de patients hospitalisés du 1er janvier 2016 au 31 décembre 2017 ont été examinées afin de déterminer si l’administration au coucher des PIPM était associée à une plus grande incidence d’hypoglycémie nocturne, par rapport à l’administration au souper.
UNASSIGNED: Dans l’échantillon sélectionné au hasard de 200 admissions de patients hospitalisés, une PIPM a été administrée au coucher au moins une fois au cours de 47 admissions (24 %). Dans l’échantillon supplémentaire de 123 admissions de patients hospitalisés au cours desquelles une PIPM avait été administrée, le taux moyen d’hypoglycémie nocturne était de 4,15 % pour l’administration au souper et se montait à 14,85 % pour l’administration au coucher (p = 0,13).
CONCLUSIONS: Pour une proportion considérable de patients, la PIPM a été prescrite de manière inappropriée et administrée au coucher dans ce milieu hospitalier et peut avoir été associée à des événements hypoglycémiques nocturnes. Les recommandations visant à réduire cette pratique comprennent une formation continue et un examen des ensembles de commandes préimprimés.

OBJECTIVE: A fully automated insulin-pramlintide-glucagon artificial pancreas that alleviates the burden of carbohydrate counting without degrading glycemic control was iteratively enhanced until convergence through pilot experiments on adults with type 1 diabetes.
METHODS: Nine participants (age, 37±13 years; glycated hemoglobin, 7.7±0.7%) completed two 27-hour interventions: a fully automated multihormone artificial pancreas and a comparator insulin-alone artificial pancreas with carbohydrate counting. The baseline algorithm was a model-predictive controller that administered insulin and pramlintide in a fixed ratio, with boluses triggered by a glucose threshold, and administered glucagon in response to low glucose levels.
RESULTS: The baseline multihormone dosing algorithm resulted in noninferior time in target range (3.9 to 10.0 mmol/L) (71%) compared with the insulin-alone arm (70%) in 2 participants, with minimal glucagon delivery. The algorithm was modified to deliver insulin and pramlintide more aggressively to increase time in range and maximize the benefits of glucagon. The modified algorithm displayed a similar time in range for the multihormone arm (79%) compared with the insulin-alone arm (83%) in 2 participants, but with undesired glycemic fluctuations. Subsequently, we reduced the glucose threshold that triggers glucagon boluses. This resulted in inferior glycemic control for the multihormone arm (81% vs 91%) in 2 participants. Thereafter, a model-based meal-detection algorithm to deliver insulin and pramlintide boluses closer to mealtimes was added and glucagon was removed. The final dual-hormone system had comparable time in range (81% vs 83%) in the last 3 participants.
CONCLUSIONS: The final version of the fully automated system that delivered insulin and pramlintide warrants a randomized controlled trial.

OBJECTIVE: In this study, we aimed to determine the association between upper extremity muscle strength and insulin dose in patients with type 2 diabetes.
METHODS: A total of 236 patients with type 2 diabetes under insulin treatment for at least 1 year were included in this cross-sectional study. Patients were divided into 3 groups based on their total daily insulin dose (TDID): group 1, TDID >2 U/kg/day or >200 units/day; group 2, TDID 1 to 2 U/kg/day or 51 to 199 U/day; and group 3, TDID <0.5 U/kg/day or 50 U/day. High-dose insulin use was defined as total daily insulin dose >2 U/kg or >200 U/day. Muscle strength was measured using a handgrip dynamometer.
RESULTS: High-dose insulin users were younger and had higher measures of generalized and central obesity and glycated hemoglobin. There was no significant difference in muscle strength between the groups. Low muscle strength was seen in 26.7% of all patients. Patients with low muscle strength were older, had lower insulin dose treatment and had better glycemic control than patients with normal muscle strength. Handgrip strength was inversely correlated with age, body mass index and duration of diabetes, but not with TDID.
CONCLUSIONS: Patients with type 2 diabetes with high-dose insulin use had similar upper extremity muscle strength measurements with standard-dose insulin users. Studies with more patients are needed to determine the relationship between muscle mass, muscle strength and high-dose insulin use.

Diabetes mellitus (DM) is a risk factor for cancer in many organs and associated with an increased risk of cholangiocarcinoma (CCA). The molecular linkage between these diseases has been demonstrated in preclinical studies, which have highlighted the role of hyperinsulinemia and hyperglycemia in the carcinogenesis and progression of CCA. Recent studies on the emerging role of antidiabetic medication in the development and progression of CCA showed a subclass of antidiabetic drug with a therapeutic effect on CCA. Although associations between CCA, insulin analogues and sulfonylureas are unclear, incretin-based therapy is likely associated with an increased risk for CCA, and may lead to CCA progression, as demonstrated by in vitro and in vivo experiments. In contrast, biguanides, especially metformin, exert an opposite effect, associated with a reduced risk of CCA and inhibited in vitro and in vivo CCA progression. The association between incretin-based therapy and the risk of CCA needs further clarification, as metformin is being studied in an ongoing clinical trial. Understanding the association between DM and CCA is critical for preventing the development of CCA in patients with DM, and for establishing the appropriateness of antidiabetic medication to treat CCA. Determining how metformin affects CCA can lead to repurposing this safe and well-known drug for improving CCA treatment, regardless of the diabetes status of patients.

OBJECTIVE: In this study, we used a double-antibody sandwich enzyme-linked immunosorbent assay to assess the association between blood glucagon levels and indices of obesity, glycemic control and renal function in patients with type 2 diabetes mellitus (T2DM).
METHODS: This investigation was a cross-sectional study on inpatients with T2DM who had plasma glucagon levels measured during hospitalization. Associations of fasting glucagon levels (G0), 120-minute postbreakfast plasma glucagon (G120), fasting glucagon/C-peptide ratio (G0/CPR0) and postbreakfast glucagon/C-peptide ratio (G120/CPR120) with clinical data were evaluated using multiple regression analysis.
RESULTS: A total of 345 patients were enrolled in the study. G0, and G120 were significantly and positively associated with serum C-peptide levels. Moreover, G0 and G120 were positively associated with waist circumference, and G0 was negatively associated with duration of diabetes mellitus. Interestingly, both G0 and G120 were negatively associated with the estimated glomerular filtration rate. In addition, G120/CPR120 was positively associated with duration of diabetes mellitus and glycoalbumin levels.
CONCLUSIONS: The balance between glucagon and insulin secretion is significantly associated with abdominal obesity and important for maintaining glucose homeostasis. Postprandial hyperglucagonemia could also be related to deterioration of renal function.

OBJECTIVE: Hypoglycemia is a common adverse event for people with type 1 and type 2 diabetes mellitus. In this article, we explore the specific roles that individuals assume to prevent or treat hypoglycemia.
METHODS: A descriptive qualitative study from the UnderstandINg the impact of HYPOglycemia on Diabetes Management Study (InHypo-DM) research program. A purposive sample of people with type 1 and type 2 diabetes were recruited for semistructured interviews. There were 16 participants (women and men), who were, on average, 53 years old. Average time since diagnosis was 15 (type 1) and 21 (type 2) years; all patients had at least 1 hypoglycemic event in the past year. Individual and team analysis of interviews were conducted to identify overarching themes.
RESULTS: Participants articulated 4 roles in preventing or treating hypoglycemia. The first role was being a manager by assuming ownership and accountability for their own glycemic control. The second role, being a technician, used both subjective and objective information and employed specific strategies to respond to hypoglycemic events. The third role, educator, extended beyond self-management to increase others\' awareness of hypoglycemia. The fourth role, advocate, involved championing one\'s own needs during a hypoglycemic event. These 4 roles were, in turn, influenced by the contexts of work, social settings, exercise and travel.
CONCLUSIONS: These findings demonstrate that strategies that individuals use to avoid or reduce the severity of a hypoglycemic event extend beyond merely making impromptu decisions during events. Instead, these 4 roles of manager, technician, educator and advocate, embedded in specific contexts, enhanced their mastery in managing hypoglycemia in daily life.

Hydrogels properties open up many possibilities for medical applications. In the present study, protein drug insulin was selected as a model drug to test the in vitro release behavior of hydrogels based on blue crab chitosan (Cs) and red marine macroalga Falkenbergia rufolanosa polysaccharide (FRP). The FRP/Cs composed hydrogels were characterized in terms of structural, morphological, thermal and antioxidant properties. Data revealed that FRP addition enhanced the water holding capacity and the water uptake percentages, as well as the textural behavior. Moreover, the prepared hydrogels are simultaneous sensitive to pH, ionic strength and temperature as demonstrated in the swelling ratio test. Additionally, hydrogels at pH 1.2 PBS underwent greater degradation, compared to samples immersed in pH 7.4 PBS. Similarly, the kinetics of insuline release, through the FRP/Cs composed hydrogels exhibited higher released amounts in acidic systems. Through this study, the prepared hydrogels provided suitable and promising microenvironment in drugs delivery.

This study aimed to determine the effect of pure forms of sucralose and aspartame, in doses reflective of common consumption, on glucose metabolism. Healthy participants consumed pure forms of a non-nutritive sweetener (NNS) that were mixed with water and standardized to doses of 14% (0.425 g) of the acceptable daily intake (ADI) for aspartame and 20% (0.136 g) of the ADI for sucralose every day for 2 weeks. Blood samples were collected and analyzed for glucose, insulin, active glucagon-like peptide-1 (GLP-1), and leptin. Seventeen participants (10 females and 7 males; age, 24 ± 6.8 years; body mass index, 22.9 ± 2.5 kg/m2) participated in the study. The total area under the curve values of glucose, insulin, active GLP-1 and leptin were similar for the aspartame and sucralose treatment groups compared with the baseline values in healthy participants. There was no change in insulin sensitivity after NNS treatment compared with the baseline values. These findings suggest that daily repeated consumption of pure sucralose or aspartame for 2 weeks had no effect on glucose metabolism among normoglycaemic adults. However, these results need to be tested in studies with longer durations. Novelty Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on glucose metabolism. Daily consumption of pure aspartame or sucralose for 2 weeks had no effect on insulin sensitivity among healthy adults.

This randomized crossover study assessed the acute effects of almonds on postprandial glycemic, hormonal, and appetite responses in a sample of 7 men with type 2 diabetes (T2D). Participants completed 2 experimental visits during which a control (white bread, butter, cheese) and a test (white bread, almonds) meal were ingested. Energy, available carbohydrate, total lipid, and protein content were the same in both meals. Blood samples were collected in fasting state as well as 15, 30, 60, 90, 120, and 240 min postprandially for quantifying blood glucose, as well as insulin and glucagon-like peptide-1 (GLP-1) serum concentrations. Subjective appetite sensations were assessed using visual analog scales at the same time-points. Within this sample of participants, the test meal was found to be associated with lower postprandial glycemia and insulinemia, higher GLP-1 serum concentrations, decreased hunger and desire to eat, and increased fullness. The test meal was also associated with an increased estimated glucose metabolic clearance rate, indicating higher postprandial insulin sensitivity. Overall, results suggest that almonds\' macronutrient subtype profile could have a beneficial impact on postprandial glycemic, hormonal, and appetite responses in men with T2D. Studies with larger sample sizes are warranted to confirm these findings. Novelty A meal containing almonds (vs. isocaloric macronutrient-matched control) induced lower glycemic and insulinemic responses. A meal containing almonds (vs. isocaloric macronutrient-matched control) induced a greater elevation in postprandial GLP-1 serum concentrations. A meal containing almonds (vs. isocaloric macronutrient-matched control) induced more favourable postprandial appetite responses.