Os insulinomas são os mais comuns neoplasmas endócrinos pancreáticos, constituindo cerca de 17% de todos os tumores neuroendócrinos do trato digestivo. São tumores raros, que tem, como principal manifestação clínica, a hipoglicemia, a qual é ocasionada por secreção exagerada de insulina pelo tumor. Devido ao fato de serem tumores raros, o conhecimento das mudanças genéticas associadas à iniciação e progressão desses tumores é muito limitado. Em função disto, o objetivo deste trabalho é a identificação de genes diferencialmente expressos em insulinomas benignos humanos, visando o melhor entendimento dos mecanismos moleculares do processo tumorigênico dos insulinomas e a descoberta de novos alvos moleculares para terapia. Utilizando-se a plataforma de \"bioarrays\" CodeLink foram identificados 354 genes mais expressos nos insulinomas benignos, sendo que 16% estavam envolvidos em proliferação. Dentre estes genes foram escolhidos 6 genes para validação por \"Real-Time PCR\", onde os genes SPARCL1, PRSS11 STAT4, ECRG4, ASCL1 confirmaram sua expressão diferencial nos tumores, porém a diferença do gene IGFALS não foi estatisticamente significativa. Através da técnica \"Representational Difference Analysis\", isolou-se o clone FLJ13072, como super-expresso nos insulinomas benignos quando comparado à ilhotas normais, sendo que a seqüência protéica putativa deste gene apresenta um domínio conservado de helicase, podendo estar envolvido em eventos de transcrição, tradução, reparo de DNA e remodelamento de cromatina. Uma das dificuldades encontradas no estudo dos insulinomas é a falta de linhagens celulares humanas. Por esta razão, iniciou-se o estabelecimento de culturas primárias e precoces de insulinomas humanos visando sua utilização como modelos celulares para futuros estudos funcionais dos genes identificados. / Insulinomas are the most common pancreatic endocrine neoplasms, comprising around 17% of all neuroendocrine tumors of the digestive tract. These rare tumors have hypoglycemia as the main clinical manifestation, caused by over secretion of insulin by the tumor. Based on that, the objective of this work is the identification of differentially expressed genes in human benign insulinomas, aiming at the better understanding of the molecular mechanisms of their tumorigenic process and the discovery of new molecular targets for therapeutics. Using the CodeLink bioarrays platform (GE Healthcare) 354 genes upregulated in human benign insulinomas were identified, among which, 16% are involved in cell proliferation. From these genes, 6 were chosen for validation by Real Time PCR, where SPARCL1, PRSS11, STAT4, ECRG4 and ASCL1 were shown to be upregulated in all benign tumors, however the expression difference of IGFALS gene were not statistically significant. Using the RDA (Representational Difference Analysis) methodology, the unknown gene FLJ13072 was shown to be upregulated in benign isulinomas when compared to normal pancreatic islets. The putative protein product from this gene has an helicase domain, being possibly involved in processes like transcription, translation, DNA repair and chromatin remodeling. An important drawback for the study of insulinomas is the lack of human cell lines. Because of that, the establishment of early primary cultures of human insulinomas was initiated, aiming at its use as a cell model for future functional studies of the genes identified.

IntroductionFreeStyle Libre (FSL) has mostly been used by patients with type 1 diabetes. In 2019, newrecommendations were announced regarding prescriptions to patients with type 2 diabetes(T2D) who have insulin treatment (basal/bolus), HbA1c > 70 mmol/mol and/or repeatedhypoglycemic events despite great effort to adjust insulin doses.AimTo evaluate if HbA1c improves with FSL compared with self-monitoring of blood glucose. Thesecondary aim was to investigate if patients with recurrent hypoglycemic events experiencedless hypoglycemic events.MethodsThis study was designed as a retrospective systematic review of medical records of patientswith T2D in Region Örebro County (RÖC) who have received an FSL 1st of January to 13th ofSeptember 2019. A control group (n = 142) was created from the National Diabetes Register tothe indication group HbA1c > 70 mmol/mol. A paired sample t-test was used to assess theprimary endpoint.ResultsHbA1c decreased significantly from 73 mmol/mol to 65 mmol/mol (p <0.001) in the wholestudy population (n = 58). Indication group HbA1c > 70 mmol/mol (n = 38) had the greatestchange, 80 mmol/mol to 68 mmol/mol (p <0.001). The mean HbA1c in the control group was82 mol/mol. There were 15 patients in the indication group with hypoglycemic events (n = 20)who experienced less hypoglycemic events.ConclusionFSL has a positive effect on the metabolic control in patients with T2D who have HbA1c > 70mmol/mol when starting with FSL in RÖC.

No description available.

Objective: Challenging differential diagnosis Background: B cell lymphoma constitutes 80-85% of cases of Non Hodgkin's lymphoma in the Untied States. Metabolic complications may arise from the disease itself or through its end organ involvement. Case Report: We describe a case of a diffuse large B cell lymphoma diagnosed by abdominal computed tomography after it initially presented as hypoglycemia not correctable by dextrose infusion that instead resulted in increased anion gap metabolic acidosis with elevated lactate levels. Conclusions: The case illustrates how lymphomas can present unusually with hypoglycemia and lactic acidosis, the latter being an ominous sign that can occur without liver involvement. In this regard, the case demonstrates the metabolic sequelae of lymphoma that should raise suspicion for an underlying process. This has implications for diagnosis, treatment, and patient survival. Attention should be paid especially in the primary care setting in order to minimize delays in diagnosis.

Objective: Challenging differential diagnosis Background: B cell lymphoma constitutes 80-85% of cases of Non Hodgkin's lymphoma in the Untied States. Metabolic complications may arise from the disease itself or through its end organ involvement. Case Report: We describe a case of a diffuse large B cell lymphoma diagnosed by abdominal computed tomography after it initially presented as hypoglycemia not correctable by dextrose infusion that instead resulted in increased anion gap metabolic acidosis with elevated lactate levels. Conclusions: The case illustrates how lymphomas can present unusually with hypoglycemia and lactic acidosis, the latter being an ominous sign that can occur without liver involvement. In this regard, the case demonstrates the metabolic sequelae of lymphoma that should raise suspicion for an underlying process. This has implications for diagnosis, treatment, and patient survival. Attention should be paid especially in the primary care setting in order to minimize delays in diagnosis.

Diabetes mellitus, whether type 1 or type 2, offers special challenges to home health care providers. Treatment of diabetes can become increasing complex. While insulin remains the cornerstone of treatment in patients with type 1 diabetes (T1DM), the utilization of insulin to safely control blood glucose is also necessary for many patients with type 2 diabetes (T2DM). Many different insulin products are available, with each product possessing different characteristics and adverse effect potential. Balancing glycemic control with patient safety is paramount. The individualization of insulin therapy can be challenging for both patients and health care professionals. Regular evaluation of blood glucose monitoring is vital for patient assessment. This article provides a review of insulin for providers caring for patients in the home health care setting.

Advanced practice providers (APPs), consisting of nurse practitioners and physician assistants, face many challenges in the provision of evidence-based practice in their management of hospitalized adult patients with diabetes. Some of the barriers faced by APPs at a Northeast acute care facility are poor communication between disciplines, lack of confidence in initiating insulin, limited understanding of the management of insulin and the insulin pump, and insufficient treatment of the hospitalized patient with diabetes that aligns with current clinical guidelines for the management of inpatient hyperglycemia. This quality improvement project focused on the development of an evidence-based theory supported educational intervention to improve APPs' knowledge regarding glycemic management. An interdisciplinary team created the educational intervention using the analyze, design, develop, implement, and evaluate (ADDIE) instructional model. A 10-member expert panel validated the program utilizing both a formative and summative evaluation. The results from the formative evaluation was discussed with the interdisciplinary team, corrections were made, and was returned to the expert panel. Once the changes were made to the satisfaction of the expert panel, the program was then validated and submitted to the institution as a completed project to be used by the institution for APPs. This project addresses social change by increasing awareness in the management of inpatients with diabetes therefore decreasing fragmented care delivered by the APPs which will improve quality of care and patient safety.

Indiana University-Purdue University Indianapolis (IUPUI) / Acute Myeloid Leukemia (AML) is the most common hematologic malignancy. Malglycemia is a disorder of glucose metabolism and includes hyperglycemia, hypoglycemia and the combination of hyperglycemia and hypoglycemia. Malglycemia has been shown to occur frequently during hospitalization among critical care patients and has been associated with increased risk of sepsis and mortality. Little is known, however, about the prevalence and role of malglycemia on the health outcomes of AML patients hospitalized for initial induction therapy. Malglycemia may be of particular importance to the patient with AML because, researchers have found that malglycemia may promote cellular changes which facilitate the progression of cancer, alter treatment response, and attenuate immune response. The purpose of this study was to determine the prevalence of malglycemia (hyperglycemia, hypoglycemia or the combination) and to examine its role on a comprehensive set of health outcomes (neutropenic days, infection, and septicemia, and sepsis, induction hospital length of stay, complete remission and mortality) in AML patients hospitalized for initial induction therapy. A retrospective cohort study design was used. Records of 103 AML patients, hospitalized for initial induction chemotherapy were reviewed. Results of the study showed that 98% of the AML patients had at least one episode of hyperglycemia, with a prevalence rate of 33% over the entire induction inpatient hospitalization for this population. All patients noted with hyperglycemia also had hypoglycemia and thus, the prevalence rate of hypoglycemia alone could not be determined. Prevalence of the combination of hyperglycemia and hypoglycemia was 1.4 %. Although not statistically significant, a trend was noted for AML patients with hyperglycemia to experience more days with neutropenia, greater numbers of infection, sepsis, septicemia and death (mortality) than patients without hyperglycemia during induction treatment. Patients with the combination of hyperglycemia and hypoglycemia also experienced an increased risk of developing septicemia (p = .025) and sepsis (p =.057). Future studies with larger sample sizes are needed to confirm these findings.

No description available.

Background: Hypoglycemia is a common adverse effect to anti-hyperglycemic treatment for diabetes mellitus, it is characterized by a plasma glucose level of 79 mg/dl (3,9 mmol/l) or lower. Hypoglycemia has an abundance of symptoms, both neurogenic and neuroglycopenic which can result in loss of consciousness, seizure, and death if left untreated. General nurses have shown they are lacking in information regarding symptoms of hypoglycemia and as such experiences Aim: The aim of this study was to elucidate the lived experiences of hypoglycemia in patients diagnosed with diabetes mellitus. Method: A general literature review with an inductive approach. Results: The results of this study found that patients diagnosed with diabetes experienced challenges associated with hypoglycemia such as fear, particularly associated with nocturnal hypoglycemia. Patients diagnosed with diabetes also experienced helplessness, a lack of control, avoidance, restrictions and stress factors associated with hypoglycemia. Patients diagnosed with diabetes experienced hypoglycemic confidence primarily based on preventing recurrence and successful treatment, and for some through hope. Conclusion: The findings of this study indicate a need for nurses to understand the experiences patients diagnosed with diabetes have of hypoglycemia, to properly assist patients in health promotion and achieving a self-care balance. / Bakgrund: Hypoglykemi är en vanlig biverkning av anti-hyperglykemibehandling vid diabetes mellitus, hypoglykemi karakteriseras av ett plasmaglukosvärde på 79 mg/dl (3,9 mmol/l) eller lägre. Hypoglykemi har många symtom, båda neurogena och neuroglykopeniska som kan resultera i medvetslöshet, samt anfall och mortalitet om tillståndet är obehandlat. Generella sjuksköterskor har visat bristande kunskap gällande vanliga symtom vid hypoglykemi och patienters erfarenheter. Syfte: Syftet var att belysa levda erfarenheter av hypoglykemi hos patienter diagnostiserade med diabetes mellitus. Metod: En allmän litteraturstudie med induktiv ansats. Resultat: Denna litteraturstudie visar att patienter med diabetes har erfarenheter av svårigheter associerade med hypoglykemi som rädsla, särskilt rädsla för nattlig hypoglykemi. Patienter med diabetes upplevde hjälplöshet, bristande kontroll och undvikande, samt restriktioner och stressfaktorer associerade med hypoglykemi. Patienter med diabetes och hypoglykemi upplevde självförtroende främst relaterat till förhindrande av återfall, och för visa, genom hopp. Konklusion: Litteraturstudiens resultat indikerar att sjuksköterskor behöver förstå erfarenheter av hypoglykemi hos patienter med diabetes för att främja patienters hälsa och egenvårdsbalans.