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7. Novel Modified Algorithm for High Fat/High Energy Density Meal in Type 1 Diabetes: Less Hypoglycemia.

Author

Altınok, Yasemin Atik, Demir, Günay, Çetin, Hafize, Özen, Samim, Darcan, Şükran, and Gökşen, Damla

Subjects
*FOOD consumption, *TYPE 1 diabetes, *MANN Whitney U Test, *INSULIN, *RANDOMIZED controlled trials, *RESEARCH funding, *DESCRIPTIVE statistics, *CROSSOVER trials, *DATA analysis software, *MEALS, *DIETARY fats
Abstract

Objective: This aim of this study was to investigate the effect of additional insulin dosing for high fat/high energy density mixed meal over 12 hours. Methods: In this single-center, non-blinded, randomized, cross-over study, a high fat/high energy density test meal was used to study the impact on glycemic response of either carbohydrate counting (CC) on the first day and the Pańkowska algorithm (PA) on the second test day. The two methods were compared in 20 adolescents with type 1 diabetes (T1D), aged 9-18 years, using insulin pump therapy and continuous glucose monitoring on postprandial early (0-120 min), late (120-720 min), and total (0-720 min) glycemic response. Results: There was no difference between groups in the duration of normoglycemia in the early period. Postprandially, 50% of patients developed hypoglycemia using the PA at a median of 6.3 (5.6-7.9) hours and the PA was subsequently modified for the remaining ten patients. Area under the curve (AUC) for the early period decreased non-significantly in the CC group, indicating less normoglycemia. No significant difference was found in the AUC of the PA (no hypoglycemia n=4) and modified PA groups (no hypoglycemia n=6) over the whole period (0-12 hours). AUC for level 2 hyperglycemia was statistically greater in the PA-no hypoglycemia patients compared to modified PA-no hypoglycemia patients. Conclusion: There were inter-individual differences in glycemic response to high fat/high energy density meals. An individualized approach to insulin dosing by evaluating food diary and postprandial glucose monitoring appears to be optimal for children and adolescents with T1D. [ABSTRACT FROM AUTHOR]

Published
2023
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8. Tip 1 Diyabetli Çocuk ve Adölesanların İnsülin Pompa Yönetiminde Sorunlar ve Çözüm Önerileri

Author

Demir, Günay, Çubukcu, Emine, and Didişen, Nurdan Akçay

Subjects
çocuk, Tip 1 diyabetes mellitus, adolesan, insülin infüzyon pompa
Abstract

Tip 1 Diyabet, diyabetli çocuk ve ebeveynlerinin tanı anından itibaren yaşam boyunca sürdürmeleri gereken tekrarlı eğitim, özen ve yakın takip ile yönetebilecekleri bir süreçtir. Tip 1 diyabet yönetim bileşenlerini insülin tedavisi, sağlıklı beslenme, fiziksel aktivite, kendi kendine izlem, multidisipliner yakın takip ve hemşirelik yaklaşımı oluşturur. Bu bileşenlerin merkezinde insülin tedavisi yer almaktadır. Diyabet teknolojilerinin gelişimi ile diyabetli çocuk ve ebeveynlerinin yaşamına sürekli insülin gönderimini otomatik olarak yapan elektromekanik bir pompa girmiştir. Bu derleme makalesinde küresel anlamda kullanımı oldukça yaygınlaşan insülin infüzyon pompasının avantaj ve dezavantajları literatür ışığında detaylı bir biçimde ele alınmıştır

Published
2022

9. Does COVID-19 predispose patients to type 1 diabetes mellitus?

Author

Ata, Aysun, primary, Jalilova, Arzu, additional, Kırkgöz, Tarık, additional, Işıklar, Hafize, additional, Demir, Günay, additional, Altınok, Yasemin Atik, additional, Özkan, Behzat, additional, Zeytinlioğlu, Ayşin, additional, Darcan, Şükran, additional, Özen, Samim, additional, and Gökşen, Damla, additional

Published
2022
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14. Local complications of insulin administration sites and effect on diabetes management.

Author

Demir, Günay, Er, Eren, Atik Altınok, Yasemin, Özen, Samim, Darcan, Şükran, and Gökşen, Damla

Subjects
*LIPODYSTROPHY, *GLYCOSYLATED hemoglobin, *NONPARAMETRIC statistics, *INJECTIONS, *SAMPLE size (Statistics), *CONFIDENCE intervals, *GLYCEMIC control, *CROSS-sectional method, *TYPE 1 diabetes, *BLOOD sugar, *BRUISES, *RETROSPECTIVE studies, *MANN Whitney U Test, *INSULIN, *SURVEYS, *STAB wounds, *INSULIN pumps, *DESCRIPTIVE statistics, *CHI-squared test, *CUTANEOUS therapeutics, *WOUNDS & injuries, *ALLERGIES, *PATIENT education, *DATA analysis software, *DISEASE management, *HEMORRHAGE, *CHILDREN
Abstract

Background: Administration of insulin may be associated with substantial cutaneous adverse effects, such as lipoatrophy and lipohypertrophy (LH), which can cause glycemic excursions above and below the target levels for blood glucose. Our aim was to evaluate the effect on compliance with the use of insulin administration site, dermatological complications and diabetes management in children with type 1 diabetes (T1D). Methods: Patients aged 0‐21 years who were followed up with the diagnosis of T1D for at least one year were included. A 14‐question survey including demographic characteristics and a subjective opinion of skin‐related complications of insulin administration was given. Data were obtained from the medical records to evaluate the effect of dermatological complications on diabetes management. This study was checked with the STROBE checklist. Results: Two hundred and fifty‐four patients were included and 53% of these were female. The mean age was 14.9 ± 4.7 years and the duration of T1D was 7.3 ± 4.1 years. The mean HbA1c level was 8 ± 1.4% and the mean total insulin dose was 0.84 ± 0.25 units/kg/day. More than half of the individuals (57%) were receiving multiple daily injections (MDI) and 43% were on insulin pump therapy (IPT). Of the participants, 11.8% reported LH, 7.5% wound, 21.7% allergy, 55.5% bleeding, 41.3% bruising and 47.2% pain. LH rates varied significantly by regimen, 17.1% in MDI and 4.6% with IPT (p =.001). Those with LH were using higher median doses of insulin (0.97 U/kg/day) than those who did not (0.78 U/kg/day; p =.016). LH was reported more frequently (18.3%) in patients with frequent hypoglycemia (p =.007). Positive correlation between BMI‐SDS and LH in patients aged <18 years was found (p =.043). LH rates by site were: right arm 20.8%, left arm 26.4%, right abdomen 26.4%, left abdomen 22.6% and 1% in the right and left leg. Conclusions: Local complications of insulin therapy are common in young patients with T1D. The complication with the most impact on metabolic control was LH, present in nearly 12% of patients. Users of IPT have a significantly lower risk of LH. The results emphasise the importance of individualised education for young T1D patients and their families about injection site preference and rotation techniques. Relevance to clinical practice: The diabetes team should check the insulin administration sites of children with type 1 diabetes at each visit and provide repeated education about the dermatological complications of insulin. [ABSTRACT FROM AUTHOR]

Published
2022
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17. İskenderun körfezi balıklarında bisfenol a (BPA) düzeylerinin belirlenmesi

Author

Demir Günay, Yeşim, Sakin, Fatih, Yipel, Mustafa, and Farmakoloji ve Toksikoloji Anabilim Dalı

Subjects
Pharmacy and Pharmacology, Eczacılık ve Farmakoloji
Abstract

Dünya genelinde en çok üretilen ve kullanılan endokrin bozucu kirleticilerden biri olan Bisfenol A (BPA), insan ve hayvan sağlığı üzerine ciddi olumsuz etkileri nedeniyle günümüzde önemli bir çevre ve halk sağlığı problemidir. Besin zincirinde önemli bir rolü olan balıklar, sucul ortamlarda yaygın olarak bulunan BPA kirliliğini izlemek için biyomonitör canlılar olarak kullanılmaktadır.Bu çalışma, İskenderun Körfezi'nde avlanan ve bölgede sık tüketilen Levrek (Dicentrarchus labrax, Linnaeus, 1758), Çipura (Sparus aurata, Linnaeus, 1758), Kefal (Mugil cephalus, Linnaeus, 1758) ve Mercan (Patlak göz mercan) (Dentex macrophthalmus, Bloch, 1791) balık türlerinde BPA düzeylerini araştırmak amacıyla gerçekleştirildi.Çalışmada her türden 7 adet olmak üzere toplam 28 adet balık kullanıldı. Balıkların boy ve ağırlık ölçümleri yapıldıktan sonra kas dokusu örneklerinde Yüksek Performanslı Sıvı Kromatografi (HPLC) ile BPA düzeyleri tespit edildi. Metot validasyonu tespit limiti (LOD), tayin limiti (LOQ), regrasyon katsayısı (R2), relatif standart sapma (RSD) ve geri kazanım parametreleri üzerinden gerçekleştirildi.Validasyon parametrelerinden; LOD ve LOQ değerleri ise sırasıyla 0.28 ve 0.92 ppb, R2 = 0.9963, % RSD değeri 9.8 ve geri kazanım oranı %96 olarak tespit edildi. Çalışılan tüm balıklarda (n:28) BPA pozitiflik oranı %50 (n:14) olarak belirlendi. Mercan, Çipura, Kefal ve Levrek türlerinde tespit edilen ortalama BPA düzeyleri sırasıyla; 0.50, 0.44, 0.33 ve 0.22 ng/g olarak tespit edildi. Balık türlerine göre tespit edilen en yüksek BPA düzeyleri; Çipura 1.84, Kefal 1.28, Mercan 1.27 ve Levrek 0.93 ng/g olarak ölçüldü. Sonuç olarak; bu çalışmada belirlenen balık türleri BPA düzeyleri farklı bölgelerde yapılan benzer çalışmalarda bildirilen düzeylerin çoğundan ve resmi otoriteler tarafından belirlenen gıdayla temas eden maddelerden kaynaklanabilen spesifik migrasyon limitinin altında tespit edilmiştir. Bununla birlikte, BPA düzeylerinin gıda değeri olan biyomonitör türler üzerinden periyodik olarak izlenmesi ve bölgesel tüketim senaryoları üzerinden risk değerlendirmelerinin yapılması halk sağlığı bakımından önem arz etmektedir. Bisphenol A (BPA), one of the most produced and used endocrine-disrupting pollutants in the world, is today an important environmental and public health problem due to its serious negative effects on human and animal health. Since fish has an important role in the food chain, are used as a biomonitor to screen BPA pollution which is commonly found in aquatic environments. This study was carried out with a view to investigating BPA levels of the fish species of Sea Bass (Dicentrarchus labrax, Linnaeus, 1758), Sea Bream (Sparus aurata, Linnaeus, 1758), Grey Mullet (Mugil cephalus, Linnaeus, 1758) and Coral (Large-eye dentex) (Dentex macrophthalmus, Bloch, 1791) which were hunted in the Gulf of İskenderun and are largely consumed in the region. A total of 28 fish, 7 of each species, were used in the study. After measuring the height and weight of the fish, High Performance Liquid Chromatography (HPLC) and BPA levels were determined in the muscle tissue samples. Method validation was performed based on the limit of detection (LOD), limit of quantification (LOQ), regression coefficient (R2), relative standard deviation (RSD) and recovery parameters. Validation parameters LOD and LOQ values were determined to be 0.28 and 0.92 ppb, respectively; R2 = 0.9963, RSD% as 9.8 and recovery rates as 96%. BPA positivity rate was determined as 50% (n:14) in all studied fish (n:28). The average BPA levels detected in Coral, Sea Bream, Grey Mullet and Sea Bass species were found to be 0.50, 0.44, 0.33 and 0.22 ng/g, respectively. The highest BPA levels determined by fish species were measured as Sea Bream 1.84, Grey Mullet 1.28, Coral 1.27 and Sea Bass 0.93 ng/g.As a result, since BPA levels detected in the fish hunted in the Gulf of İskenderun were below the most of the reported levels in similar studies in different regions and specific migration limit that can be caused by substances that come into contact with foods and which set by the official authorities. However, it is important to monitor BPA levels with periodic biomonitoring studies in terms of public health and to make risk assessments through regional consumption scenarios. 49

Published
2020

21. Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5.

Author

Ata, Aysun, Er, Eren, Evin, Ferda, Işıklar, Hafize, Abdullayev, Nushaba, Demir, Günay, Özen, Samim, Altınok, Yasemin Atik, Darcan, Şükran, and Gökşen, Damla

Abstract

This study aimed to determine the effects of continuous subcutaneous insulin infusion (CSII) treatment on anthropometric measurements, mean HbA1c, and insulin dosage in patients diagnosed under 5 years of age and compare with multiple-dose injection therapy (MDI). Children with type 1 diabetes mellitus, diagnosed <5 years since 2000 and their 19-year follow-up were evaluated retrospectively. Weight, height, body mass index (BMI), blood pressure, and HbA1c values were recorded for each visit. Hundred and five patients (58.1% female, 41.9% male) were included in the study. Sixty-three (60 %) patients were treated by CSII and 42 (40%) by MDI. Mean age at diagnosis was 2.68 ± 1.42 and 3.29 ± 1.30 years respectively. Mean follow-up was 7.42 ± 4.76 and 6.01 ± 4.41 years respectively. For each group, weight standard deviation score (SDS) increased significantly in the first year after the diagnosis (p<0.001), and with the onset of puberty weight SDS decreased significantly (p<0.001). The trend of weight and BMI SDS changes over the years showed similar characteristics in both groups. During follow-up height SDS was similar in both groups except in Tanner stage 5. When puberty was completed, mean height SDS was 0.51 ± 1.03 in CSII and −0.31 ± 0.75 in the MDI group (p: 0.029). Mean HbA1c was significantly lower in the CSII group (7.62 ± 0.82 and 8.17 ± 1.22 respectively). Systolic and diastolic blood pressure change trends during the follow-up were also similar in both groups. CSII treatment had positive effects on metabolic control and height SDS in patients with early-onset diabetes without increasing BMI. [ABSTRACT FROM AUTHOR]

Published
2021
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23. Tip 1 diyabetli çocuk ve ergenlerde sürekli cilt altı glükoz ölçüm sistemleri ile hipoglisemi duyarsızlığının saptanması ve eğitimin etkinliği

Author

Demir, Günay, Gökşen Şimşek, Ruhsar Damla, Kronik Hastalıklar Anabilim Dalı, Gökşen Şimşek, Damla, and Sağlık Bilimleri Enstitüsü

Subjects
Yapılandırılmış Eğitim, Continous Glucose Measurement Systems, Hypoglycemia Unawareness, Structured Education, Endocrinology and Metabolic Diseases, Patient education, Type 1 Diabetes Mellitus, Hipoglisemi, Adolescents, Hypoglycemia, Sürekli Cilt Altı Glükoz Ölçüm Sistemi, Glucose, Diabetes mellitus, Hipoglisemi Duyarsızlığı, Diabetes mellitus-type 1, Endokrinoloji ve Metabolizma Hastalıkları, Tip 1 Diyabet, Blood glucose, Children, Skin
Abstract

Tip 1 Diyabet Mellituslu (T1DM) çocuk ve ergenlerde hipoglisemi duyarsızlığı varlığında normoglisemi ve iyi metabolik kontrol sağlanmaya çalışılması ağır hipoglisemi riskini arttırmaktadır. Hipoglisemi duyarsızlığı (HD); otonomik bulgular olmadan doğrudan nöroglukopenik bulguların ortaya çıkması olarak tanımlanmaktadır. Çocukluk çağında HD saptanmasına yönelik çok fazla çalışma bulunmamaktadır. Bu çalışma; Tip 1 DM çocuk ve ergenlerde hipoglisemi duyarsızlığını sıklığını belirlemek, sürekli cilt altı glükoz ölçüm sisteminin etkinliğini saptamak ve yapılandırılmış eğitimin duyarsızlığın düzelmesi üzerine etkisini araştırmak için yapılmıştır. Gereç ve yöntemler: Niceliksel Prospektif kontrollü olarak planlanan çalışmada, 5 yıl ve üzeri DM yaşı olan rastlantısal seçilen 37 olgu çalışmaya alındı. Hipoglisemi duyarsızlığını saptamak amacıyla tüm olgulara Medtronic iPro®2 profesyonel CGM sürekli glükoz ölçüm sistemi (SCGÖS) başlangıçta ve HD saptanan olgulara 3. ayda 6'şar gün süre ile uygulandı. Bu sürede hipoglisemi belirtileri için günlük tutuldu. Hipoglisemi için eşik değer, Seeking strict normoglycemia in type 1 diabetes mellitus increases the risk of hypoglycemia, exposing to hypoglycemia unawareness. Hypoglycemia unawareness (HU) is defined as the occurrence of hypoglycemic symptoms directly without autonomic symptoms. This study is designed to determine the incidence of HU in children and adolescents with continuous subcutaneous glucose monitoring system and to assess the effect of structured education to improve awareness. Materials and Methods: In this prospective controlled quantitative study, randomly selected 39 Type 1 diabetic children and adolescents with a diabetes duration of at least 5 years were included. Continuous Subcutaneous Glucose Monitoring System, Medtronic iPro®2 was used to determine HU. A diary was kept for the symptoms of hypoglycemia. Hypoglycemia was defined as sensor glucose level < 70 mg/dl. Patients who were diagnosed with HU initially undergone a structured education and after 3 months CGMS was used again in HU patients to detect the influence of education. Results: Thirty seven type 1 diabetic patients (mean age 13,8 ± 2,42 years, 43 % male, mean diabetes duration 7,67 ± 1,66 years, mean hemoglobin A1c 8.0 ± 1.2%) participated in the study. 25 patients were on MDI therapy while the rest were on continuous insulin infusion therapy (CSII). 24,3% (n=9) of the patients were diagnosed as having HU with CGMS. 6 of them were on MDI, 3 on CSII. 27.3% of the patients with a diabetes duration of 5-8 years and 72.7 % of the patients with a duration of 8-11 years had HU. Mean HbA1c of the patients with and without HU within the preceding year was 7,9%±0,97 % and 8,4±1,2 % respectively (p:0, 230). HU cases were < 70 mg/dl for 11,44±5,12 hours while patients without HU were < 70 mg/dl for 1,93±2,23 hours at the beginning of the study (p:0,00). AUC for hypoglycemia and number of low excursions were; 1,81±0,95 and 8,33±3,60 for HU group and 0,23±0,31 and 2,68±2,05 for the without HU group respectively at the beginning of the study (p:0,00). HU patients were hypoglycemic for 4,44±3,78 hours, AUC for hypoglycemia was 0,43±0,47 and the number of low excursions were 5,22±3,99. Though AUC and hypoglycemia duration statistically decreased compared to the initial findings, the number of hypoglycemic excursions did not change with structured education. Conclusions: HU is commonly seen in patients with type 1 diabetes mellitus. Continuous subcutaneous glucose monitoring system is effective in determining HU. Rate of HU can be reduced by structured education.

Published
2016

26. Continuous subcutaneous insulin infusion in preschool children with type 1 diabetes mellitus as initial treatment: Effect on glycemic control.

Author

Er, Eren, Ata, Aysun, Evin, Ferda, Altınok, Yasemin Atik, Demir, Günay, Özen, Samim, Darcan, Şükran, and Gökşen, Damla

Subjects
*TYPE 1 diabetes, *GLYCEMIC control, *SUBCUTANEOUS infusions, *PRESCHOOL children, *TREATMENT effectiveness
Abstract

Background: Diabetes management and achieving good glycemic control are challenging in preschool period. Continuous subcutaneous insulin infusion (CSII) is the treatment of choice for managing type 1 diabetes mellitus (T1DM), especially in children under seven years of age. Objective: To compare the glycemic control (HbA1c), anthropometric measurements, daily insulin requirement and basal and bolus insulin rates of the group using CSII as initial therapy with the group using multiple initial daily injection (MDI) treatment. Method: Ten children with T1DM using CSII as a first-line therapy, who were followed up regularly for at least 1 year, and 10 children using MDI, who were similar in terms of age and gender with CSII group, were included in this retrospective study. Daily total insulin (U/kg), basal and bolus insulin rates, and HbA1c values of the children, obtained from medical records, were compared during the first year of the follow-up. Results: The mean age of diagnosis of children with T1DM was 2.01 ± 1.28 years in the CSII group and 3.11 ± 1.49 years in the MDI group. While HbA1c values measured in the first year showed a significant decrease in both treatment groups, first year HbA1c was significantly lower in the CSII group compared to the MDI group (p=0.04). Mean total daily insulin requirement for first year was 0.61 ± 0.10 U/kg in the CSII group, and 0.82 ± 0.18 U/kg in MDI (p=0.007). Conclusion: In children under the age of 5 with T1DM, using CSII as initial therapy provided better metabolic control with a lower daily insulin dose than MDI regimen even in the first year of the treatment. Studies with longer duration and more participants are needed. [ABSTRACT FROM AUTHOR]

Published
2020

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