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23 protocols using insulin aspart

1

Covalent Conjugation of Insulin to Chitosan

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Medium Mw CS (75 kDa), 90% deacetylated, was obtained from Primex (Siglufjörður, Iceland). Triton X-100, N-hydroxysuccinimide (NHS), N-ethyl-N′-(3-dimethylaminopropyl) carbodiimide (EDC) and dicarboxylic acid polyethylene glycol (PEG; average Mn, 500 Da) were purchased from Merck KGaA (Darmstadt, Germany). Dialysis bag (molecular weight cut-off, 12,000 Da) was obtained from Sigma-Aldrich (St Louis, MO, USA). Regular human insulin USP (recombinant; regular human insulin, 28.9 IU/mg) was a gift from Ronak Ltd (Tehran, Iran), and aspart insulin was procured from Novo Nordisk (Bagsvaerd, Denmark). Caco-2 cell line with passage number 30–40 was provided by Pasteur Institute (Tehran, Iran). Human Insulin & Insulin Analogs (lispro, aspart) enzyme-linked immunosorbent assay (ELISA) kit was procured from Alpha Diagnostic International (San Antonio, TX, USA).
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2

Insulin Pump Comparison Study

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Only mechanical equipment was used in these studies, therefore ethics approval was not sought.
Five Animas 2020 pumps with 2 mL cartridges (IR1200/2020; Animas, West Chester, Pennsylvania, USA) and Inset II infusion systems (Animas), five Medtronic Paradigm pumps with 1.8 mL cartridge and Quickset (Medtronic, Minneapolis, Minnesota, USA), and three Roche Accu-chek spirit pumps with 3.15 mL cartridge (F.Hoffman-La Roche, Basel, Switzerland) and Inset II infusion sets (Animas) were used.
The cartridges were filled with aspart insulin (NovoNordisk, Bagsvaerd, Denmark) and loaded into the pumps as described in the product literature.
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3

Bromocriptine-QR Adjunct Therapy for T2D

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Patients continued baseline treatment with metformin (1-2 gm in divided doses) and MDI insulin (either premixed human 70/30 insulin twice daily or basal-bolus regimen with basal insulin glargine [rDNA origin; Lantus, Sanofi, Paris, France] and insulin aspart [rDNA origin; Novolog, Novo Nordisk, Bagsvaerd, Denmark] at each meal). Bromocriptine-QR was titrated weekly according to a schedule used in previous studies and detailed on the FDA-approved package insert; 1 tablet (0.8 mg) is taken within 2 hours of waking for the first week and each week thereafter; an additional tablet is added until a maximum tolerated dose of two to six tablets (1.6 to 4.8 mg, resp.) during week six was achieved. Patients were contacted by phone each week during the titration period to inquire about hypoglycemia and potential side effects, primarily nausea, headache, and dizziness. If intolerable side effects were encountered, the patient was instructed to reduce the dose to the highest previously tolerated dose and continue taking this dose through the remainder of the 24-week trial. Metformin dose was held constant. Insulin was titrated according to good clinical practice to target an HbA1c ≤ 7.0%, while minimizing hypoglycemia.
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4

Metabolic Biomarker Assessment Protocol

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Serum insulin was measured by commercial ELISA (Crystal Chem). Serum glucose was measured in whole blood by glucometer (Bayer). Intraperitoneal glucose tolerance testing (1 g/kg body weight) and insulin tolerance testing (1 unit/kg body weight insulin aspart; Novo Nordisk) were performed as previously described (3 (link)). Urine RBP4 levels were determined by ELISA by using a monoclonal IgA-based assay (21 (link)) according to the manufacturer’s instructions (Adipogen). Body composition was measured by whole-body nuclear magnetic resonance (minispec; Bruker). Retinol and retinyl esters (REs) were measured as previously described for serum, tissue, and cells. The RE fraction contains the summed levels of retinyl palmitate, retinyl oleate, retinyl stearate, and retinyl linoleate. These four REs account for >95% of the RE present in liver.
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5

Hyperinsulinemic Euglycemic Clamp Protocol

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After completion of the perfusion scan, a HEC was started. Patients without known diabetes and patients with type 2 diabetes treated with oral glucose-lowering drugs were examined in the fasting state. Patients treated with metformin were allowed to take their medication on the morning of the scan. Patients with insulin treated diabetes could eat breakfast before the perfusion PET and HEC and were instructed to take insulin and oral glucose-lowering drugs as usual. At time 0 min, a constant infusion of insulin (1 mIE/kg/min insulin aspart, Novo Nordisk, Denmark) mixed with 20 ml NaCl was initiated. After 15 min, an exogenous infusion with 20% glucose was started. Plasma glucose concentration in arterialized blood was measured at baseline and every 10 min during the HEC, and the infusion rate was adjusted continuously to maintain a plasma glucose concentration at 5.0 mmol/l. During steady state, the exogenous glucose infusion rate will equal the total amount of metabolized glucose in the body and is consequently a measurement of whole-body insulin sensitivity commonly known as the M-value (μmol/kg/min). The HEC was performed for 2 h and the M-value was calculated during the last 30 min, where steady state was assured [8] (link).
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6

Insulin-Induced Glucose Dynamics

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The mice were fasted for 5 h and then intraperitoneally injected with insulin aspart (1 U/kg; Novo Nordisk A/S, Bagsvaerd, Denmark). Blood samples were collected from the caudal vein at 0, 30, 60, 90, and 120 min after injection. Blood glucose level was measured using a glucose meter (FreeStyle Freedom Lite; NIPRO).
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7

Type 1 Diabetes Eligibility Criteria

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Patients aged between 7 months and 15 years and with new diagnoses of type 1 diabetes were eligible to participate. Patients with the following characteristics were ineligible: previous treatment for type 1 diabetes, haemoglobinopathy, coexisting conditions or treatment likely to affect glycaemic control, psychological or psychiatric disorder, an allergy to a component of insulin aspart or determir (Novo Nordisk, Gatwick, UK) or insulin glargine (Sanofi, Guildford, UK), and a sibling with type 1 diabetes. Patients with thyroid disease or coeliac disease were eligible if thyroid hormone concentrations or coeliac antibodies demonstrated good adherence to treatment. Patients and carers were given written and age appropriate information about the study at diagnosis, supplemented by a video presented by participants and parents from February 2014. Written informed consent or, where appropriate, assent was obtained from carers and participants.
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8

Metformin and Insulin Formulation Study

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Metformin and placebo were prepared as identical capsules by Boulevard Pharmaceutical Compounding Center, Worcester, Massachusetts, USA.
The study drugs (insulin detemir and insulin aspart) were shipped directly from Novo Nordisk, Inc., to the Investigational Drug Services (IDS) of the University of Massachusetts Medical School, which maintained accountability logs for receipt and dispensing of study drugs.
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9

Short-Term Intensive Insulin Therapy via CSII

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All participants were treated with short-term intensive insulin therapy using insulin pumps (Paradigm 712 pump, Medtronic Inc., Northridge, CA) with Insulin Aspart (Novo Nordisk, Bagsværd, Denmark) for at least three consecutive days. The initial insulin doses were 0.4-0.5 IU/kg, and total daily doses were divided into 50% of basal and 50% of premeal. Dosages were titrated every day based on the fasting and postprandial glucose by an experienced physician in order to achieve glycemic goal. Glycemic targets were defined as fasting/premeal blood glucose less than 6.1 mmol/L and 2 h postprandial blood glucose less than 8.0 mmol/L. No other hypoglycemic agents were added during short-term CSII therapy.
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10

Managing Hyperglycemia in ICU Patients

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Blood glucose levels were drawn from an arterial line and measured using an on-site blood gas analyser (Rapidlab® 1265, Siemens, München, Germany) and they were used to adjust the insulin infusion rate. Insulin aspart (Novo Nordisk, Bagsvaerd, Denmark), in a concentration of 50 units in 50 cc 0.9 % NaCl, was continuously infused using the Injectomat Agilia® syringe infusion system (flow-rate change, range 0.1−200 ml/h, Fresenius Kabi, Bad Homburg, Germany). During the ICU stay, treatment of hyperglycaemia was performed using the adapted Yale protocol, maintaining glycaemia between 60 and 140 mg/dl [14 (link)]. SH was defined as glucose levels exceeding this threshold of 140 mg/dl, in accordance with the consensus statement [15 (link)]. Patients were fed according to the local ICU policy, preferably enterally.
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