№ lp_1_2_44840
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Clinical governance document outlining criteria, assessment steps, and decision rules for adjusting insulin doses in adult outpatients with diabetes under a UK health board.
Document title:
Protocol for the adjustment of insulin doses in diabetes
Organisation:
Aneurin Bevan University Health Board
Service area:
Adult Diabetes Service
Type of document:
Clinical protocol
Target population:
Adults with diabetes
Clinical setting:
Acute and community settings
Intended users:
Diabetes dietitians within the multidisciplinary team
Author:
Elaine Hibbert-Jones
Contributors:
Francesca Annan; Dorothy Debrah; Neera Agarwal; Kathryn John
Responsible committee:
Medicines Management
Geographical scope:
Wales
Insulin preparations:
Aneurin Bevan Drug Formulary
Exclusions:
Inpatients; pregnancy; paediatrics; insulin pump therapy without additional training
Date issued:
May 2018
Review date:
May 2021
Key topics:
Insulin dose adjustment; hypoglycaemia; hyperglycaemia; blood glucose monitoring; basal and bolus insulin; injection technique
Price: 8 / 10 USD
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2020
Region / city:
Australia
Topic:
Medical Submission for Pharmaceutical Product
Document Type:
Submission
Organization / Institution:
Chiesi Australia Pty Ltd
Author:
Chiesi Australia Pty Ltd
Target Audience:
Medical professionals, regulatory authorities
Period of validity:
Not specified
Approval Date:
June 24, 2020
Date of changes:
Not specified
Year:
2019
Region / City:
Australia
Topic:
Hormone Replacement Therapy (HRT)
Document Type:
Regulatory Submission
Organization / Institution:
Besins Healthcare Australia Pty Ltd
Author:
Not specified
Target Audience:
Health professionals and regulatory authorities
Period of Effectiveness:
Not specified
Approval Date:
8 May 2019
Modification Date:
Not specified
Registration Status:
TGA Registered
Indications:
Estrogen deficiency, prevention of osteoporosis, menstrual irregularities, hormone replacement therapy
Purpose:
Request for listing of medications in General Schedule
Product Names:
Estrogel®, Prometrium®, Estrogel Pro
Safety Data:
Includes safety outcomes such as breast pain, tenderness, breakthrough bleeding, and breast cancer risk
Comparator Products:
Sandrena®, MPA (medroxyprogesterone acetate)
Clinical Claims:
Efficacy and safety comparison of Estrogel and MP to Sandrena and MPA
Source:
Tables 1.2, pp23-24
Year:
2026
Region / City:
Not specified
Subject:
Chemical risk assessment, toxicology
Document Type:
Supplemental tables
Institution / Agency:
Not specified
Author:
Not specified
Exposure Routes:
Oral, Inhalation
Exposure Duration:
Acute, Intermediate, Chronic
Data Type:
Quantal, Continuous, Not applicable
Chemicals Included:
Chromium (VI), 1,1,2,2-Tetrachloroethane, 1,3-Dichloropropene, Cresols, Ethylene Glycol, Tris(2-Chloroethyl) Phosphate, Tributyl Phosphate, Tris(2-Butoxyethyl) Phosphate, Tris(1,3-Dichloro-2-Propyl) Phosphate, Monomethylarsonic Acid, Dimethylarsinic Acid, Acrylamide, Toxaphene, Uranium, 2-Methylnaphthalene, Barium Salts, Boron Compounds, Cadmium, Vanadium Compounds, Benzene, 1,3 Butadiene, Polybrominated Diphenyl Ethers, Sulfur Mustard, Ethylbenzene, Toluene, Xylenes
MRL Values:
Listed per chemical in mg/kg/day or mg/m³ or ppm
Risk Levels:
K=1, Upper Bound Risk, Relative Risk Ratios (RR) at 2x and 5x MRL
Benchmark Dose Type:
BMD, BMDL, BMCL, LOAEL
Jurisdiction:
Western Australia, Australia
Responsible authority:
Department of Health
Subject:
Prescribing of stimulant medicines
Document type:
Prescribing guidance / regulatory information
Target users:
Medical practitioners authorised to prescribe stimulant medicines
Approved conditions:
ADHD; Acquired brain injury; Depression; Narcolepsy; Binge eating disorder
Approved specialists:
Paediatrician; Neurologist; Paediatric neurologist; Psychiatrist; Child and adolescent psychiatrist; Rehabilitation physician; Paediatric rehabilitation physician; Respiratory and sleep physician; Thoracic medicine physician
Patient eligibility:
Patients within specified approved age criteria depending on prescriber specialisation
Minimum patient age:
4 years (for child-specialist prescribers)
Maximum stimulant doses:
Dexamfetamine up to 60 mg/day; Lisdexamfetamine up to 70 mg/day; Methylphenidate up to 120 mg/day; combination doses calculated as dexamfetamine equivalents
Prescription setting:
Clinical treatment of approved conditions
Regulatory requirement:
Notification to the Department of Health when commencing stimulant treatment or when specified patient or prescriber details change
Co-prescriber rules:
Co-prescribers must be medical practitioners practising in Western Australia and recorded in the notification
Review requirement:
Annual patient review by the primary stimulant prescriber
Contact service:
Schedule 8 Medicines Prescriber Information Service
Telehealth provision:
Interstate practitioners may prescribe via telehealth for Western Australian residents for prescriptions issued on or after 13 December 2023
Year:
2021
Region / city:
Nepal
Topic:
Public health / Covid-19 vaccination
Document type:
Urgent action / appeal letter
Organization:
Amnesty International
Author:
Not specified
Target audience:
International community, governments with vaccine surplus
Action deadline:
17 August 2021
Vaccine involved:
Oxford-AstraZeneca
Population affected:
Over 1.4 million high-risk individuals
First dose period:
7–15 March 2021
Required second dose period:
27 June–5 July 2021
Vaccination coverage at time of report:
2.4% fully vaccinated
Urgent needs:
Immediate vaccine delivery, international support, TRIPS waiver advocacy
Year:
2018
Region / City:
London
Topic:
Diabulimia, Integrated Diabetes and Mental Health Pathway
Document Type:
Response Template
Organization:
NHS England
Author:
Not specified
Target Audience:
Health providers, commissioners
Period of Implementation:
15 months
Approval Date:
Not specified
Amendment Date:
Not specified
Year:
2026
Organization:
Canberra Health Services
Department:
Neonatology
Document Type:
Procedure
Target Audience:
Medical Officers, Registered Nurses, Midwives, Student Nurses under supervision
Scope:
Neonates from birth to 44 weeks corrected gestational age
Related Policies:
Neonatal Intensive Care Drug Manual, ANMF guidelines
Definitions Included:
Blood Glucose Levels, Hyperglycaemia, Significant Hyperglycaemia
Treatment Recommendations:
Insulin infusion, glucose monitoring, TPN and enteral feeding guidance
Risks Addressed:
Hypoglycaemia, glucose delivery variability, insulin-plastic binding
Year:
2022
Region / City:
England
Topic:
Healthcare, Insulin Administration
Document Type:
Policy
Organization / Institution:
NHS England and Improvement (NHSEI)
Author:
Not specified
Target Audience:
Healthcare workers, support workers, non-regulated health and care roles, allied health professionals
Period of validity:
Not specified
Approval date:
November 2022
Date of changes:
Not specified
Year:
2022
Region / City:
ACT and surrounding NSW
Topic:
Paediatric Diabetes Care, Insulin Pump Therapy
Document Type:
Clinical Guideline
Organization:
Canberra Health Services (CHS)
Author:
Canberra Health Services, Paediatric Endocrinology and Diabetes Service
Target Audience:
Paediatric Diabetes Healthcare Providers
Period of Validity:
N/A
Approval Date:
N/A
Date of Last Revision:
N/A
Note:
Year
Region / city:
Canberra
Topic:
High-Risk Medicines, Insulin Administration
Document Type:
Procedure
Institution:
Canberra Health Services
Target Audience:
CHS Employees (Medical, Nursing, Midwifery, Pharmacy, Allied Health)
Year:
2026
Region / city:
Canberra
Topic:
Insulin infusion management in hospital settings
Document type:
Procedure
Organization / institution:
Canberra Health Services
Author:
Not specified
Target audience:
Medical officers, nurses, midwives, ICU/HDU/ED staff at North Canberra Hospital
Effective period:
Not specified
Approval date:
Not specified
Revision date:
Not specified
Year:
2025
Region / City:
Tower Hamlets, Newham, Bedfordshire
Topic:
Diabetes care, insulin administration, healthcare policy
Document type:
Policy
Organization:
East London NHS Foundation Trust
Author:
Georgina Amparado Molina, Michael Asuma, Caroline Ogunsola
Target Audience:
Healthcare professionals, clinical staff
Effective period:
May 2025 – May 2028
Approval date:
14th May 2025
Date of last review:
May 2025
Date of next review:
May 2028
Version:
6
Issuing organisation:
Frimley Integrated Care System
Region:
Frimley ICS
Country:
United Kingdom
Document status:
Controlled document
Review date:
August 2025
Key topics:
Hybrid Closed Loop systems, insulin pump therapy, continuous glucose monitoring
Clinical area:
Paediatric type 1 diabetes
Target population:
Children and young people with type 1 diabetes
Relevant guidance:
NICE Technology Appraisal TA943
Care setting:
Specialist Diabetes Service
Multidisciplinary team involvement:
Yes
Implementation scope:
NHS England services
Year:
2025
Region / City:
Lancashire (North, Central and East Lancashire), Blackpool, Blackburn with Darwen, South Cumbria
Topic:
Insulin safety
Document Type:
Prescribing Alert
Organisation:
LSC ICB Medicines Safety Committee
Author:
NHS England
Target Audience:
Healthcare professionals
Period of Action:
Ongoing
Approval Date:
06.08.2025
Modification Date:
06.08.2025
Year:
2024
Region / City:
Global
Topic:
Insulin treatment in children and adolescents with diabetes
Document Type:
Clinical Practice Consensus Guidelines
Institution:
ISPAD
Authors:
Eda Cengiz, Thomas Danne, Tariq Ahmad, Ahila Ayyavoo, David Beran, Ethel Codner, Sarah Ehtisham, Przemyslawa Jarosz-Chobot, Lucy N. W. Mungai, Sze May Ng, Megan Paterson, Leena Priyambada
Target Audience:
Healthcare professionals involved in pediatric diabetes care
Period of Effect:
2024 and ongoing
Approval Date:
2024
Date of Changes:
2024
Keywords:
Type 1 diabetes, insulin, children, adolescents, intensive insulin therapy, diabetes complications
Description:
Clinical guidelines for insulin therapy in pediatric diabetes, focusing on updated insulin treatment regimens, including bolus and basal insulins, as well as new insulin analogs and devices for therapy.
Note:
Year
Topic:
Health
Document Type:
Procedural Guideline
Organization:
Plano Independent School District
Target Audience:
School health staff, nurses
Year:
2015
Region / city:
Global
Topic:
Acute hyperkalemia treatment
Document type:
Research review
Organization / institution:
Not specified
Author:
Not specified
Target audience:
Healthcare professionals
Period of validity:
Not specified
Date of approval:
Not specified
Date of amendments:
Not specified
Conflict of Interests:
None
Clinical outcomes:
Potassium levels, ECG findings
Main intervention:
Intravenous calcium
Comparison:
No intervention, other interventions, placebo
Setting:
Adults
Background:
The acute treatment of hyperkalemia was reviewed in 2015.
Assessment:
Hyperkalemia is a common and life-threatening electrolyte imbalance.
Desirable effects:
Moderate effect of pharmacological intervention in mitigating hyperkalemia.
Undesirable effects:
Potential harm from calcium administration, especially in cardiac arrest patients.
Certainty of evidence:
Low certainty, based on limited observational data.
Values:
Primary outcome is ECG changes, with limited clinical relevant data.
Balance of effects:
Suggests against routine calcium use in cardiac arrest (weak recommendation).
Resources required:
Low cost of calcium.
Cost effectiveness:
No evidence of cost-effectiveness studies.
Equity:
No studies identified.
Acceptability:
Calcium has been recommended in international guidelines, but the new suggestion may face resistance.
Feasibility:
Feasible as a recommendation against routine use.
Context:
This document reviews evidence on the use of intravenous calcium for acute hyperkalemia treatment and recommends against its routine use in patients with hyperkalemia-induced cardiac arrest.
Population:
Paediatric patients in cardiac arrest suspected to be caused by hyperkalaemia
Intervention:
Insulin with glucose or salbutamol
Comparison:
No insulin with glucose and no salbutamol
Main outcomes:
Survival to discharge; Survival to discharge with favourable neurological outcome (PCPC 1–3 or no change from baseline); Survival to discharge with PCPC 1–2 or no change from baseline
Setting:
Any setting
Perspective:
Not specified
Conflict of interests:
None
Problem priority:
Varies
Desirable effects:
Small
Undesirable effects:
Trivial
Certainty of evidence:
No included studies
Values and preferences:
Probably no important uncertainty or variability
Balance of effects:
Probably favors the intervention
Resources required:
Varies
Certainty of evidence of required resources:
No included studies
Cost effectiveness:
No included studies
Equity impact:
Unknown
Acceptability:
Unknown
Feasibility:
Probably yes
Title:
Supplementary Information for Ethanol extract of Lentinus edodes exerted antioxidant activity in Caenorhabditis elegans by regulating insulin DAF-16 signaling pathway
Document Type:
Supplementary information
Section:
Materials and Methods
Research Topic:
Antioxidant activity and insulin DAF-16 signaling pathway
Biological Material:
Lentinus edodes
Model Organism:
Caenorhabditis elegans (N2)
Experimental Groups:
NFD, LEEE-L (0.1 mg/mL), LEEE-M (0.5 mg/mL), LEEE-H (1 mg/mL)
Extraction Method:
Ethanol extraction with ultrasonic treatment
In Vitro Assays:
DPPH, ABTS, hydroxyl radical scavenging assays
In Vivo Assays:
Heat stress assay, acute oxidative stress assay
Biochemical Indicators:
MDA, T-SOD, GSH-PX, CAT, ROS
Cell Analysis:
Apoptosis assay with acridine orange staining
Reagents and Kits:
Beyotime Biotechnology cell lysate; Jiancheng Bioengineering assay kits
Replication:
Three independent repeats per experiment
Geographical Reference:
Jinggangshan, China; Fuzhou, China; Shanghai, China; Nanjing, China
Storage Conditions:
-80°C freezer storage for extract