15, 16 HDR brachytherapy, on the other hand, with a more flexible dose distribution, no radiation exposure to health care personnel, and lower patient cost, has drawn much more attention in the field of radiation oncology recently.
This finding is consistent with the rationale behind multiple daily insulin (MDI) injections (i.e. four injections per day with separate basal and bolus components), where each injection provides a unique opportunity for more flexible dose adjustment [ 16] to improve glycaemic control while avoiding hypoglycaemia.
The new basal insulin analog, insulin degludec, has showed peculiar characteristics, including stable pharmacokinetic and pharmacodynamic profiles, true 24-hour duration of action in all patients, low within-person variability in absorption and glucose-lowering action, more flexible dose timing, and low occurrence of hypoglycemia [ 231].
The DTSQ is highly sensitive to major changes in treatment, for example, from tablets to injections [ 25], or from conventional (more rigid insulin regimen with fixed meal times) to a more flexible insulin dosing (allowing for dietary freedom) [ 26].
Most studies to date have been conducted among heroin users, in controlled settings, and using similar strict dosing schedules (i.e., daily witnessed ingestion) despite buprenorphine/naloxone's superior safety profile, which allows a more flexible take-home dosing schedule.
16 This unique characteristic allows a more flexible once daily dosing regimen within 8 to 40 hours of administration, thus allowing injection times to be changed from day to day without compromising glycemic control or safety.
Management of type 1 diabetes has evolved from fixed daily insulin doses (as prescribed) to more flexible but complex insulin dose self-adjustment based upon carbohydrate consumption and self-monitoring of blood glucose levels.
Mild hypoglycemia (<3.9 mmol/L) was common in this study and tended to occur more frequently in the flexible dosing group (23 and 39% in the fixed dose and flexible dose groups, respectively), despite the algorithmic approach to insulin.
In general, the reduction in total insulin was more prominent in the flexible dosing group, which also required significantly less prandial insulin overall and a significant divergence from the fixed dose group in correction insulin requirements over time.
For the open label extension phase, dose titration was more flexible and the rate of withdrawal was decreased to 19% (Farlow et al 2000).
