AnatomyOrganismsDiseasesChemicals and DrugsAnalytical, Diagnostic and Therapeutic Techniques and EquipmentPsychiatry and PsychologyPhenomena and ProcessesNamed GroupsHealth Care
HyperglycemiaHypoglycemiaBlood GlucoseDiabetic KetoacidosisInsulinDiabetes Mellitus, ExperimentalIslets of LangerhansDiabetes Mellitus, Type 2Diabetes MellitusHypoglycemic AgentsDiabetes Mellitus, Type 1GlucagonGlucoseHyperinsulinismGlucose Clamp TechniqueHemoglobin A, GlycosylatedEpinephrineBlood Glucose Self-MonitoringInsulin Infusion SystemsPancreatic PolypeptideInsulin, Long-ActingEpisode of CareC-PeptideGlucose Tolerance TestInsulin ComaStreptozocinClinical AlarmsGluconeogenesisFastingTime FactorsVentromedial Hypothalamic NucleusSulfonylurea CompoundsNesidioblastosisPostprandial PeriodHydrocortisoneInsulinomaCongenital HyperinsulinismInsulin-Secreting CellsPancreas, ArtificialGlipizideGlucokinaseInsulin ResistanceDiabetes ComplicationsNorepinephrinePregnancy in DiabeticsHomeostasisRats, Sprague-DawleyFatty Acids, NonesterifiedTreatment OutcomeDiabetic AngiopathiesRisk FactorsDiazoxideCritical IllnessGlucagon-Like Peptide 13-Hydroxybutyric AcidLiverRetrospective StudiesInsulin AntibodiesInfusions, IntravenousGlycosuriaInsulin LisproInsulin AspartInsulin, IsophaneMonitoring, AmbulatoryInfant, NewbornPancreasInfusions, SubcutaneousPhlorhizinMetforminPancreatectomyReference ValuesAwarenessAcute DiseaseDipeptidyl-Peptidase IV InhibitorsBody WeightRecurrenceHuman Growth HormoneLactic AcidLactatesAutonomic Nervous SystemMonitoring, PhysiologicGlucagon-Secreting CellsRats, WistarDiabetic ComaAcarboseDiabetic NeuropathiesGlycogenSomatostatinDisease Models, AnimalDiabetic NephropathiesVenomsGlucose IntoleranceInsulin, Regular, PorkProspective StudiesLiver GlycogenBrainHormonesAcidosis, Lactic
Glycaemic controlComplicationsVariabilityType 2 diabetOutcomesRecurrent hypoglycemiaSymptomsCritically illNocturnalGlucose levelsAssociated with higher mortalityIncreases the riskIncidenceDiabetic patientsHigher mortalityChronicLactic acidosisPersistentDehydrationReductionDiabetes mellitusClinicalFrequentSymptomaticOralEtiologyOccurPatientsAcuteAbnormalMortalitySubcutaneous insulinHighMildLevelsAdverseCardiovascularAbsentInterventionRegimenSeverityControlPeriodsOccursFactorsCoronaryIllnessFrequencyInfusionHemolytic anemiaBlood sugarPatient
Glycaemic control4
  • Risk groups include patients in whom glycaemic control is markedly improved, hypoglycaemia develops gradually, an autonomic neuropathy is present, or who are elderly. (idnmsa.ie)
  • Healthy lifestyle, appropriate glycaemic control, hypoglycaemia risk reduction and an organised and a holistic care is appropriate. (lidsen.com)
  • Some oral glucose lowering agents have significant side effects, such as weight gain and hypoglycaemia, which might affect patient compliance and therefore glycaemic control. (biomedcentral.com)
  • Therefore existing treatments for these patients are unsatisfactory, and many patients do not have good glycaemic control, which will increase the risk of complications. (biomedcentral.com)
Complications7
  • Acute and chronic complications including renal failure, retinopathy, neuropathy, and cardiovascular disease are related to and likely caused by the hyperglycemic state. (wikidoc.org)
  • This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. (jmir.org)
  • 4] Such conditions include type 1 diabetes, type 2 diabetes, gestational diabetes, and complications of diabetes such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. (askandanswer.info)
  • Insulin is used to treat a number of diseases including diabetes and its acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycemic states. (askandanswer.info)
  • Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA), although there is very little evidence that DKA is increased in Ramadan. (bmj.com)
  • Exclusion criteria included recent acute complications such as diabetic ketoacidosis and hyperglycemic hyperosmolar state, severe and recurrent hypoglycemic events in the previous 3 months, a history of hepatic or renal impairment, or of other diseases that can influence glucose metabolism, including recent acute cerebral stroke, acute myocardial infarction, malnutrition, and cancers. (biomedcentral.com)
  • Over time, persistently elevated levels of plasma glucose (hyperglycaemia) lead to various microvascular (retinopathy, nephropathy and neuropathy) and macrovascular (cardiovascular diseases) complications. (biomedcentral.com)
Variability4
  • In this regard, as strongly advocated by recent consensus statements, the use of CGM via a standardized metric reporting, using the ambulatory glucose profile (AGP) for data visualization, is considered a part of the evolving standard of diabetes care, supplementing periodic HbA1c testing in addition to accurate evaluation of glycemic variability, and the identification of nocturnal hypoglycemic episodes ( 1 - 6 ). (frontiersin.org)
  • The hypothesis of our study was that adding a DPP4-inhibitor at the beginning of insulin treatment could lead to less exogenous insulin requirement, a reduction of hyperinsulinemia and side effects (hypoglycemia and weight gain), less glucose variability and improvement of insulin and glucagon dynamics during a mixed meal test. (biomedcentral.com)
  • This study could be used as a guidance for larger studies that are required to investigate the effects of this intervention on insulin requirements, glycemic variability, hypoglycemia and weight gain. (biomedcentral.com)
  • The aim of the study was to investigate whether or not the addition of a DPP4-inhibitor to start of insulin treatment could lead to lower exogenous insulin requirements together with lower glucose variability, less weight gain, less hypoglycemia, and improved insulin and glucagon dynamics after a mixed meal test through improvement in alpha and beta cell function. (biomedcentral.com)
Type 2 diabet10
  • Hypoglycemia is it Type 1 or Type 2 diabetes? (paleorecipediet.com)
  • Regarding type 2 diabetes Hypoglycemia is particularly prevalent in insulin-dependent individuals, such as those with type 1 diabetes. (paleorecipediet.com)
  • However, persons with type 2 diabetes are increasingly utilizing insulin, which may indicate an increase in the incidence of hypoglycemia in this population. (paleorecipediet.com)
  • Is type 2 diabetes hypoglycemic or hyperglycemic? (paleorecipediet.com)
  • 49% of persons with Type 2 diabetes (excluding those treated with insulin) had at least one hypo - an episode of low blood glucose that may cause symptoms ranging from sweating to loss of consciousness - within a two-week period, according to a new Diabetes UK poll. (paleorecipediet.com)
  • A person with type 2 diabetes might develop hyperglycemia, a condition characterized by elevated blood sugar levels. (paleorecipediet.com)
  • Care by an interprofessional diabetes health-care team composed of a diabetes nurse educator, dietitian, obstetrician and endocrinologist/internist with expertise in diabetes, both prior to conception and during pregnancy, has been shown to minimize maternal and fetal risks in women with pre-existing type 1 and type 2 diabetes. (diabetes.ca)
  • Women should be screened for diabetes between 6 weeks and 6 months postpartum, with a 75 g oral glucose tolerance test and be given ongoing education regarding strategies to reduce the risk of developing type 2 diabetes. (diabetes.ca)
  • Poorly controlled diabetes in a pregnant woman with type 1 or type 2 diabetes increases her risk of miscarrying, having a baby born with a malformation and having a stillborn. (diabetes.ca)
  • Low blood sugar levels (hypoglycemia) generally occur in people with type 1 or type 2 diabetes taking insulin or other blood sugar-lowering medications. (diabetestalk.net)
Outcomes6
  • Hypoglycemia is associated with adverse outcomes in mixed populations of patients in intensive care units. (diabetesjournals.org)
  • Hyperglycemia is associated with adverse clinical outcomes, and randomized controlled trials in intensive care units (ICUs) have shown that aggressive treatment of elevated blood glucose improves outcomes. (diabetesjournals.org)
  • If we're able to prevent severe hypoglycemia, treat hyperglycemia, get the outcomes we want, this will translate into areas of cost saving. (glytecsystems.com)
  • Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. (biomedcentral.com)
  • Because the long-term effect of a single episode of critical illness on health is substantial, and the costs associated with care of survivors, particularly those with pre-existing chronic illnesses, are considerable, there is an urgent need for interventions that modify these outcomes in patients with chronic illnesses. (biomedcentral.com)
  • Primary outcomes included HbA1c, weight change and adverse events. (biomedcentral.com)
Recurrent hypoglycemia4
  • Previous studies showed a broad clinical spectrum ranging from asymptomatic to recurrent hypoglycemia with/without lactic acidosis, encephalopathy, seizures, and liver failure. (bvsalud.org)
  • In sensitivity analyses, we studied whether any association with outcome was different in patients with iatrogenic or spontaneous/recurrent hypoglycemia. (biomedcentral.com)
  • Impaired executive functions were most pronounced in patients with spontaneous or recurrent hypoglycemia. (biomedcentral.com)
  • Critically ill children exposed to hypoglycemia in PICU were at higher risk of impaired executive functions after 4 years, especially in cases of spontaneous/recurrent hypoglycemia. (biomedcentral.com)
Symptoms8
Critically ill3
  • It remains unknown whether the risks associated with hypoglycemia found in critically ill patients can be generalized to non-ICU settings. (diabetesjournals.org)
  • Previously, hypoglycemia occurring under tight glucose control in critically ill children receiving early PN did not associate with long-term harm. (biomedcentral.com)
  • After 4 years, critically ill children with hypoglycemia scored significantly worse for certain parent/caregiver-reported executive functions (working memory, planning and organization, metacognition) than patients without hypoglycemia, also when adjusted for risk factors including baseline NSE and S100B. (biomedcentral.com)
Nocturnal2
  • Abs 43-LB). To test the incremental advantage of a flatter but more extended PK curve, one of the key efficacy end points was the comparison of nocturnal hypoglycemic events in the last 3 months of the study. (mednet.ca)
  • As expected, reductions in HbA 1c at 6 months did not differ between study arms (-0.83% in both groups), but the percentage of patients reporting at least 1 severe or confirmed nocturnal hypoglycemic event from month 3 to 6 was 36.1% in the Gla-300 group and 46% in the Gla-100 group. (mednet.ca)
Glucose levels1
Associated with higher mortality2
  • In this study, we aimed to determine whether hypoglycemic episodes are associated with higher mortality in diabetic patients hospitalized in the general ward. (diabetesjournals.org)
  • Hypoglycemia univariably associated with higher mortality in PICU, at 90 days and 4 years after randomization, but not when adjusted for risk factors. (biomedcentral.com)
Increases the risk2
Incidence1
  • Infants of mothers with preexisting diabetes mellitus experience double the risk of serious injury at birth, triple the likelihood of cesarean delivery, and quadruple the incidence of newborn intensive care unit (NICU) admission. (medscape.com)
Diabetic patients4
  • It is not known whether the same risks exist for diabetic patients who are less severely ill. (diabetesjournals.org)
  • Hypoglycemia is common in diabetic patients hospitalized in the general ward. (diabetesjournals.org)
  • A short 30-min session of moderate-intensity endurance-type exercise substantially reduces the prevalence of hyperglycemia throughout the subsequent day in type 2 diabetic patients. (diabetesjournals.org)
  • A single bout of exercise lowers circulating blood glucose concentrations and reduces the prevalence of hyperglycemic episodes throughout the subsequent day in type 2 diabetic patients ( 7 - 9 ). (diabetesjournals.org)
Higher mortality1
Chronic4
  • In particular, aggressively tight glucose control, either patient driven or clinician directed, may give rise to chronic or recurrent episodes of hypoglycemia. (medscape.com)
  • The American Diabetes Association/European Association for the Study of Diabetes consensus recommendations emphasize the importance of patient factors and comorbidities when choosing diabetes medications including the presence of comorbidities, atherosclerotic cardiovascular disease, heart failure, chronic kidney disease, hypoglycemia risk, weight issues and costs. (bmj.com)
  • 4 ) Two key pathways are chronic hyperglycaemia and renin-angiotensin system (RAS) activation. (smj.org.sg)
  • Chronic hyperglycaemia leads to the accumulation of advanced glycation end-products, reactive oxygen species and inflammatory cytokines. (smj.org.sg)
Lactic acidosis1
  • Certain medications used concomitantly with metformin may also increase the risk of lactic acidosis. (pdr.net)
Persistent3
  • Diabetes mellitus is characterized by persistent hyperglycemia from a variety of causes, and it is the most prominent disease related to the failure of blood sugar regulation. (wikipedia.org)
  • Let's look a little closer at the financial benefits of optimal glycemic management, preventing severe hypoglycemia, treating persistent hyperglycemia. (glytecsystems.com)
  • [ 1 , 2 ] A study by Stuebe et al found this condition to be associated with persistent metabolic dysfunction in women at 3 years after delivery, separate from other clinical risk factors. (medscape.com)
Dehydration1
Reduction4
  • The options continue to expand, but we continue to look for opportunities to further improve basal insulins, notably with regard to further reduction in the risk of hypoglycemia as well as more convenient dosing," observed Dr. Matthew C. Riddle, Oregon Health & Science University, Portland, Oregon. (mednet.ca)
  • We're seeing the serious safety event reduction, a morbidity reduction, translating into a length of stay reduction, readmission rate reduction, and begin to see those cost savings. (glytecsystems.com)
  • A reduction in glycated haemoglobin (HbA1c) and less hypoglycemia was shown in a previous study adding vildagliptin on top off an existing insulin regimen [ 4 ]. (biomedcentral.com)
  • Discover UPMC Central Pennsylvania's approach to a 92% reduction in hypoglycemia. (monarchmedtech.com)
Diabetes mellitus6
Clinical6
  • Preexisting hyperglycemia worsens the clinical outcome of acute stroke. (medscape.com)
  • [ 6 ] If the hypoglycemia is transitory and the clinical status of the patient returns to normal, follow-up CT-scan findings may again be normal. (medscape.com)
  • The safety and efficacy of IV insulin in the treatment of hyperglycemia in patients with acute stroke are being determined by ongoing/planned clinical trials. (medscape.com)
  • This report will help to expand the clinical understanding of this rare disease and recommends screening for PEPCK-C deficiency in unexplained hypoglycemia. (bvsalud.org)
  • Its clinical presentation is due to hyperinsulinemia and the subsequent hypoglycemia. (bvsalud.org)
  • Particular caution should be exercised, and intensified blood glucose monitoring is advisable for patients in whom hypoglycaemic episodes might be of clinical relevance and in those where dose adjustments may be required. (idnmsa.ie)
Frequent2
  • Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the initiation of an insulin infusion sliding scale for quality improvement. (biomedcentral.com)
  • DM that begins throughout pregnancy owing to adjustments in glucose metabolism and insulin ranges-for-high-blood-pressure resistance The disease is marked by alternating episodes of hypoglycemia and hyperglycemia Frequent changes of dietary intake and insulin dosage are required. (gov.et)
Symptomatic1
  • People with T1DM have an average of two bouts of symptomatic hypoglycemia every week, which amounts to thousands of episodes over the course of a lifetime with diabetes. (paleorecipediet.com)
Oral5
Etiology1
Occur2
Patients17
  • Nondiabetic ischemic stroke patients with hyperglycemia have a 3-fold higher 30-day mortality rate than do patients without hyperglycemia. (medscape.com)
  • Because hyperglycemia may accelerate the ischemic process in stroke, it is possible that characteristic features of acute stroke will appear on computed tomography (CT) or magnetic resonance imaging (MRI) scans sooner than they would in patients without hyperglycemia. (medscape.com)
  • Later, in patients with severe hypoglycemia that is prolonged and complicated by anoxic brain injury and coma, CT scanning of the brain may show cortical atrophy (reflecting laminar necrosis). (medscape.com)
  • Patients with acute stroke and hyperglycemia are often kept NPO (nothing by mouth), because of the complicating effects of feeding on the blood glucose level. (medscape.com)
  • In recent years, there has been an increasing focus on controlling hyperglycemia in hospitalized patients ( 1 ). (diabetesjournals.org)
  • All patients presented with unexplained hypoglycemia as a common feature. (bvsalud.org)
  • Two out of the seven patients presented with episodes of encephalopathy that resulted in seizures and neuroregression leading to global developmental delay and one patient had a neonatal presentation. (bvsalud.org)
  • thereby achieving the full metabolic normalization not yet possible and making some degree of hyperglycemia persists in virtually all patients with diabetes. (wikidoc.org)
  • Hypoglycemia is common, almost 20% of patients stays, they have a blood sugar reading less than 70. (glytecsystems.com)
  • And many patients that have severe hypoglycemia, up to 40%, will have a repeat hypoglycemia event. (glytecsystems.com)
  • Work from Dr. Umpierrez, one of our speakers at this conference, has shown that up to almost 40% of patients in the hospital have diabetes or hyperglycemia, stress hyperglycemia. (glytecsystems.com)
  • BBI, Basal/Bolus insulin, managed with Glucommander SubQ, getting patients in range with no severe hypoglycemia in this particular study. (glytecsystems.com)
  • Sodium-glucose cotransporter 2 inhibitors improved time-in-range without increasing hypoglycemia in Japanese patients with type 1 diabetes: A retrospective, single-center, pilot study. (omicsdi.org)
  • Cases of cardiac failure have been reported when pioglitazone was used in combination with insulin, especially in patients with risk factors for development of cardiac heart failure. (idnmsa.ie)
  • However, it remains debated whether brief hypoglycemia occurring in the context of critical illness by itself causes harm, since hypoglycemia more frequently occurs in patients with higher illness severity, which introduces potential bias [ 3 ]. (biomedcentral.com)
  • Some 25 % of all adult ICU patients have diabetes, and it is plausible that ICU survivors with co-existing diabetes are at heightened risk of sequelae from their critical illness. (biomedcentral.com)
  • High-risk elderly patients receiving nonsurgical treatment for aortic stenosis (AS) are rarely studied. (aacnjournals.org)
Acute1
Abnormal3
  • Relative to the standard regimens they will replace, the newer therapies reduce abnormal glycemic excursions at periods of peak risk, including hypoglycemia at night or during exercise and hyperglycemia after meals. (mednet.ca)
  • The introduction of once-daily dosing of insulin through long-acting basal insulin analogs advanced the predictability and simplicity of blood glucose control, but subsequent advances have been focused on further reducing risk of abnormal glycemic excursions. (mednet.ca)
  • If unequivocal hyperglycemia is absent, two abnormal test results are required for diagnosis, using the same sample or two separate test samples. (medscape.com)
Mortality4
  • The associations between the number and severity of hypoglycemic (≤50 mg/dl) episodes and inpatient mortality, length of stay (LOS), and mortality within 1 year after discharge were evaluated. (diabetesjournals.org)
  • In particular, hypoglycemia in ICUs has been linked to increased risk of mortality, seizures, and coma ( 4 ). (diabetesjournals.org)
  • Recent evidence has proved that perioperative (intraoperative plus postoperative) hyperglycaemia is directly correlated with the development of deep sternal wound infection, increased mortality and morbidity, and increased hospital stay [ 8 ]. (biomedcentral.com)
  • In this secondary analysis of the multicenter PEPaNIC RCT, we studied whether hypoglycemia in PICU associated with mortality ( N = 1440) and 4-years neurodevelopmental outcome ( N = 674) through univariable comparison and multivariable regression analyses adjusting for potential confounders. (biomedcentral.com)
Subcutaneous insulin1
  • The prolonged effect of subcutaneous insulin glargine may delay recovery from hypoglycaemia. (idnmsa.ie)
High6
  • Measures should be undertaken to decrease the frequency of hypoglycemia in this high-risk patient population. (diabetesjournals.org)
  • They saw that over $10,000 were related to severe hypoglycemia when compared to normal glycemia, extremely high costs of not preventing severe hypoglycemia. (glytecsystems.com)
  • Alternatively, for high-risk women or in areas in which the prevalence of insulin resistance is 5% or higher (eg, the southwestern and southeastern United States), a 1-step approach can be used by proceeding directly to the 100-g, 3-hour OGTT. (medscape.com)
  • seven 402 of 764 trials were at low risk of simvastatin and high blood sugar bias in random sequence generation and 529 692 were at low risk of bias in allocation concealment. (ggim.in)
  • On the flip side, hyperglycemia happens when your blood sugar is too high, and can happen to nondiabetics. (sugarprotalk.com)
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Mild1
Levels2
Adverse1
  • The commonest adverse events with all GLP-1 agonists were initial nausea and vomiting. (biomedcentral.com)
Cardiovascular1
  • Thirdly, the family physician has an important role in health promotion and in managing comorbidities, especially cardiovascular risk factors. (smj.org.sg)
Absent1
  • Warning signs of hypoglycaemia may be changed, less pronounced or absent in certain risk groups, potentially resulting in severe hypoglycaemia and loss of consciousness. (idnmsa.ie)
Intervention2
  • However, the intervention increased the risk of hypoglycemia, which may have counteracted part of the benefit. (biomedcentral.com)
  • Further adjustment for the interaction of hypoglycemia with the randomized intervention or treatment center revealed a potential interaction, whereby tight glucose control and withholding early PN may be protective. (biomedcentral.com)
Regimen1
  • In case of insufficient glucose control or a tendency to hyper/hypoglycaemic episodes, the patient's adherence to the prescribed treatment regimen, injection sites and proper injection technique and all other relevant factors must be reviewed before dose adjustment is considered. (idnmsa.ie)
Severity1
  • Likewise, a longer duration of stay in the pediatric intensive care unit (PICU), also indicating higher illness severity, prolongs the exposure to glucose control strategies and hence increases the odds of developing a hypoglycemic event. (biomedcentral.com)
Control4
  • Tight glucose control, however, is not without risk. (diabetesjournals.org)
  • Studies have suggested that the benefits of tight glycemic control may be at least partially offset by the increased risk of hypoglycemia ( 2 , 3 ). (diabetesjournals.org)
  • We investigated whether hypoglycemia in PICU differentially associates with outcome in the context of withholding early PN, and whether any potential association with outcome may depend on the applied glucose control protocol. (biomedcentral.com)
  • To study whether an association of hypoglycemia with outcome may be affected by the nutritional strategy or center-specific glucose control protocol, we further adjusted the models for the interaction between hypoglycemia and the randomized nutritional strategy, respectively, treatment center. (biomedcentral.com)
Periods1
  • The main drawbacks of self-monitoring blood glucose (SMBG) systems include inadequate patient compliance to intermittent capillary sampling, unreliability of patient-recorded data, inability to capture and store large amounts of glycemic data including hypoglycemic episodes for extended periods of time ( 2 ). (frontiersin.org)
Occurs1
Factors1
  • Although there is some evidence that intermittent fasting during Ramadan may be of benefit in losing weight and cardiometabolic risk factors, there is no strong evidence these benefits apply to people with diabetes. (bmj.com)
Coronary1
  • www.aemmedi.it viagra for men directly associated with the risk of coronary arteryin all groups of age examined.treated with glucose at 33%.v. followed by glucose 10%compensation-born were divided in subjects with Earlythe disease. (ericamulherin.com)
Illness2
  • Diabetes itself does not cause changes in personality or psychiatric illness, but particular subgroups of the diabetic population appear to be at risk for developing psychosocial problems. (cdc.gov)
  • In addition to being a strong predictor of death, an episode of critical illness leads to substantial morbidity, with survivors frequently experiencing long-term physical and neuropsychiatric problems including weakness, impaired physical function, depression, anxiety, and cognitive dysfunction [ 5 ]. (biomedcentral.com)
Frequency1
  • The implementation of protocols led to the achievement of blood glucose concentration targets more rapidly and the maintenance of a specified target blood glucose range for a longer time, without any increased frequency of hyperglycaemia. (biomedcentral.com)
Infusion1
  • Treat severe hypoglycemia with IV D50W followed by continuous IV infusion of more dilute dextrose solution at a rate sufficient to keep serum glucose at approximately 100 mg/dL. (unboundmedicine.com)
Hemolytic anemia1
  • A hemolytic anemia episode may be preceded by behavioral changes such as irritability or lethargy. (ggim.in)
Blood sugar4
Patient1