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Hypoglycemia and management

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https://www.readbyqxmd.com/read/28942790/glucagon-like-peptide-1-receptor-agonists-a-class-update-for-treating-type-2-diabetes
#1
REVIEW
Julie A Lovshin
Current management options for treating type 2 diabetes are diverse. Many different classes of antidiabetes therapies are used in clinic, and several new candidates are in late-phase clinical trial. This therapeutic abundance is a windfall for patients because it facilitates individualized patient care. Evidence-based positioning of these agents is challenging, however, requiring comprehensive and balanced familiarity with each drug class. In this review, I provide a clinical update of glucagon-like peptide-1 receptor agonists (GLP-1RAs), a class of incretin-based, injectable antidiabetes therapies which improve fasting and postprandial blood glucose control through glucose-dependent pancreatic islet cell hormone secretion without significant risks for hypoglycemia...
October 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28942789/the-role-of-sodium-glucose-cotransporter-2-inhibitors-in-the-management-of-type-2-diabetes
#2
REVIEW
Oren Steen, Ronald M Goldenberg
Sodium-glucose cotransporter 2 (SGTL2) inhibitors are a novel class of antihyperglycemic agents that work in an insulin-independent manner by promoting urinary glucose excretion. In addition to efficacious glucose lowering, they exert beneficial effects on blood pressure and weight while avoiding hypoglycemia unless combined with insulin or insulin secretagogues. This review explores the mechanism of action of SGLT2 inhibitors, their effects on glycated hemoglobin, weight, blood pressure and hypoglycemia, potential adverse effects, renal considerations and cardiovascular outcomes...
October 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28942788/insulin-management-strategies-for-exercise-in-diabetes
#3
REVIEW
Dessi P Zaharieva, Michael C Riddell
There is no question that regular exercise can be beneficial and lead to improvements in overall cardiovascular health. However, for patients with diabetes, exercise can also lead to challenges in maintaining blood glucose balance, particularly if patients are prescribed insulin or certain oral hypoglycemic agents. Hypoglycemia is the most common adverse event associated with exercise and insulin therapy, and the fear of hypoglycemia is also the greatest barrier to exercise for many patients. With the appropriate insulin dose adjustments and, in some cases, carbohydrate supplementation, blood glucose levels can be better managed during exercise and in recovery...
October 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28938433/type-2-diabetes-and-osteoporosis-a-guide-to-optimal-management
#4
Stavroula Paschou, Anastasia D Dede, Panagiotis G Anagnostis, Andromachi Vryonidou, Daniel Morganstein, Dimitrios G Goulis
Context: Both type 2 diabetes (T2D) and osteoporosis are affected by aging and quite often co-exist. Furthermore, the fracture risk in patients with T2D is increased. The aim of this article is to review updated information on osteoporosis and fracture risk in patients with T2D, to discuss the effects of diabetes treatment on bone metabolism, as well as the effect of anti-osteoporotic medications on the incidence and control of T2D and to provide a personalized guide to the optimal management...
June 21, 2017: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/28932408/golden-hour-of-neonatal-life-need-of-the-hour
#5
REVIEW
Deepak Sharma
"Golden Hour" of neonatal life is defined as the first hour of post-natal life in both preterm and term neonates. This concept in neonatology has been adopted from adult trauma where the initial first hour of trauma management is considered as golden hour. The "Golden hour" concept includes practicing all the evidence based intervention for term and preterm neonates, in the initial sixty minutes of postnatal life for better long-term outcome. Although the current evidence supports the concept of golden hour in preterm and still there is no evidence seeking the benefit of golden hour approach in term neonates, but neonatologist around the globe feel the importance of golden hour concept equally in both preterm and term neonates...
2017: Maternal Health, Neonatology and Perinatology
https://www.readbyqxmd.com/read/28930827/comparative-efficacy-and-safety-of-oral-antidiabetic-drugs-and-insulin-in-treating-gestational-diabetes-mellitus-an-updated-prisma-compliant-network-meta-analysis
#6
Hui-Ling Liang, Shu-Juan Ma, Yan-Ni Xiao, Hong-Zhuan Tan
BACKGROUND: The safety and efficacy of different drugs in treatment of gestational diabetes mellitus (GDM) patients who could not maintain normal glucose level only through diet and exercise remains to be debated. We performed this network meta-analysis (NAM) to compare and rank different antidiabetic drugs in glucose level control and pregnancy outcomes in GDM patients. METHODS: We searched PubMed, Cochrane Library, Web of Science, and Embase up to December 31, 2016...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28929796/a-coordinated-control-strategy-for-insulin-and-glucagon-delivery-in-type-1-diabetes
#7
Pau Herrero, Jorge Bondia, Nick Oliver, Pantelis Georgiou
Type 1 diabetes is an autoimmune condition characterised by a pancreatic insulin secretion deficit, resulting in high blood glucose concentrations, which can lead to micro- and macrovascular complications. Type 1 diabetes also leads to impaired glucagon production by the pancreatic α-cells, which acts as a counter-regulatory hormone to insulin. A closed-loop system for automatic insulin and glucagon delivery, also referred to as an artificial pancreas, has the potential to reduce the self-management burden of type 1 diabetes and reduce the risk of hypo- and hyperglycemia...
September 20, 2017: Computer Methods in Biomechanics and Biomedical Engineering
https://www.readbyqxmd.com/read/28920012/comparative-effectiveness-for-glycemic-control-in-older-adults-with-diabetes
#8
Michael Quartuccio, Brian Buta, Rita R Kalyani
PURPOSE OF REVIEW: To review and summarize the current data for comparative effectiveness of glycemic control in older adults. RECENT FINDINGS: In the last several years, professional societies have released guidelines for glycemic control in older adults, generally recommending individualized HbA1c goals. However, recent observational studies demonstrate that many older adults remain aggressively managed and are at increased risk of hypoglycemia. Large randomized trials of older adults with diabetes have failed to show cardiovascular benefit from intensive glycemic control and show only minimal microvascular benefit...
September 2017: Current Geriatrics Reports
https://www.readbyqxmd.com/read/28917079/insulin-autoimmune-syndrome-hirata-s-disease-in-an-italian-patient-a-case-report-and-review-of-the-literature
#9
REVIEW
Simona Censi, Maria Paola Albergoni, Nicoletta Gallo, Mario Plebani, Marco Boscaro, Corrado Betterle
We describe the case of a 54-year-old Caucasian Italian male experiencing episodes of hypoglycemia, occurring mainly after meals. He had never been exposed to insulin and was taking ramipril, flecainide and acetylsalicylic acid. An oral glucose tolerance test (OGTT) showed high blood glucose levels diagnostic for diabetes mellitus at 120 min and hypoglycemia with inappropriately high insulin levels at 240 min. The 72-h fasting test, abdominal computed tomography (CT) and positron emission tomography-CT were normal...
September 16, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28913745/management-of-type-1-diabetes-in-the-hospital-setting
#10
REVIEW
Carlos E Mendez, Guillermo E Umpierrez
PURPOSE OF REVIEW: The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. RECENT FINDINGS: Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described...
September 14, 2017: Current Diabetes Reports
https://www.readbyqxmd.com/read/28895642/initiation-of-basal-insulin-analog-treatment-for-type-2-diabetes-and-reasons-behind-patients-treatment-persistence-behavior-real-world-data-from-germany
#11
Elisabeth Moennig, Magaly Perez-Nieves, Irene Hadjiyianni, Dachuang Cao, Jasmina Ivanova, Ralf Klask
Background Poor treatment persistence can affect the real-world effectiveness of insulin therapy. A cross-sectional online survey in 942 patients with type 2 diabetes from 7 different countries evaluated patient experience when initiating basal insulin and the reasons behind insulin persistence patterns. Here, we report the quantitative results for the subset of patients from Germany. Methods Adults with type 2 diabetes who had initiated basal insulin during the last 3-24 months, identified from market-research panels, participated in the survey...
September 11, 2017: Experimental and Clinical Endocrinology & Diabetes
https://www.readbyqxmd.com/read/28892425/laparoscopic-resection-of-a-pancreatic-%C3%AE-cell-tumor-in-a-dog
#12
Janet Kovak Mcclaran, Philippa Pavia, Anthony J Fischetti, Taryn A Donovan
Laparoscopic partial pancreatectomy has been performed in experimental canine studies and has been evaluated in human medicine but has not been reported in a clinical veterinary case. The authors present a 9 yr old field spaniel with weakness and hypoglycemia with insulin levels and Amended Insulin: Glucose Ratio results equivocal for a pancreatic insulinoma. Multiple abdominal ultrasounds did not detect the tumor, yet dual-phase computed tomographic angiography revealed the presence of a focal hypoattenuating nodule in the left lobe of the pancreas...
September 11, 2017: Journal of the American Animal Hospital Association
https://www.readbyqxmd.com/read/28892225/expectant-management-of-pregnancies-complicated-by-fetal-growth-restriction-without-any-evidence-of-placental-dysfunction-at-term-comparison-with-routine-labor-induction
#13
Nobuhiro Hidaka, Yuka Sato, Saki Kido, Yasuyuki Fujita, Kiyoko Kato
AIM: To assess the feasibility and practicality of expectant management for pregnancies with fetal growth restriction (FGR) at term without evidence of placental dysfunction. METHODS: We reviewed the records of pregnancies with an estimated fetal weight ≤ 1.5 SD below the mean at 37 weeks of gestation. We excluded elective cesarean deliveries and pregnancies that, at 37 weeks, were complicated by oligohydramnios, decreased fetal cerebroplacental ratio, or pregnancy-related hypertensive disorders...
September 11, 2017: Journal of Obstetrics and Gynaecology Research
https://www.readbyqxmd.com/read/28878933/comparison-of-a-two-bag-system-versus-conventional-treatment-protocol-one-bag-system-in-the-management-of-diabetic-ketoacidosis
#14
Iqbal Munir, Ramiz Fargo, Roger Garrison, Almira Yang, Andy Cheng, Ilho Kang, Ali Motabar, Karen Xu, Lawrence K Loo, Daniel I Kim
OBJECTIVE: We compared the conventional 'one-bag protocol' of management of diabetic ketoacidosis (DKA) with the 'two-bag protocol' which utilizes two bags of fluids, one containing saline and supplemental electrolytes and the other containing the same solution with the addition of 10% dextrose. RESEARCH DESIGN AND METHODS: A retrospective chart review and analysis was done on adult patients admitted for DKA to the Riverside University Health System Medical Center from 2008 to 2015...
2017: BMJ Open Diabetes Research & Care
https://www.readbyqxmd.com/read/28875722/diabetes-injectable-therapy-type-2-diabetes-management-in-danish-practice
#15
Daniel Sterzi, Sébastien Auziere, Marie Markert Jensen, Sandra Lopes
Most diabetes care is done by GPs in Denmark. This study aimed to identify the barriers for GPs to initiate injectable therapies and reasons for referral to specialists. The web-interview conducted included 85 GPs, and 30 specialists experienced in type 2 diabetes (T2D). GPs felt more comfortable with initiating the 1(st) injectable therapy (defined as a glucagon-like peptide-1 receptor agonist (GLP-1 RA) or basal insulin) than the 2(nd) (defined as adding a basal insulin in patients treated with a GLP-1 RA (± OADs), or adding either a GLP-1 RA or a bolus insulin in patients treated with basal insulin (± OADs)...
September 6, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28871565/cost-effectiveness-analysis-of-sensor-augmented-insulin-pump-therapy-with-automated-insulin-suspension-versus-standard-insulin-pump-therapy-in-patients-with-type-1-diabetes-in-sweden
#16
Johan Jendle, Jayne Smith-Palmer, Alexis Delbaere, Simona de Portu, Natalie Papo, William Valentine, Stéphane Roze
INTRODUCTION: In Sweden an estimated 10,000 people with type 1 diabetes use continuous subcutaneous insulin infusion (CSII). Sensor-augmented pump therapy (SAP) is associated with higher acquisition costs but provides additional clinical benefits (e.g. reduced rate of hypoglycemic events) over and above that of CSII alone. The aim of the analysis was to assess the cost-effectiveness of SAP with automated insulin suspension relative to CSII alone in two different groups of patients with type 1 diabetes in Sweden...
September 4, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28864965/pharmacological-management-of-gestational-diabetes-mellitus
#17
Geetha Mukerji, Denice S Feig
Gestational diabetes mellitus (GDM) is associated with an increased risk of adverse pregnancy outcomes in the setting of poor glycemic control. The initial management for GDM includes intensive lifestyle modification, which often requires behavioral and nutritional changes to optimize glycemic control. Pharmacotherapy for GDM is initiated when glycemic targets are not met. The rapid-acting bolus analogues aspart and lispro achieve postprandial targets with less hypoglycemia compared to regular insulin, with similar fetal outcomes...
September 2, 2017: Drugs
https://www.readbyqxmd.com/read/28858080/comparative-assessment-of-the-efficacy-and-safety-of-acarbose-and-metformin-combined-with-premixed-insulin-in-patients-with-type-2-diabetes-mellitus
#18
RANDOMIZED CONTROLLED TRIAL
Honghua Wu, Jie Liu, Qingqing Lou, Jing Liu, Li Shen, Mingxia Zhang, Xiaofeng Lv, Mingjun Gu, Xiaohui Guo
This study, a subgroup analysis of the data from the Organization Program of DiabEtes INsulIN ManaGement study, aimed to compare the efficacy and safety profiles of acarbose and metformin used in combination with premixed insulin.This analysis included 80 and 192 patients taking only 1 oral antidiabetic drug, classified into acarbose (treated with acarbose + insulin) and metformin groups (treated with metformin + insulin), respectively. The efficacy and safety data were analyzed for within- and between-group differences...
September 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28857864/hypoglycemia-in-diabetes-mellitus
#19
Barbara Freeland
Hypoglycemia is a serious acute complication of diabetes treatment. Recognizing the risk factors and taking steps to prevent low blood glucose should be a part of self-management education for all people taking glucose-lowering medications. It is important for home care clinicians to evaluate their patient's understanding of hypoglycemia and the appropriate treatment options.
September 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28855239/closed-loop-control-during-intense-prolonged-outdoor-exercise-in-adolescents-with-type-1-diabetes-the-artificial-pancreas-ski-study
#20
Marc D Breton, Daniel R Cherñavvsky, Gregory P Forlenza, Mark D DeBoer, Jessica Robic, R Paul Wadwa, Laurel H Messer, Boris P Kovatchev, David M Maahs
OBJECTIVE: Intense exercise is a major challenge to the management of type 1 diabetes (T1D). Closed loop control (CLC) systems (artificial pancreas) improve glycemic control during limited intensity and short duration of physical activity (PA). However, CLC has not been tested during extended vigorous outdoor exercise common among adolescents. RESEARCH DESIGN AND METHODS: Skiing presents unique metabolic challenges: intense prolonged PA, cold, altitude, and stress/fear/excitement...
August 30, 2017: Diabetes Care
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