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Hypoglycemia and management

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https://www.readbyqxmd.com/read/27903941/prep-t1-preteen-re-education-with-parents-type-1-diabetes-feasibility-intervention-results
#1
Susan Sullivan-Bolyai, Sybil Crawford, Kim Johnson, Neesha Ramchandani, Diane Quinn, Bianca D'Alesandro, Kailyn Stern, Terry Lipman, Gail Melkus, Randi Streisand
There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the "driver's seat." The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens (n = 22) and parents (n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents...
November 2016: Journal of Family Nursing
https://www.readbyqxmd.com/read/27896927/a-retrospective-review-of-anesthesia-and-perioperative-care-in-children-with-medium-chain-acyl-coa-dehydrogenase-deficiency
#2
Claire Allen, Russell Perkins, Bernd Schwahn
BACKGROUND: Medium-chain acyl-CoA dehydrogenase deficiency is the most common genetically determined disorder of mitochondrial fatty acid oxidation. Decompensation can result in hypoglycemia, seizures, coma, and death but may be prevented by ensuring glycogen stores do not become depleted. Perioperative care is of interest as surgery, fasting, and infection may all trigger decompensation and the safety of anesthetic agents has been questioned. Current guidelines from the British Inherited Metabolic Disease Group advise on administering fluid containing 10% glucose during the perioperative period...
November 29, 2016: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/27889401/clinical-and-psychosocial-outcomes-of-a-structured-transition-program-among-young-adults-with-type-1-diabetes
#3
Elizabeth A Pyatak, Paola A Sequeira, Cheryl L P Vigen, Marc J Weigensberg, Jamie R Wood, Lucy Montoya, Valerie Ruelas, Anne L Peters
PURPOSE: We identified and treated young adults with type 1 diabetes who had been lost to follow-up during their transfer from pediatric to adult care, comparing their clinical, psychosocial, and health care utilization outcomes to participants receiving continuous care (CC) throughout the transition to adult care. METHODS: Individuals in their last year of pediatric care (CC group, n = 51) and individuals lost to follow-up in the transfer to adult care ("lapsed care" [LC] group, n = 24) were followed prospectively for 12 months...
November 23, 2016: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/27887024/insulinoma-or-non-insulinoma-pancreatogenous-hypoglycemia-a-diagnostic-dilemma
#4
Blaire Anderson, Jordan Nostedt, Safwat Girgis, Tara Dixon, Veena Agrawal, Edward Wiebe, Peter A Senior, A M James Shapiro
Insulinoma is the most common cause of endogenous hyperinsulinemic hypoglycemia in adults. An alternate etiology, non-insulinoma pancreatogenous hypoglycemia (NIPH), is rare. Clinically, NIPH is characterized by postprandial hyperinsulinemic hypoglycemia, negative 72-h fasts, negative preoperative localization studies for insulinoma and positive selective arterial calcium infusion tests. Histologically, diffuse islet hyperplasia with increased number and size of islet cells is present and confirms the diagnosis...
November 24, 2016: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/27879355/pregnancy-outcomes-in-women-with-diabetes-lessons-learned-from-clinical-research-the-2015-norbert-freinkel-award-lecture
#5
Elisabeth R Mathiesen
Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of severe preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or diabetic nephropathy preventing preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict glycemic control before and during pregnancy is paramount to prevent preterm delivery...
December 2016: Diabetes Care
https://www.readbyqxmd.com/read/27875061/glycemic-control-reduces-infections-in-post-liver-transplant-patients-results-of-a-prospective-randomized-study
#6
Amisha Wallia, Kathleen Schmidt, Diana Johnson Oakes, Teresa Pollack, Nicholas Welsh, Susan Kling-Colson, Suruchi Gupta, Candice Fulkerson, Grazia Aleppo, Neehar Parikh, Josh Levitsky, J P Norvell, Alfred Rademaker, Mark E Molitch
CONTEXT: Prior studies have shown a relationship between glycemic control and post-transplant morbidity. OBJECTIVE: We conducted a prospective randomized controlled trial in post liver transplant patients, evaluating intensive inpatient glycemic control and effects on outcomes to 1 year. Research Design and Intervention: 164 patients (blood glucose (BG) > 180 mg/dL) were randomized to two target groups: BG 140 mg/dL (N= 82) and 180 mg/dL (N= 82). Patients were initiated on insulin drips and then converted to subcutaneous basal bolus insulin therapy by our Glucose Management Service...
November 22, 2016: Journal of Clinical Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27872168/accurate-carbohydrate-counting-is-an-important-determinant-of-postprandial-glycemia-in-children-and-adolescents-with-type-1-diabetes-on-insulin-pump-therapy
#7
Asma Deeb, Ahlam Al Hajeri, Iman Alhmoudi, Nico Nagelkerke
BACKGROUND: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. METHODS: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days...
November 20, 2016: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/27871780/type-2-diabetes-hypoglycemia-and-basal-insulins-ongoing-challenges
#8
REVIEW
Ian Blumer, Maureen Clement
Hypoglycemia in people with insulin-treated type 2 diabetes can be a limiting factor for management and a barrier to optimizing glycemic control. Even mild episodes of hypoglycemia can affect an individual's quality of life, and fear of hypoglycemia can lead to underinsulinization. This article explores the prevalence and consequences of hypoglycemia in people with type 2 diabetes with a focus on those who use basal insulins, offering strategies for prevention and management. It also discusses the benefits and challenges associated with new basal insulins, and their potential role in reducing hypoglycemia risk...
November 18, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27866176/hypoglycemia-alert-dogs-a-novel-cost-effective-approach-for-diabetes-monitoring
#9
Giuseppe Lippi, Gianfranco Cervellin, Maurizio Dondi, Giovanni Targher
The recent publication of the results of 3 small trials, and as many as 5 case reports on dogs producing clear and intelligible alerts in the presence of their owners' hypoglycemia, opens an intriguing clinical scenario for management of diabetes. The skill seems attributable to the ability of dogs to identify patterns in skin and breath odors as well as to understand and interpret visual cues from humans during hypoglycemia. Provided that further trials can confirm the findings, the use of diabetes alert dogs that are trained to detect the onset of hypoglycemia can be regarded as a fast, versatile, reliable, and cost-effective approach for safeguarding the health of individuals with diabetes...
November 2016: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/27865808/postprandial-hyperinsulinemic-hypoglycemia-after-roux-en-y-gastric-bypass-an-update
#10
Caroline Christfort Øhrstrøm, Dorte Worm, Dorte Lindqvist Hansen
Roux-en-Y gastric bypass (RYGB) is an efficient treatment for morbid obesity and reduces obesity-related co-morbidities. With the growing number of patients undergoing gastric bypass, complications now demand further attention. Postprandial hyperinsulinemic hypoglycemia (PHH) after Roux-en-Y gastric bypass is a complex condition, characterized by increased glucose variability including both hyperglycemic and hypoglycemic values. PHH seems to be more prevalent than previously suggested and is highly dependent on the choice of diagnostic tool, which has not yet been standardized...
September 28, 2016: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
https://www.readbyqxmd.com/read/27865017/isolated-thoughts-and-feelings-and-unsolved-concerns-adolescents-and-parents-perspectives-on-living-with-type-1-diabetes-a-qualitative-study-using-visual-storytelling
#11
Pernille Castensøe-Seidenfaden, Grete Teilmann, Finn Kensing, Eva Hommel, Birthe Susanne Olsen, Gitte Reventlov Husted
AIMS AND OBJECTIVES: To explore and describe the experiences of adolescents and their parents living with type 1 diabetes (T1DM), to identify their needs for support to improve adolescents' self-management skills in the transition from child- to adulthood. BACKGROUND: Adolescents with T1DM often experience deteriorating glycemic control and distress. Parents are important in adolescents' ability to self-manage T1DM, but they report anxiety and frustrations. A better understanding of the challenges adolescents and parents face, in relation to the daily self-management of T1DM, is important to improve clinical practice...
November 16, 2016: Journal of Clinical Nursing
https://www.readbyqxmd.com/read/27864238/outcomes-of-a-pharmacist-managed-glucose-collaborative-practice-agreement
#12
Vidya Pugazhenthi, Travis B Dick, Matthew Call
PURPOSE: The impact of a pharmacist-managed glucose collaborative practice agreement (CPA) on glycemic control at a tertiary medical center was investigated. METHODS: A retrospective data analysis was performed on hospitalized, noncritically ill patients admitted between December 2012 and June 2014 who received at least one dose of subcutaneous insulin and experienced at least one blood glucose concentration of 140 mg/dL or higher. The study population was divided into cohorts based on admittance before versus after implementation of the CPA, as well as glucose management by pharmacist versus nonpharmacist provider...
December 1, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27855237/insulin-autoimmune-syndrome-a-rare-cause-of-postprandial-hypoglycemia
#13
Pooja Sahni, Nitin Trivedi, Abdulkadir Omer
: A 65-year-old obese Caucasian woman presented with symptomatic postprandial hypoglycemic episodes, resolution of symptoms with carbohydrate intake and significantly elevated anti-insulin antibody levels. She did not have any evidence for the use of oral antidiabetic medications, insulin, herbal substances, performing strenuous exercise or history of bariatric surgery. Fingerstick blood glucose readings revealed blood sugar of 35 mg/dL and 48 mg/dL, when she had these symptoms. Her medical history was significant for morbid obesity, hypothyroidism and gastro esophageal reflux disease...
2016: Endocrinology, Diabetes & Metabolism Case Reports
https://www.readbyqxmd.com/read/27848073/glycemia-management-in-a%C3%A2-slovenian-general-hospital
#14
Jana Makuc, Katja Ravber, Tajda Keber
BACKGROUND: In-hospital hyperglycemia is common and associated with an increased risk of in-hospital mortality and extensive length of stay but there are only few studies on real-life hyperglycemia and diabetes management. METHODS: In this cross-sectional, non-interventional, prospective study we analyzed medical charts on glycemia status at our internal medicine department for 5 consecutive months. Patients were grouped by departments and divided into subgroups by diabetes type, etiology and duration...
November 15, 2016: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/27832978/current-practice-of-hypoglycemia-management-in-the-ed
#15
Matthew H Bilhimer, Cierra N Treu, Nicole M Acquisto
PURPOSE: To characterize hypoglycemia management and identify characteristics associated with refractory (need for additional treatment following initial management) and recurrent (adequate initial treatment followed by blood glucose [BG] ≤50 mg/dL) hypoglycemia. METHODS: Retrospective review of adult emergency department (ED) patients who presented to a large academic medical center with hypoglycemia (BG ≤ 50 mg/dL) between January 2011 and July 2015. Data collection focused on BG measurements and treatment practices...
October 8, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27823868/effects-of-glimepiride-versus-saxagliptin-on-%C3%AE-cell-function-and-hypoglycemia-a-post-hoc-analysis-in-older-patients-with-type-2-diabetes-inadequately-controlled-with-metformin
#16
Shira Perl, William Cook, Cheryl Wei, Peter Ohman, Boaz Hirshberg
PURPOSE: The management of hyperglycemia is challenging in older patients with type 2 diabetes owing to excess fragility and risk for adverse outcomes should hypoglycemia episodes occur. We evaluated baseline β-cell function as a potential risk factor for the development of hypoglycemia when saxagliptin or glimepiride was added in patients aged ≥65 years whose type 2 diabetes was poorly controlled on stable metformin monotherapy. METHODS: A post hoc analysis of data from the GENERATION (Efficacy and Tolerability of Saxagliptin Compared with Glimepiride in Elderly Patients with Type 2 Diabetes: A Randomized, Controlled Study) trial, which enrolled 720 patients aged ≥65 years, was conducted...
November 4, 2016: Clinical Therapeutics
https://www.readbyqxmd.com/read/27823609/inpatient-diabetes-management-in-the-twenty-first-century
#17
REVIEW
Natasha B Khazai, Osama Hamdy
In hospitalized patients, both hyperglycemia and hypoglycemia have been associated with poor outcomes. During the inpatient period, hyperglycemia has been associated with increased risk of infection, cardiovascular events, and mortality. It is also associated with longer length of hospital stay. Hypoglycemia has also been associated with an increased risk of mortality. Therefore, current evidence supports avoidance of both conditions among hospitalized patients whether they are admitted to critical care units or noncritical care units...
December 2016: Endocrinology and Metabolism Clinics of North America
https://www.readbyqxmd.com/read/27822115/danish-registry-of-childhood-and-adolescent-diabetes
#18
REVIEW
Jannet Svensson, Charlotte Cerqueira, Per Kjærsgaard, Lene Lyngsøe, Niels Thomas Hertel, Mette Madsen, Henrik B Mortensen, Jesper Johannesen
AIM: The aims of the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) are to monitor and improve the quality of care for children and adolescents with diabetes in Denmark and to follow the incidence and prevalence of diabetes. STUDY POPULATION: The study population consists of all children diagnosed with diabetes before the age of 15 years since 1996. Since 2015, every child followed up at a pediatric center (<18 years of age) will be included...
2016: Clinical Epidemiology
https://www.readbyqxmd.com/read/27819771/glycemic-outcomes-three-years-after-implementation-of-a-perioperative-glycemic-control-algorithm-in-an-academic-institution
#19
Lindsay M Arnold, Mufaddal Mahesri, Marie E McDonnell, Sara M Alexanian
OBJECTIVE: While hyperglycemia in the postoperative setting has been linked to an increase in surgical complications, limited data is available to inform the management of patients with diabetes (DM) in the operating room and the immediate perioperative period. We describe the results of a perioperative glycemic control program that standardized intravenous insulin with a target glucose (BG) range of 120-180 mg/dL for patients with DM presenting with a BG level > 180mg/dL and included transition to subcutaneous insulin...
November 7, 2016: Endocrine Practice
https://www.readbyqxmd.com/read/27818105/role-of-continuous-glucose-monitoring-for-type-2-in-diabetes-management-and-research
#20
REVIEW
Robert Vigersky, Maneesh Shrivastav
The advent of continuous glucose monitoring (CGM) is a significant stride forward in our ability to better understand the glycemic status of our patients. Current clinical practice employs two forms of CGM: professional (retrospective or "masked") and personal (real-time) to evaluate and/or monitor glycemic control. Most studies using professional and personal CGM have been done in those with type 1 diabetes (T1D). However, this technology is agnostic to the type of diabetes and can also be used in those with type 2 diabetes (T2D)...
October 14, 2016: Journal of Diabetes and its Complications
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