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Hypoglycemia and management

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https://www.readbyqxmd.com/read/29777519/combination-glucose-lowering-therapy-plans-in-t2dm-case-based-considerations
#1
REVIEW
Lawrence Blonde, Susana Dipp, Daniel Cadena
Type 2 diabetes mellitus (T2DM) is a complex disease, and while lifestyle interventions remain the cornerstone of therapy, most patients will also require pharmacotherapy. Current diabetes treatment guidelines and algorithms recommend an individualized approach to setting glycemic goals and selecting treatment. Although a single antihyperglycemic agent may be appropriate as the initial T2DM pharmacotherapy, the progressive nature of the disease due to declining pancreatic β-cell function will result in the vast majority of T2DM patients eventually requiring two or more antihyperglycemic agents...
May 18, 2018: Advances in Therapy
https://www.readbyqxmd.com/read/29773934/iglarlixi-a-new-once-daily-fixed-ratio-combination-of-basal-insulin-glargine-and-lixisenatide-for-the-management-of-type-2-diabetes
#2
Debbie Hinnen, Jodi Strong
Background: Patients with type 2 diabetes require treatment intensification to maintain glycemic control. Clinician reluctance, patient injection fears, hypoglycemia, weight gain, or other objections may lead to clinical inertia, whereby therapy is not intensified and patients live with uncontrolled hyperglycemia and increased risk for complications. Initiation of injectable therapy with a glucagon-like peptide (GLP)-1 receptor agonist and/or basal insulin is a recommended option for patients with type 2 diabetes inadequately controlled on one or more oral agents...
May 2018: Diabetes Spectrum: a Publication of the American Diabetes Association
https://www.readbyqxmd.com/read/29760928/aneurysmal-subarachnoid-hemorrhage-intensive-care-for-improving-neurological-outcome
#3
REVIEW
Tomoya Okazaki, Yasuhiro Kuroda
Background: Aneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29756070/reducing-severe-hypoglycaemia-in-hospitalised-patients-with-diabetes-early-outcomes-of-standardised-reporting-and-management
#4
Katherine A Araque, Deepak K Kadayakkara, Nino Gigauri, Diane Sheehan, Sachin Majumdar, Gregory Buller, Clare A Flannery
Background: Severe hypoglycaemic events (HGEs) in hospitalised patients are associated with poor outcomes and prolonged hospitalization. Systematic, coordinated care is required for acute management and prevention of HGEs; however, studies evaluating quality control efforts are scarce. Objective: To investigate the effectiveness of system-based interventions to improve management response to HGEs. Methods: System-based interventions were designed and implemented following a root cause analysis of HGE in adult patients with diabetes from two general medical wards with the highest incidence of HGE...
2018: BMJ Open Quality
https://www.readbyqxmd.com/read/29751961/recurrent-hospitalizations-for-severe-hypoglycemia-and-hyperglycemia-among-u-s-adults-with-diabetes
#5
Rozalina G McCoy, Jeph Herrin, Kasia J Lipska, Nilay D Shah
AIMS: Examine 30-day readmissions for recurrent hypoglycemia and hyperglycemia in a national cohort of adults with diabetes. METHODS: Retrospective analysis of data from OptumLabs Data Warehouse for all adults with diabetes hospitalized January 1, 2009 to December 31, 2014 with a principal diagnosis of hypoglycemia or hyperglycemia. We examined the rates and risk factors of 30-day readmissions for hypoglycemia and hyperglycemia. RESULTS: After 6419 index hypoglycemia hospitalizations, 1...
April 24, 2018: Journal of Diabetes and its Complications
https://www.readbyqxmd.com/read/29751237/current-anti-diabetic-agents-and-their-molecular-targets-a-review
#6
REVIEW
Nagaraju Kerru, Ashona Singh-Pillay, Paul Awolade, Parvesh Singh
Diabetes mellitus is a medical condition characterized by the body's loss of control over blood sugar. The frequency of diagnosed cases and consequential increases in medical costs makes it a rapidly growing chronic disease that threatens human health worldwide. In addition, its unnerving statistical projections are perilous to both the economy of the nation and man's life expectancy. Type-I and type-II diabetes are the two clinical forms of diabetes mellitus. Type-II diabetes mellitus (T2DM) is illustrated by the abnormality of glucose homeostasis in the body, resulting in hyperglycemia...
May 3, 2018: European Journal of Medicinal Chemistry
https://www.readbyqxmd.com/read/29750952/glucostabilizer%C3%A2-software-guided-insulin-dosing-improves-intrapartum-glycemic-management-in-women-with-diabetes
#7
Cheryl Dinglas, Jolene Muscat, Tracy Adams, Virginia Peragallo-Dittko, Anthony Vintzileos, Hye J Heo
BACKGROUND: During labor, maintenance of maternal euglycemia is critical to decrease the risk of neonatal hypoglycemia and associated morbidities. When continuous intravenous insulin infusion is needed, standardized insulin dosing charts have been used for titration of insulin to maintain glucose in target range. GlucoStabilizer™ is a software-guided insulin dosing system that calculates the dose of intravenous insulin needed based on metabolic parameters, target glucose concentration, and an individual's response to insulin...
May 8, 2018: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/29750770/genetic-characteristics-of-patients-with-congenital-hyperinsulinism
#8
Mary Ellen Vajravelu, Diva D De León
PURPOSE OF REVIEW: Congenital hyperinsulinism is the most common cause of persistent hypoglycemia in infants and children. Early and appropriate recognition and treatment of hypoglycemia is vital to minimize neurocognitive impairment. RECENT FINDINGS: There are at least 11 known monogenic forms of hyperinsulinism and several associated syndromes. Molecular diagnosis allows for prediction of the effectiveness of diazoxide and the likelihood of focal hyperinsulinism...
May 9, 2018: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/29745918/the-role-of-psychological-features-in-management-of-patients-with-type-1-diabetes-case-report
#9
M Dunicheva, T Zagorovskaya, E Patrakeeva
Studies have shown that effective diabetes management (and also self-management) can delay or prevent the micro- and macrovascular complications. But sometimes the way of achieving optimal glycemic control can affect quality of patient's life resulting in different fears and other psychological problems. Our clinical case demonstrates type 1 diabetes (T1D) patient with frequent episodes of hypoglycemia, including severe hypoglycemia, and various psychosocial problems. It confirms the importance of doctor's communication skills and necessity of constant collaboration with psychologist in organization of diabetes care...
April 2018: Georgian Medical News
https://www.readbyqxmd.com/read/29739729/congenital-hyperinsulinism-and-evolution-to-sulfonylurea-responsive-diabetes-later-in-life-due-to-a-novel-homozygous-p-l171f-abcc8-mutation
#10
Emregül Işık, Huseyin Demirbilek, Jayne A L Houghton, Sian Ellard, Sarah E Flanagan, Khalid Hussain
BACKGROUND: Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants and children. Recessive inactivating mutations in the ABCC8 and KCNJ11 genes account for approximately 50 % of all CHI cases. Hyperinsulinaemic hypoglycaemia (HH) in infancy and diabetes in later life have been reported in subjects with HNF1A , HNF4A and ABCC8 mutations. CASE REPORT: Herein, we present a child who was diagnosed with CHI at birth, then developed diabetes mellitus at the age of 9 years due to a novel homozygous missense, p...
March 29, 2018: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/29737214/the-real-world-of-blood-glucose-point-of-care-testing-poct-system-running-in-china-teaching-hospital
#11
Feng-Fei Li, Yun Xie, Bing-Yin Shi, Min Niu, Hui Guo, Yan Cao, Bing-Li Liu, Reng-Na Yan, Xiao-Fei Su, Jin-Dan Wu, Dan-Feng Zhang, Li-Ming Chen, Jian-Hua Ma
BACKGROUND:  The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. METHODS: The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting...
May 9, 2018: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/29735574/management-of-type-1-diabetes-with-a-very-low-carbohydrate-diet
#12
Belinda S Lennerz, Anna Barton, Richard K Bernstein, R David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T Rhodes, Cara B Ebbeling, Eric C Westman, William S Yancy, David S Ludwig
OBJECTIVES: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events...
May 7, 2018: Pediatrics
https://www.readbyqxmd.com/read/29732933/challenges-imposed-by-hypoglycemia-in-adults-with-type-1-diabetes
#13
Pamela Martyn-Nemeth, Jennifer Duffecy, Cynthia Fritschi, Laurie Quinn
Little is known regarding how hypoglycemia and associated fears influence day-to-day life among adults with type 1 diabetes (T1DM) who use contemporary diabetes management strategies. To address this gap, we performed an exploratory qualitative study with five focus groups of 30 people aged 20 to 57 years with T1DM. Sessions were audiotaped and transcribed, and then analyzed. Eight themes emerged: (a) hypoglycemic worry, (b) unpredictability and loss of control, (c) contending with life stress, (d) exercise benefits and challenges, (e) a changed relationship with food, (f) sleep fears, (g) a love/hate relationship with technology, and (h) coping strategies to make it better...
May 1, 2018: Clinical Nursing Research
https://www.readbyqxmd.com/read/29725636/treatment-of-hyperkalemia-with-a-low-dose-insulin-protocol-is-effective-and-results-in-reduced-hypoglycemia
#14
Bairbre A McNicholas, Mai H Pham, Katrina Carli, Chang Huei Chen, Nancy Colobong-Smith, Arthur Eric Anderson, Hien Pham
Introduction: Complications associated with insulin treatment for hyperkalemia are serious and common. We hypothesize that, in chronic kidney disease (CKD) and end-stage renal disease (ESRD), giving 5 units instead of 10 units of i.v. regular insulin may reduce the risk of causing hypoglycemia when treating hyperkalemia. Methods: A retrospective quality improvement study on hyperkalemia management (K+  ≥ 6 mEq/l) from June 2013 through December 2013 was conducted at an urban emergency department center...
March 2018: KI Reports
https://www.readbyqxmd.com/read/29718785/finally-after-56-years-of-type-1-diabetes-a-regimen-that-works
#15
David S H Bell
Prior to the availability of degludec and regular human insulin inhalation powder in the type 1 diabetic patient glycemic control with subcutaneous insulin injections was difficult to obtain due to nocturnal, pre-prandial and often severe hypoglycemia as well as post-prandial hyperglycemia and hypoglycemia due to "stacking" of insulin. A 62-year-old female with type 1 diabetes for 56 years who could not be controlled with continuous subcutaneous insulin aspart infusion obtained glycemic control without significant hypoglycemia or increased post-prandial glycemic excursions utilizing degludec insulin for basal needs and technosphere before meals and between meals if needed...
May 2, 2018: Postgraduate Medicine
https://www.readbyqxmd.com/read/29713649/treatment-discontinuation-and-clinical-events-in-type-2-diabetes-patients-treated-with-dipeptidyl-peptidase-4-inhibitors-or-nph-insulin-as-third-line-therapy
#16
Cristiano S Moura, Zale B Rosenberg, Michal Abrahamowicz, Sasha Bernatsky, Hassan Behlouli, Louise Pilote
Objective: To compare dipeptidyl peptidase-4 (DPP-4) inhibitors with neutral protamine Hagedorn (NPH) insulin, in terms of effectiveness and safety for the management of patients with type 2 diabetes mellitus (DM2) not controlled on metformin and sulfonylureas. Methods: A retrospective cohort study of individuals with DM2 newly dispensed with either DPP-4 inhibitors or NPH as third-line therapy, after metformin and sulfonylurea. Treatment discontinuation, macrovascular outcomes, and hypoglycemia were compared using multivariable Cox regression models, adjusted for sex, age, year of cohort entry, place of residence, hypertension, past history of hypoglycemia, diabetic ketoacidosis, comorbidities, and number of visits to emergency departments, outpatient physician, and hospitalizations...
2018: Journal of Diabetes Research
https://www.readbyqxmd.com/read/29710737/cerebral-glucose-deficiency-versus-oxygen-deficiency-in-neonatal-encephalopathy
#17
A M Rudolph
Hypoxic-ischemic encephalopathy (HIE) in newborn infants is generally considered to result from decreased arterial oxygen content or cerebral blood flow. Cerebral injury similar to that of HIE has been noted with hypoglycemia. Studies in fetal lambs have shown that ventilation with 3% oxygen did not change cerebral blood flow, but ventilation with 100% oxygen resulted in marked reduction in cerebral blood flow, glucose delivery and glucose consumption. Blood glucose concentration falls markedly after birth; this, associated with the fall in cerebral blood flow, greatly reduces glucose supply to the brain...
April 24, 2018: Journal of Neonatal-perinatal Medicine
https://www.readbyqxmd.com/read/29691964/transition-to-adult-diabetes-care-in-germany-high-risk-for-acute-complications-and-declining-metabolic-control-during-the-transition-phase
#18
T M Kapellen, S Müther, A Schwandt, J Grulich-Henn, B Schenk, K O Schwab, W Marg, R W Holl
OBJECTIVE: There is evidence that transition from pediatric to adult health care is frequently associated with deterioration of health in youths with type 1 diabetes (T1D). The aim of this study was to compare metabolic control, acute complications and microvascular complications in adolescents and young adults before and after transfer to an adult treatment center with respect to the time between first visit in the adult center and last visit in pediatric treatment. METHODS: All data were collected during routine care and retrieved from the German/Austrian DPV database...
April 25, 2018: Pediatric Diabetes
https://www.readbyqxmd.com/read/29688879/managing-diabetes-in-patients-hospitalized-in-internal-medicine-units
#19
Irit Hochberg
Diabetes and hyperglycemia are present in over one-third of inpatients in internal medicine units and are associated with worse prognosis in multiple morbidities. Treatment of inpatient hyperglycemia is usually with basal bolus insulin in a dose calculated by the patient's weight, with lower doses recommended in patients who are at a higher risk for hypoglycemia. Other antihyperglycemic medications and insulin regimens can be used in selected patients. There are no adequately powered studies on the effect of improving glycemic control on hospitalization outcomes in non-critically ill patients in internal medicine units, and in most patients a modest glucose target of 140-180 mg/dL is recommended...
April 19, 2018: Rambam Maimonides Medical Journal
https://www.readbyqxmd.com/read/29686450/using-shared-decision-making-to-address-possible-overtreatment-in-patients-at-high-risk-for-hypoglycemia-the-veterans-health-administration-s-choosing-wisely-hypoglycemia-safety-initiative
#20
Samantha M Wright, Sandra C Hedin, Mark McConnell, Brian V Burke, Sharon A Watts, Donna M Leslie, David C Aron, Leonard M Pogach
IN BRIEF Successful management of patients with diabetes requires individualizing A1C and treatment goals in conjunction with identifying and managing hypoglycemia risk. This article describes the Veterans Health Administration's Choosing Wisely Hypoglycemia Safety Initiative (CW-HSI), a voluntary program that aims to reduce the occurrence of hypoglycemia through shared decision-making about deintensifying diabetes treatment in a dynamic cohort of patients identified as being at high risk for hypoglycemia and potentially overtreated...
April 2018: Clinical Diabetes: a Publication of the American Diabetes Association
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