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Hypoglycemia and management

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https://www.readbyqxmd.com/read/28642988/development-of-pulmonary-hypertension-during-treatment-with-diazoxide-a-case-series-and-literature-review
#1
Matthew R Timlin, Alexander B Black, Heather M Delaney, Renée I Matos, Candace S Percival
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy. The mainstay of medical management for CHI is diazoxide. Diazoxide inhibits insulin release from the pancreas, but also causes smooth muscle relaxation and fluid retention so it is typically given with chlorothiazide. In July 2015, the FDA issued a drug safety communication warning that pulmonary hypertension (PH) had been reported in 11 infants being treated with diazoxide and that the PH resolved with withdrawal of diazoxide...
June 22, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28639756/-value-of-continuous-glucose-monitoring-in-type-2-diabetic-patients
#2
Antonella Corcillo, Sylvie Girardin, Magali Andrey, Olivier Le Dizès, François R Jornayvaz
Management of type 1 and type 2 diabetes mellitus is getting complex with the apparition of new treatments, but also new technologies. Among these, continuous glucose monitoring systems (CGMS) lead to a better glycemic control and less hypoglycemia in type 1 diabetic patients. Studies are scarce in type 2 diabetes but also seem to show a benefit, particularly in patients using insulin. Nevertheless, type 2 diabetic patients taking advantage of CGMS must be better defined. In any case, a multidisciplinary approach to the use of CGMS and interpretation of data is warranted...
May 31, 2017: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28629656/clinical-practice-points-for-diabetes-management-during-ramadan-fast
#3
REVIEW
Shaukat Sadikot, K Jothydev, A H Zargar, Jamal Ahmad, S R Arvind, Banshi Saboo
Diabetes management during Ramadan is very crucial from the patient perspective as it can present significant risk of hypoglycemia and death when proper care is not taken. Moreover, managing diabetes in fasting Ramadan patients require different mechanisms than the routine diabetes management and pose significant challenge to the health care practitioners. Here we set forth to review the available literature of various clinical trials and studies on different antidiabetic agents in the context of Ramadan. On the basis of available evidence, we suggest that gliclazide is effective and it could be safely recommended in type 2 diabetic patients fasting during Ramadan...
June 13, 2017: Diabetes & Metabolic Syndrome
https://www.readbyqxmd.com/read/28616207/changes-in-metformin-use-in-chronic-kidney-disease
#4
Talha H Imam
Metformin is one of the oldest and most widely prescribed antidiabetic medicines worldwide. It is the only such medicine that has shown a reduction of cardiovascular mortality in diabetes mellitus type 2. Since many diabetic patients have chronic kidney disease, its use is often curtailed by practitioners due to fear of lactic acidosis and the US Food and Drug Administration (FDA) warnings that, until recently, had been in place for decades. Current guidelines, though somewhat vague regarding dosages, clearly pave the way for spreading the use of metformin in patients with lower glomerular filtration rates...
June 2017: Clinical Kidney Journal
https://www.readbyqxmd.com/read/28606343/pharmacologic-management-of-type-2-diabetes-mellitus-available-therapies
#5
James Thrasher
Choices for the treatment of type 2 diabetes mellitus (T2DM) have multiplied as our understanding of the underlying pathophysiologic defects has evolved. Treatment should target multiple defects in T2DM and follow a patient-centered approach that considers factors beyond glycemic control, including cardiovascular risk reduction. The American Association of Clinical Endocrinologists/American College of Endocrinology and the American Diabetes Association recommend an initial approach consisting of lifestyle changes and monotherapy, preferably with metformin...
July 1, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28600118/so-many-antihyperglycemics-how-to-choose-a-practical-approach
#6
Alice Y Y Cheng
Guidelines from around the world have stressed the importance of glycemic control in the management of patients with type 2 diabetes (T2DM) to reduce the risk of developing complications. To achieve this goal, both lifestyle and pharmacologic therapies are available. There are 9 classes of antihyperglycemic therapies available in Canada and each class provides a different mechanism of action to address the pathophysiology of T2DM. Metformin remains the first choice for pharmacologic therapy. Thereafter, individualization is essential...
June 6, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28596236/acute-hypoglycemia-in-healthy-humans-impairs-insulin-stimulated-glucose-uptake-and-glycogen-synthase-in-skeletal-muscle-a-randomized-clinical-study
#7
Thomas S Voss, Mikkel H Vendelbo, Ulla Kampmann, Janne R Hingst, Jørgen F P Wojtaszewski, Mads V Svart, Niels Møller, Niels Jessen
Hypoglycemia is the leading limiting factor in glycemic management of insulin-treated diabetes. Skeletal muscle is the predominant site of insulin-mediated glucose disposal and our study was designed to test to what extent insulin induced hypoglycemia affects glucose uptake in skeletal muscle and whether hypoglycemia counter-regulation modulates insulin and catecholamine signaling and glycogen synthase activity in skeletal muscle.Nine healthy volunteers were examined on three randomized study days in a crossover design: i) hyperinsulinemic hypoglycemia (bolus insulin), ii) hyperinsulinemic euglycemia (bolus insulin and glucose infusion) and iii) saline control with skeletal muscle biopsies taken just before, 30 min and 75 min after insulin/saline injection...
June 8, 2017: Diabetes
https://www.readbyqxmd.com/read/28589383/von-hippel-lindau-disease-a-single-gene-several-hereditary-tumors
#8
REVIEW
J Crespigio, L C L Berbel, M A Dias, R F Berbel, S S Pereira, D Pignatelli, T L Mazzuco
The Von Hippel-Lindau (VHL) disease is an autosomal dominant disorder characterized by the predisposition for multiple tumors caused by germline mutations in the tumor suppressor gene VHL. This disease is associated with a high morbidity and mortality and presents a variable expression, with different phenotypes from family to family, affecting different organs during the lifetime. The main manifestations of VHL are hemangioblastomas of the central nervous system and retina, renal carcinomas and cysts, bilateral pheochromocytomas, cystic and solid tumors of the pancreas, cystadenomas of the epididymis, and endolymphatic sac tumors...
June 6, 2017: Journal of Endocrinological Investigation
https://www.readbyqxmd.com/read/28588003/pituitary-adenoma-apoplexy-in-an-adolescent-a-case-report-and-review-of-the-literature
#9
Hero Zijlker, Sebastian Schagen, Jan Maarten Wit, Biermasz Nienke, Wouter van Furth, Wilma Oostdijk
We present a 13-year-old boy who became progressively sleepy and experienced a sudden headache with vomiting and fever. Laboratory testing showed hypoglycemia, multiple pituitary hormonal deficiencies and elevated C-Reactive Protein (CRP). A cranial MRI showed an opaque sphenoid sinus and an intrasellar mass suspect for hemorrhage, so that we suspected a pituitary apoplexy (PA) originating from a non-functioning adenoma, although a pituitary abscess could not completely be excluded. The boy was treated with antibiotics, hydrocortisone and levothyroxine and a close follow-up to monitor the clinical course...
June 7, 2017: Journal of Clinical Research in Pediatric Endocrinology
https://www.readbyqxmd.com/read/28587531/dapagliflozin-for-the-treatment-of-type-1-diabetes-mellitus
#10
Kalliopi Pafili, Efstratios Maltezos, Nikolaos Papanas
In 2017, the management of type 1 diabetes mellitus (T1DM) remains intriguing for the clinician, who has to balance between adequate glycemic control and untoward events related to insulin up-titration. Thus, agents that will complement insulin actions and reduce adverse effects are highly welcome. Areas covered: In this review, the authors summarize results from studies on the sodium glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin in T1DM. Expert opinion: In T1DM, dapagliflozin is associated with significant antihyperglycemic and metabolic properties, which are achieved with reduction or stabilization of insulin dose and with a very low trend for hypoglycemia...
June 12, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/28586073/effects-of-the-tangningtongluo-formula-as-an-alternative-strategy-for-diabetics-via-upregulation-of-insulin-receptor-substrate-1
#11
Long Cheng, Junmei Song, Geng Li, Yue Liu, Yuming Wang, Xiangbao Meng, Guibo Sun, Xiaobo Sun
Tangningtongluo (TNTL), a traditional Chinese medicine, has been widely used in clinics for decades in southwest China. Its pharmacological properties and underlying molecular mechanisms remain unclear. The main goal of ethnopharmacology is to identify novel bioactive compounds derived from plants for use in indigenous medical practice. This knowledge can be used to develop novel pharmaceuticals. In the present study, hyperglycemic C57BL/KsJ‑db/db (db/db) mice were used to test the effect of TNTL on microvasculature of the retina and hypoglycemia...
July 2017: Molecular Medicine Reports
https://www.readbyqxmd.com/read/28585180/efficacy-and-safety-of-insulin-degludec-for-hyperglycemia-management-in-noncritical-hospitalized-patients-with-diabetes-an-observational-study
#12
Natalino Simioni, Alessio Filippi, Marco Scardapane, Antonio Nicolucci, Maria Chiara Rossi, Vera Frison
INTRODUCTION: To assess the efficacy and safety of insulin degludec administered in a basal-bolus regimen according to the GesTIO protocol in noncritical hospitalized patients with T1DM and T2DM. METHODS: Mean blood glucose levels (BG) and their standard deviations (SD) at admission vs. discharge were compared in 52 subjects (48.1% ≥75 years) managed through a basal-bolus scheme including degludec. The percentages of patients with BG at target (140-180 mg/dl) or below at discharge and the incidence rate (and the 95% confidence interval for it) of hypoglycemia were assessed...
June 5, 2017: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
https://www.readbyqxmd.com/read/28581209/the-effect-of-continuous-exenatide-infusion-on-cardiac-function-and-perioperative-glucose-control-in-cardiac-surgery-patients-a-single-blind-randomized-controlled-trial
#13
Michal Lipš, Miloš Mráz, Jana Kloučková, Petr Kopecký, Miloš Dobiáš, Jarmila Křížová, Jaroslav Lindner, Michaela Diamant, Martin Haluzík
To intensify perioperative glucose control while minimizing the risk of hypoglycemia and to evaluate the suggested cardioprotective effects of GLP-1-based treatments we performed a randomized controlled trial with the GLP-1 receptor agonist exenatide as add-on to standard perioperative insulin therapy in subjects undergoing elective cardiac surgery. 38 subjects with decreased left ventricular systolic function (ejection fraction ≤50%) scheduled for elective CABG (coronary artery by-pass grafting) were randomized to receive either exenatide or placebo in a continuous 72-hour i...
June 5, 2017: Diabetes, Obesity & Metabolism
https://www.readbyqxmd.com/read/28579198/considerations-for-initiating-a-sodium-glucose-co-transporter-2-inhibitor-in-individuals-with-type-2-diabetes-using-insulin
#14
REVIEW
Vincent C Woo, Lori D Berard, Harpreet S Bajaj, Jean-Marie Ekoé, Peter A Senior
In order to meet and maintain glycemic control, pharmacological management of individuals with type 2 diabetes typically begins with metformin followed by the introduction of other oral antihyperglycemic agents as needed. In some patients, the aggressive and progressive degeneration of pancreatic β cell activity means insulin therapy will become a given. The need to routinely monitor blood glucose levels coupled with the undesirable effects associated with insulin-primarily hypoglycemia and weight gain-commonly contribute to physician and patient inertia...
May 31, 2017: Canadian Journal of Diabetes
https://www.readbyqxmd.com/read/28572099/nurse-directed-blood-glucose-management-in-a-medical-intensive-care-unit
#15
Friederike Compton, Robert Ahlborn, Torsten Weidehoff
BACKGROUND: Insulin-delivery algorithms for achieving glycemic control in the intensive care unit require frequent checks of blood glucose level and thus increase nursing workload. Hypoglycemia is a serious complication associated with intensive insulin therapy. OBJECTIVES: To evaluate a nurse-directed protocol for blood glucose management that allows individualized insulin delivery within a predefined blood glucose corridor, intended to avoid hypoglycemia while maintaining adequate control of blood glucose level without increasing nursing workload...
June 2017: Critical Care Nurse
https://www.readbyqxmd.com/read/28570329/endocrine-emergencies-with-neurologic-manifestations
#16
Makoto Ishii
PURPOSE OF REVIEW: This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities...
June 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28569076/clinical-impact-of-blood-glucose-monitoring-accuracy-an-in-silico-study
#17
Enrique Campos-Náñez, Kurt Fortwaengler, Marc D Breton
BACKGROUND: Patients with diabetes rely on blood glucose (BG) monitoring devices to manage their condition. As some self-monitoring devices are becoming more and more accurate, it becomes critical to understand the relationship between system accuracy and clinical outcomes, and the potential benefits of analytical accuracy. METHODS: We conducted a 30-day in-silico study in type 1 diabetes mellitus (T1DM) patients using continuous subcutaneous insulin infusion (CSII) therapy and a variety of BG meters, using the FDA-approved University of Virginia (UVA)/Padova Type 1 Simulator...
May 1, 2017: Journal of Diabetes Science and Technology
https://www.readbyqxmd.com/read/28568353/prevention-of-complications-in-glycogen-storage-disease-type-ia-with-optimization-of-metabolic-control
#18
REVIEW
M Dambska, E B Labrador, C L Kuo, D A Weinstein
Prior to 1971, type Ia glycogen storage disease was marked by life-threatening hypoglycemia, lactic acidosis, severe failure to thrive, and developmental delay. With the introduction of continuous feeds in the 1970s and cornstarch in the 1980s, the prognosis improved, but complications almost universally developed. Changes in the management of type Ia glycogen storage disease have resulted in improved metabolic control, and this manuscript reviews the increasing evidence that complications can be delayed or prevented with optimal metabolic control as previously was seen in diabetes...
June 1, 2017: Pediatric Diabetes
https://www.readbyqxmd.com/read/28562577/bowel-management-program-for-pediatric-postoperative-fecal-incontinence-in-china-a-surgeon-s-experience
#19
Yong Wang, Huiying Liang, Qiang Wu, Haiqing Zheng, Guangjian Liu, Zhe Wen, Menglong Lan, Jiakang Yu, Deli Zhu, Jiankun Liang, Jingqi Zhang, Xiaogang Xu, Huimin Xia
The purpose of this article is to report the status of the efficacy of and long-term adherence to the Bowel Management Program (BMP) for fecal incontinence (FI) postoperation in China.Children over 3 years of age with FI postoperation referred to our medical center were included in the study. Evaluations were performed before and 2 years after their clinic visit. The cost of bowel care, improvement in incontinence, health-related quality of life, and family functioning with the BMP were analyzed.A total of 48 children with FI were included in our study, of whom 38 were boys...
June 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28562256/sporadic-insulinoma-presenting-as-early-morning-night-terrors
#20
Daniel Beisang, Gregory P Forlenza, Mark Luquette, Kyriakie Sarafoglou
A 16-year-old boy with a recent diagnosis of night terrors was evaluated for recurrent early morning hypoglycemia after an early morning seizure. Evaluation in clinic with critical laboratories identified hyperinsulinemic hypoglycemia. Additional investigation revealed a sporadic insulinoma as the etiology of his hypoglycemia and all symptoms were resolved after pancreaticoduodenectomy. The importance of obtaining critical laboratory samples is highlighted and appropriate radiologic, medical, and pathologic testing is discussed...
May 24, 2017: Pediatrics
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