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hypoglycemia unawareness

Michelle L Litchman, Nancy A Allen
BACKGROUND: Older adults with long-standing type 1 diabetes (T1D) have a higher risk for hypoglycemia and hypoglycemia unawareness. Hypoglycemia can be dangerous, even fatal. Real-time continuous glucose monitoring (RT-CGM) effectively supports diabetes management and well-being in adult and pediatric populations. Little is known about older adults and RT-CGM use. The purpose of this study was to identify why RT-CGM was important for diabetes management in individuals with T1D 65 years of age...
April 1, 2017: Journal of Diabetes Science and Technology
Martina Zahradnicka, Frantisek Saudek, Kvetoslav Lipar, Jelena Skibova
BACKGROUND: Low dehydroepiandrosterone sulfate (DHEAS) levels and a high cortisol/DHEAS ratio are associated with higher mortality in elderly, dialyzed, and immunocompromised patients. The role of these hormones in patients with hypoglycemia unawareness (hypo) or in pancreas or islet recipients treated by glucocorticoid-free immunosuppressive regimen (IS) has not been studied. OBJECTIVE: The aim of this study was to determine the effects of IS and of recurrent hypoglycemia on DHEAS and adrenocorticotropic hormone (ACTH) levels in patients with type-1 diabetes (T1DM)...
February 13, 2017: Endocrine, Metabolic & Immune Disorders Drug Targets
Ronit Koren, Hadas Zafrir Danieli, Keren Doenyas-Barak, Tomer Ziv-Baran, Ahuva Golik
Context • The use of complementary and alternative medicine (CAM) has been on the rise in the last decade. Subpopulations of patients with chronic diseases are at risk for adverse events and potential drug-herb interactions, among them dialysis patients. Objective • The study aimed to evaluate the prevalence of CAM consumption among dialysis patients and to search for potential interactions. Design • The study was cross-sectional, based on questionnaires. Setting • The study occurred in the hemodialysis unit at Assaf Harofeh Medical Center (Zeriffin, Israel)...
January 2017: Alternative Therapies in Health and Medicine
Anne-Sophie Sejling, Troels W Kjaer, Ulrik Pedersen-Bjergaard, Line S Remvig, Christian S Frandsen, Linda Hilsted, Jens Faber, Jens Juul Holst, Lise Tarnow, Jakob Skadkær Møller, Martin N Nielsen, Birger Thorsteinsson, Claus B Juhl
BACKGROUND: Recurrent hypoglycemia has been shown to blunt hypoglycemia symptom scores and counterregulatory hormonal responses during subsequent hypoglycemia. We therefore studied whether hypoglycemia-associated electroencephalogram (EEG) changes are affected by an antecedent episode of hypoglycemia. METHODS: Twenty-four patients with type 1 diabetes mellitus (10 with normal hypoglycemia awareness, 14 with hypoglycemia unawareness) were studied on 2 consecutive days by hyperinsulinemic glucose clamp at hypoglycemia (2...
February 2017: Diabetes Technology & Therapeutics
Ana María Gómez, Lisseth Fernanda Marín Carrillo, Oscar Mauricio Muñoz Velandia, Martín Alonso Rondón Sepúlveda, Carol M Arévalo Correa, Edwin Mora Garzón, Maria Camila Cuervo Diaz, Diana Cristina Henao Carrillo
BACKGROUND: Literature supports short-term efficacy and safety of Sensor Augmented Insulin Pump (SAP) therapy in patients with type 1 diabetes (T1D). However, no data are available showing long-term outcomes. Our study describes the long-term outcomes of SAP therapy with low-glucose suspend feature (SAP+LGS) in hypoglycemia in a Colombian population with T1D and hypoglycemia. METHODS: A cohort study was conducted with T1D patients receiving SAP+LGS therapy who initiated this therapy because of hypoglycemia at San Ignacio University Hospital diabetes center in Bogotá, Colombia...
February 2017: Diabetes Technology & Therapeutics
Martina Zahradnická, Peter Girman, Jan Kříž, Zuzana Berková, Tomáš Koblas, Ema Vávrová, Lucie Kosinová, David Habart, Eva Fábryová, Eva Dovolilová, Tomáš Neškudla, Jan Peregrin, Jozef Kováč, Květoslav Lipár, Matěj Kočík, Lenka Németová, Jiří Svoboda, František Saudek
Islet transplantation (ITx) started in 2005 in IKEM as a potentially safer alternative to pancreas transplantation (PTx), which so far had represented the method of choice in type-1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. The aim of the study was to compare these two methods with regard to severe hypoglycemia elimination and to frequency of complications.Up to November 2015 a total number of 48 patients underwent ITx. The results from 22 patients with hypoglycemia unawareness were statistically analyzed...
2016: Casopís Lékar̆ů C̆eských
Gülin Öz, Mauro DiNuzzo, Anjali Kumar, Amir Moheet, Ameer Khowaja, Kristine Kubisiak, Lynn E Eberly, Elizabeth R Seaquist
Supercompensated brain glycogen levels may contribute to the development of hypoglycemia-associated autonomic failure (HAAF) following recurrent hypoglycemia (RH) by providing energy for the brain during subsequent periods of hypoglycemia. To assess the role of glycogen supercompensation in the generation of HAAF, we estimated the level of brain glycogen following RH and acute hypoglycemia (AH). After undergoing 3 hyperinsulinemic, euglycemic and 3 hyperinsulinemic, hypoglycemic clamps (RH) on separate occasions at least 1 month apart, five healthy volunteers received [1-(13)C]glucose intravenously over 80+ h while maintaining euglycemia...
January 1, 2016: Journal of Cerebral Blood Flow and Metabolism
Marie Moth Henriksen, Louise Færch, Birger Thorsteinsson, Ulrik Pedersen-Bjergaard
BACKGROUND: Prediction of risk of severe hypoglycemia (SH) in patients with type 1 diabetes is important to prevent future episodes, but it is unknown if it is possible to predict the long-term risk of SH. The aim of the study is to assess if long-term prediction of SH is possible in type 1 diabetes. METHODS: A follow-up study was performed with 98 patients with type 1 diabetes. At baseline and at follow-up, the patients filled in a questionnaire about diabetes history and complications, number of SH in the preceding year and state of awareness, and HbA1c and C-peptide levels were measured...
November 2016: Journal of Diabetes Science and Technology
Michael R Rickels, Amy J Pelekis, Eileen Markmann, Cornelia Dalton-Bakes, Stephanie M Kong, Karen L Teff, Ali Naji
CONTEXT: Islet transplantation has been shown to improve glucose counterregulation and hypoglycemia symptom recognition in patients with type 1 diabetes (T1D) complicated by severe hypoglycemia episodes and symptom unawareness, but long-term data are lacking. OBJECTIVE: To assess the long-term durability of glucose counterregulation and hypoglycemia symptom responses 18 months after intrahepatic islet transplantation, and associated measures of glycemic control during a 24 month follow-up period...
August 29, 2016: Journal of Clinical Endocrinology and Metabolism
D Jane Holmes-Walker, Thomas W H Kay
PURPOSE OF REVIEW: Islet transplantation has made great progress in recent years. This is a remarkable technical feat but raises the question of what the long-term benefits and risks are for type I diabetes recipients. RECENT FINDINGS: Graft survival continues to improve, and recent multicenter studies show that islet transplantation is particularly effective to prevent hypoglycemic events even in those who do not become insulin-independent and to achieve excellent glycemic control...
October 2016: Current Opinion in Organ Transplantation
David M Harlan
No abstract text is available yet for this article.
July 2016: Diabetes Care
S Franchini, L Comegna, G Prezioso, A Blasetti
No abstract text is available yet for this article.
September 2016: Current Medical Research and Opinion
Saud Al Sifri, Kashif Rizvi
UNLABELLED: Muslim patients with type 2 diabetes (T2D) who fast during Ramadan face challenges in diabetes management due to substantial alterations in lifestyle and treatment that frequently accompany the decision to fast. International guidelines for treating T2D do not fully address the clinical issues unique to fasting, and other guidance documents lack the large and high-quality evidence base available for non-fasting conditions. We reviewed 10 randomized controlled trials and 20 observational studies in T2D during Ramadan to assess the quality of evidence and identify issues in trial design that should be addressed in future studies...
June 2016: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
Willis K Samson, Lauren M Stein, Mollisa Elrick, Alison Salvatori, Grant Kolar, John A Corbett, Gina L C Yosten
Insulin-dependent individuals with diabetes are at risk for a severe hypoglycemic event that may predispose them to several repeat episodes during which the normal counter regulatory mechanisms that protect against hypoglycemia fail to be activated. This state of hypoglycemia unawareness is characterized by a failure of glucagon release, preventing mobilization of endogenous glucose stores from the liver. We describe the discovery of a novel hormone, produced in pancreatic delta cells, which stimulates glucagon production and release, particularly under low glucose conditions...
August 1, 2016: Physiology & Behavior
Klemens Wallner, A M James Shapiro, Peter A Senior, Christopher McCabe
BACKGROUND: Islet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness and unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through restoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and estimates the value of further research to reduce uncertainty around cost-effectiveness. METHODS: We performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate costs and health outcomes over a life-time horizon...
April 9, 2016: BMC Endocrine Disorders
Annika Sjoeholm, Andrew Gray, Jenny Rayns, Paul A Tomlinson, Benjamin J Wheeler
AIMS: Despite advances in diabetes management, self-monitoring of blood glucose (SMBG) remains fundamental. A number of studies, principally in adults, have confirmed that logbook entries and verbal SMBG reports are prone to common errors. In the context of an adolescent diabetes camp, the accuracy of verbally reported SMBG is crucial for guiding safe therapeutic management, and negating the risk of exercise-induced hypoglycemia. We aimed to assess whether awareness of a planned meter download at the completion of a diabetes camp would improve the overall accuracy of verbally reported SMBG...
August 2016: Acta Diabetologica
Ahad Qayyum, Tahseen A Chowdhury, Elizabeth Ley Oei, Stanley L Fan
INTRODUCTION: Glycated hemoglobin is used to assess diabetic control although its accuracy in dialysis has been questioned. How does it compare to the Continuous Glucose Monitoring System (CGMS) in peritoneal dialysis (PD) patients? METHODS: We conducted a retrospective analysis of 60 insulin-treated diabetic patients on PD. We determined the mean interstitial glucose concentration and the proportion of patients with hypoglycemia (<4 mmol/l) or hyperglycemia (>11 mmol/l)...
2016: Blood Purification
Amy Bronstone, Claudia Graham
BACKGROUND: Severe hypoglycemia remains a major barrier to optimal diabetes management and places a high burden on the US health care system due to the high costs of hypoglycemia-related emergency visits and hospitalizations. Patients with type 1 diabetes (T1DM) who have hypoglycemia unawareness are at a particularly high risk for severe hypoglycemia, the incidence of which may be reduced by the use of real-time continuous glucose monitoring (RT-CGM). METHODS: We performed a cost calculation using values of key parameters derived from various published sources to examine the potential cost implications of standalone RT-CGM as a tool for reducing rates of severe hypoglycemia requiring hospitalization in adult patients with T1DM who have hypoglycemia unawareness...
July 2016: Journal of Diabetes Science and Technology
David Rodbard
Continuous glucose monitoring (CGM) provides information unattainable by intermittent capillary blood glucose, including instantaneous real-time display of glucose level and rate of change of glucose, alerts and alarms for actual or impending hypo- and hyperglycemia, "24/7" coverage, and the ability to characterize glycemic variability. Progressively more accurate and precise, reasonably unobtrusive, small, comfortable, user-friendly devices connect to the Internet to share information and are sine qua non for a closed-loop artificial pancreas...
February 2016: Diabetes Technology & Therapeutics
Ruth S Weinstock, Stephanie N DuBose, Richard M Bergenstal, Naomi S Chaytor, Christina Peterson, Beth A Olson, Medha N Munshi, Alysa J S Perrin, Kellee M Miller, Roy W Beck, David R Liljenquist, Grazia Aleppo, John B Buse, Davida Kruger, Anuj Bhargava, Robin S Goland, Rachel C Edelen, Richard E Pratley, Anne L Peters, Henry Rodriguez, Andrew J Ahmann, John-Paul Lock, Satish K Garg, Michael R Rickels, Irl B Hirsch
OBJECTIVE: Severe hypoglycemia is common in older adults with long-standing type 1 diabetes, but little is known about factors associated with its occurrence. RESEARCH DESIGN AND METHODS: A case-control study was conducted at 18 diabetes centers in the T1D Exchange Clinic Network. Participants were ≥60 years old with type 1 diabetes for ≥20 years. Case subjects (n = 101) had at least one severe hypoglycemic event in the prior 12 months. Control subjects (n = 100), frequency-matched to case subjects by age, had no severe hypoglycemia in the prior 3 years...
April 2016: Diabetes Care
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