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hypoglycemia unawareness

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...
November 8, 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...
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
Breay W Paty
Intensive glucose management, targeting lower glycated hemoglobin (A1C) levels, has been shown to reduce the microvascular complications of diabetes, but the effect on cardiovascular (CV) outcomes is less clear. Observational follow-up of intensive glucose management studies suggest possible long-term CV benefits, but no clear reduction in CV events has been seen over 3 to 5 years. Intensive glucose management also increases the risk for hypoglycemia, particularly in patients with longstanding diabetes, cognitive impairment and hypoglycemia unawareness...
December 2015: Canadian Journal of Diabetes
Ty B Dunn, Varvara Kirchner, Melena D Bellin
PURPOSE OF REVIEW: This article provides a summary of the current outcomes of β-cell replacement strategies, an algorithm for choosing a specific modality while highlighting associated advantages and disadvantages, and outlines remaining challenges and areas of active investigation in β-cell replacement therapy. RECENT FINDINGS: The most recent reports of islet cell allotransplantation have shown improvements over previous eras and now rival some outcomes of pancreas alone transplantation...
December 2015: Current Opinion in Organ Transplantation
Oleg Otlivanchik, Nicole M Sanders, Ambrose Dunn-Meynell, Barry E Levin
While the neural control of glucoregulatory responses to insulin-induced hypoglycemia is beginning to be elucidated, brain sites responsible for behavioral responses to hypoglycemia are relatively poorly understood. To help elucidate central control mechanisms associated with hypoglycemia unawareness, we first evaluated the effect of recurrent hypoglycemia on a simple behavioral measure, the robust feeding response to hypoglycemia, in rats. First, food intake was significantly, and similarly, increased above baseline saline-induced intake (1...
January 1, 2016: American Journal of Physiology. Regulatory, Integrative and Comparative Physiology
Loyal K Coshway, Robert P Hoffman
BACKGROUND: Extremely young children aged ≤6 years old represent a unique population among patients with type 1 diabetes in terms of glycemic variation, diabetes management and complications. OBJECTIVE: We describe distinct features of diabetes care and outcomes in preschool age children. METHODS: We searched PubMed, Google Scholar, and authors' bibliographies in order to extract articles specific to type 1 diabetes in preschool age children...
October 22, 2015: Current Diabetes Reviews
David L Carpenter, Sara R Gregg, Kejun Xu, Timothy G Buchman, Craig M Coopersmith
OBJECTIVES: Many patients with diabetes and their care providers are unaware of the presence of the disease. Dysglycemia encompassing hyperglycemia, hypoglycemia, and glucose variability is common in the ICU in patients with and without diabetes. The purpose of this study was to determine the impact of unknown diabetes on glycemic control in the ICU. DESIGN: Prospective observational study. SETTING: Nine ICUs in an academic, tertiary hospital and a hybrid academic/community hospital...
December 2015: Critical Care Medicine
Dana S Hardin, Wesley Anderson, Jennifer Cattet
INTRODUCTION: Hypoglycemia (Hypo) is the most common side effect of insulin therapy in people with type 1 diabetes (T1D). Over time, patients with T1D become unaware of signs and symptoms of Hypo. Hypo unawareness leads to morbidity and mortality. Diabetes alert dogs (DADs) represent a unique way to help patients with Hypo unawareness. Our group has previously presented data in abstract form which demonstrates the sensitivity and specificity of DADS. The purpose of our current study is to expand evaluation of DAD sensitivity and specificity using a method that reduces the possibility of trainer bias...
December 2015: Diabetes Therapy: Research, Treatment and Education of Diabetes and related Disorders
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