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Hypoglycemia prevention

Akihiko Soyama, Tota Kugiyama, Takanobu Hara, Masaaki Hidaka, Takashi Hamada, Satomi Okada, Tomohiko Adachi, Shinichiro Ono, Mitsuhisa Takatsuki, Susumu Eguchi
BACKGROUND: Intraoperative hyperglycemia during liver transplantation can induce infectious bacterial complications after surgery. The aim of this study was to evaluate the efficacy of the artificial endocrine pancreas in achieving perioperative blood glucose control and preventing infection in patients undergoing living donor liver transplantation. METHODS: We compared the 14 patients with an artificial endocrine pancreas device to 14 patients who underwent glycemic control using the sliding scale method with respect to perioperative blood glucose level and postoperative infection...
October 17, 2018: Artificial Organs
Prisca Da Lozzo, Andrea Magnolato, Irene Del Rizzo, Fabio Sirchia, Irene Bruno, Egidio Barbi
Hereditary fructose intolerance is an autosomal recessive disorder of fructose metabolism caused by catalytic deficiency of aldolase B enzyme [1]. The disease is typically expressed when fructose- and sucrose-containing foods are first introduced in the diet; acute manifestations include nausea, vomiting, abdominal distress, and symptomatic hypoglycemia [1,2]. Chronic fructose ingestion eventually leads to poor feeding, growth retardation and gradual liver and/or renal failure [3,4]. Some patients may remain undiagnosed until adulthood because of a self-protective avoidance of sweet tasting food that prevents the development of acute toxicity from fructose containing food; however, these subjects may suffer intermittent symptoms throughout life, leading to potentially serious misdiagnosis [4]...
October 13, 2018: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
Harold W De Valk, Sandrine Lablanche, Emanuele Bosi, Pratik Choudhary, Julien Da Silva, Javier Castaneda, Linda Vorrink, Simona De Portu, Ohad Cohen
BACKGROUND: Sensor-integrated pump systems with low-glucose suspend (also known as threshold suspend) functions have markedly transformed the management of type 1 diabetes, but most studies to date have excluded patients at high risk of hypoglycemia. The SMILE study is investigating the efficacy of the MiniMed™ 640G insulin pump with the SmartGuard™ predictive low-glucose management (PLGM) feature in the prevention of hypoglycemia in adults with type 1 diabetes, who are at high risk of hypoglycemia...
October 16, 2018: Diabetes Technology & Therapeutics
Mohammad Ismail, Sidra Noor, Umme Harram, Inamul Haq, Iqbal Haider, Faiza Khadim, Qasim Khan, Zahid Ali, Tahir Muhammad, Muhammad Asif
BACKGROUND: Potential drug-drug interactions (pDDIs) are one of the preventable drug related problems having the risk of serious adverse events or therapeutic failure. In developing countries like Pakistan, this issue remains poorly addressed. The objective of this study was to explore prevalence of pDDIs in the Outpatient Department (OPD) of a tertiary care hospital in Pakistan. The secondary aim was to describe the levels of reported pDDIs and develop a list of widespread clinically relevant interactions...
October 10, 2018: BMC Health Services Research
Colin P Hawkes, Juan J Lado, Stephanie Givler, Diva D De Leon
BACKGROUND/AIMS: Continuous intravenous glucagon is frequently used in the management of severe congenital hyperinsulinism (HI), but its efficacy in these patients has not been systematically evaluated. The aim of this study was to describe the use of continuous intravenous glucagon and to evaluate its effect on the glucose infusion rate (GIR) requirement in infants with HI. METHODS: Retrospective chart review of children with HI who received continuous intravenous glucagon for prevention of hypoglycemia at the Children's Hospital of Philadelphia between 2003 and 2013...
October 12, 2018: JIMD Reports
Hitomi Oda, Akihiro Mori, Satoko Ishii, Saori Shono, Eri Onozawa, Toshinori Sako
Insulin degludec (IDeg) is a new insulin formulation that facilitates long-term control of glucose level in humans. In this study, we investigated the effects of IDeg on glycemic control in dogs. Its time-action profiles were monitored in healthy dogs using an artificial pancreas apparatus under euglycemic conditions. At 9.0-13.5 hr post-IDeg injection, an indistinct peak of glucose level was detected. Moreover, the action of IDeg was persistent for >20 hr. Both IDeg and neutral protamine Hagedorn insulin (NPH) lowered blood glucose concentrations in diabetic dogs, but IDeg caused postprandial hyperglycemia and a somewhat lower preprandial glucose level than that caused by NPH...
October 11, 2018: Journal of Veterinary Medical Science
Michael A Wood, Dorothy I Shulman, Gregory P Forlenza, Bruce W Bode, Orit Pinhas-Hamiel, Bruce A Buckingham, Kevin B Kaiserman, David R Liljenquist, Timothy S Bailey, John Shin, Suiying Huang, Xiaoxiao Chen, Toni L Cordero, Scott W Lee, Francine R Kaufman
BACKGROUND: The Medtronic predictive low-glucose management (PLGM) algorithm automatically stops insulin delivery when sensor glucose (SG) is predicted to reach or fall below a preset low-glucose value within the next 30 min, and resumes delivery after hypoglycemia recovery. The present study evaluated the PLGM algorithm performance of the MiniMed™ 670G system SmartGuard™ "suspend before low" feature in children aged 7-13 years with type 1 diabetes (T1D). METHOD: Participants (N = 105, mean ± standard deviation of 10...
October 6, 2018: Diabetes Technology & Therapeutics
Emin Evren Özcan, Muhammet Dural, Bülent Görenek
In endocrine diseases, hormonal changes, electrolyte abnormalities, and the deterioration of heart structure can lead to various arrhythmias. In diabetic patients, hypoglycemia, hyperglycemia, and hypokalemia can trigger arrhythmias, and diabetic cardiomyopathy can also cause electrical and structural remodeling to form substrates for arrhythmias. The risk of atrial fibrillation (AF) increases in hyperthyroidism; however, the prevalence of ventricular arrhythmias in hypothyroidism is higher. Besides AF and ventricular tachycardias, bradycardias and atrioventricular blocks can also be seen in pheochromocytoma due to the desensitization of adrenergic cardiovascular receptors...
October 2018: Anatolian Journal of Cardiology
Kazunori Sakurai, Yuko Kawai, Masanori Yamazaki, Mitsuhisa Komatsu
AIMS: Continuous glucose monitoring (CGM) is not available for all patients with type 2 diabetes (T2D) at risk of nocturnal hypoglycemia (NH). This study was performed to predict the lowest nocturnal blood glucose (LNBG) levels. METHODS: An LNBG prediction formula was developed by multivariate analysis using the data including self-monitoring of blood glucose from a formula making (FM) group of 29 insulin-treated T2D patients with CGM. The validity of the formula was assessed by nonparametric regression analysis of actual and predicted values in a formula validation group consisting of 21 other insulin-treated patients...
September 13, 2018: Journal of Diabetes and its Complications
Yoshia Miyawaki, Ken-Ei Sada, Yosuke Asano, Keigo Hayashi, Yuriko Yamamura, Sumie Hiramatsu, Keiji Ohashi, Michiko Morishita, Haruki Watanabe, Yoshinori Matsumoto, Katsue Sunahori-Watanabe, Tomoko Kawabata, Jun Wada
BACKGROUND: Numerous patients develop diabetes in response to glucocorticoid therapy. This study explored the efficacy, safety, and preventive potential of the dipeptidyl peptidase-4 inhibitor, linagliptin (TRADJENTA®), in the development of glucocorticoid-induced diabetes mellitus. METHODS: From December 2014 to November 2015, we recruited non-diabetic Japanese patients scheduled for treatment with daily prednisolone ≥20 mg. Enrolled patients had at least one of following risk factors for glucocorticoid-induced diabetes mellitus: estimated glomerular filtration rate ≤ 60 mL/minute/1...
October 4, 2018: Journal of Medical Case Reports
Lenka Petruzelkova, Jan Soupal, Veronika Plasova, Pavlina Jiranova, Vit Neuman, Lukas Plachy, Stepanka Pruhova, Zdenek Sumnik, Barbora Obermannova
OBJECTIVE: Officially licensed hybrid closed-loop systems are not currently available worldwide; therefore, open-source systems have become increasingly popular. Our aim was to assess the safety, feasibility, and efficacy of an open-source hybrid closed-loop system (AndroidAPS) versus SmartGuard® technology for day-and-night glucose control in children under extreme sports conditions. RESEARCH DESIGN AND METHODS: Twenty-two children (16 girls, 6-15 years of age, median HbA1c 56 ± 9 mmol/mol) were enrolled in this pivotal winter sports camp study...
October 4, 2018: Diabetes Technology & Therapeutics
Almut G Winterstein, Nakyung Jeon, Ben Staley, Dandan Xu, Carl Henriksen, Gloria Pflugfelder Lipori
PURPOSE: Hypoglycemia is one of the most concerning adverse drug events in hospitalized patients. Using information from institutional electronic health records, we aimed to develop dynamic predictive models to identify patients at high risk for hypoglycemia during antihyperglycemic therapy. METHODS: The study population consisted of 21,840 patients who received antihyperglycemic medication on any of the first 5 hospital days (the "risk model days") at 2 large hospitals...
October 2, 2018: American Journal of Health-system Pharmacy: AJHP
Sijing Chen, Ying Zheng, Lin Chen, Qihua Yi
INTRODUCTION: Solitary fibrous tumors (SFTs) are uncommon mesenchymal neoplasms and are particularly rare in the female genital tract. Doege-Potter syndrome is a paraneoplastic syndrome involving SFT-associated hypoglycemia. We report, for the first time, on a broad ligament SFT with Doege-Potter syndrome; additionally, we review 30 cases of women with SFTs reported in the literature. PATIENT CONCERNS: A 37-year-old woman who presented with life-threatening hypoglycemia and a pelvic mass (16 × 15 × 15 cm)...
September 2018: Medicine (Baltimore)
Joseph A Sujka, Katrina L Weaver, Joel D Lim, Katherine W Gonzalez, Deborah J Biondo, David Juang, Pablo Aguayo, Richard J Hendrickson
INTRODUCTION: Hepatic dysfunction in patients reliant on total parenteral nutrition (TPN) may benefit from cycled TPN. A concern for neonatal hypoglycemia has limited the use of cycled TPN in neonates less than 1 week of age. We sought to determine both the safety and efficacy of cycled TPN in surgical neonates less than 1 week of age. METHODS: A retrospective chart review was conducted on surgical neonates placed on prophylactic and therapeutic cycled TPN from January 2013 to March 2016...
November 2018: Pediatric Surgery International
Muhammad Abdul-Ghani, Osama Migahid, Ayman Megahed, Rajvir Singh, Mohammad Fawaz, Ralph A DeFronzo, Amin Jayyousi
Because of the unique mechanism of action of sodium-glucose co-transport inhibitors (SGLT2i), which is independent of insulin secretion and insulin action, members of this class of drugs effectively lower plasma glucose concentration when used in combination with all other antidiabetic agents, including insulin. Increased plasma ketone concentration has been reported in association with SGLT2i initiation, which under certain clinical conditions has developed into diabetic ketoacidosis. The daily insulin dose often is reduced at the time of initiating SGLT2i therapy in insulin-treated patients to avoid hypoglycemia...
September 26, 2018: Diabetes, Obesity & Metabolism
Dawn Cameron, Fiona Harris, Josie M M Evans
Objective: To explore how and why self-monitoring of blood glucose (SMBG) is carried out in a real-world context. Research design and methods: We conducted a multicase study among ten people with type 1 and insulin-treated type 2 diabetes mellitus in Scotland, alongside seven nominated support people and four healthcare professionals. All participants were interviewed in depth and six participants provided SMBG diaries. Stones' version of structuration theory informed the analysis...
2018: BMJ Open Diabetes Research & Care
Maya Fayfman, Georgia Davis, Elizabeth W Duggan, Maria Urrutia, David Chachkhiani, Joanna Schindler, Francisco J Pasquel, Rodolfo J Galindo, Priyathama Vellanki, David Reyes-Umpierrez, Heqiong Wang, Guillermo E Umpierrez
AIM: We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery. METHODS: This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery...
September 1, 2018: Journal of Diabetes and its Complications
Michiel F Nijhoff, Eelco J P de Koning
PURPOSE OF REVIEW: New treatment strategies are needed for patients with type 1 diabetes (T1D). Closed loop insulin delivery and beta-cell replacement therapy are promising new strategies. This review aims to give an insight in the most relevant literature on this topic and to compare the two radically different treatment modalities. RECENT FINDINGS: Multiple clinical studies have been performed with closed loop insulin delivery devices and have shown an improvement in overall glycemic control and time spent in hypoglycemia...
September 24, 2018: Current Diabetes Reports
Basilio Pintaudi, Raffaella Fresa, Mariagrazia Dalfrà, Alessandro Roberto Dodesini, Ester Vitacolonna, Andrea Tumminia, Laura Sciacca, Cristina Lencioni, Teresa Marcone, Giuseppe Lucisano, Antonio Nicolucci, Matteo Bonomo, Angela Napoli
AIMS: To assess the risk of adverse neonatal outcomes in women with gestational diabetes (GDM) by identifying subgroups of women at higher risk to recognize the characteristics most associated with an excess of risk. METHODS: Observational, retrospective, multicenter study involving consecutive women with GDM. To identify distinct and homogeneous subgroups of women at a higher risk, the RECursive Partitioning and AMalgamation (RECPAM) method was used. Overall, 2736 pregnancies complicated by GDM were analyzed...
September 17, 2018: Acta Diabetologica
Xuan He, Xiufang Chen, Lei Wang, Wenqing Wang, Qiao Liang, Long Yi, Yong Wang, Qian Gao
AIMS: The accumulation of lipids in macrophages contributes to the development of atherosclerosis. Cholesterol efflux of lipid-loaded macrophages mediated by ATP binding cassette (ABC) cholesterol transporters, on the other hand, has been shown to attenuate atherosclerosis progression in patients with unknown mechanism. We therefore sought to test the effect of metformin that reduced cardiovascular risk in diabetic patients independent of its hypoglycemia effect on cholesterol transport in murine raw264...
September 12, 2018: Life Sciences
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