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Your search term(s) "hypoglycemia" returned 234 results.

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Early Patient and Clinician Experiences with Continuous Glucose Monitoring. Diabetes Spectrum. 21(2):128-133. Spring 2008.

This article reports on a study that evaluated data from a 12-week study of patients using the FreeStyle Navigator continuous glucose monitoring (CGM) system. The authors note that CGM can assist in overcoming some of the limitations of self-monitoring of blood glucose (SMBG) by providing the ability to track glucose levels 24 hours a day, observe glucose trends and patterns, and receive alarms or alerts for actual and impending hypoglycemia and hyperglycemia. In the study, the authors evaluated responses to questionnaires from both clinicians and patients. Topics include initial impression and ease of use, important features and benefits, data management software, patient compliance, overall experience, future purchase and usage of CGM devices, training materials and content, and individual versus group training. Clinicians noted the ability to train easily on the CGM system, and both patients and clinicians felt they were able to make more informed decisions on therapy adjustments based on information from the receiver and the data management reports. Patients liked the ability to make day-to-day decisions based on the 1-minute glucose readings, threshold and projected glucose alarms, and the glucose trend arrows that allowed them to observe the rate and direction of glucose change. The authors conclude that CGM can be a valuable adjunct to diabetes care but improvement in control depends on the willingness and ability of patients to use CGM information to modify their diabetes management. 3 figures. 1 table. 6 references.

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Executive Summary: Standards of Medical Care in Diabetes: 2008. Diabetes Care. 31(Suppl 1): S5-S11. January 2008.

This executive summary is from the special supplement issue of Diabetes Care journal that contains the latest update of the American Diabetes Association’s (ADA) major position statement, “Standards of Medical Care in Diabetes.” The position statement contains all of the ADA’s key recommendations, including national standards for diabetes self-management education (DSME). The executive summary outlines the revisions to the clinical practice recommendations made for 2008, covering the diagnosis of diabetes, testing for pre-diabetes and diabetes, testing for type 2 diabetes in children, the detection and diagnosis of gestational diabetes mellitus, the prevention or delay of type 2 diabetes, self-monitoring of blood glucose (SMBG), glycemic goals, medical nutrition therapy, DSME, physical activity, psychosocial assessment and care, hypoglycemia, immunization, hypertension control, dyslipidemia management, antiplatelet agents, smoking cessation, coronary heart disease (CHD), nephropathy, retinopathy, neuropathy, foot care, children and adolescents, preconception care, older adults, diabetes care in the hospital, diabetes care in schools and daycare settings, diabetes care at diabetes camp, diabetes management in correctional institutions, emergency and disaster preparedness, and third-party reimbursement. The standards are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. Targets that are desirable for most patients with diabetes are provided. The recommendations included are screening, diagnostic, and therapeutic actions known or believed to favorably affect health outcomes of patients with diabetes. For each recommendation, the ADA has assigned a letter grade that represents the level of supporting evidence.

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Glycemic Control and Hemoglobinopathy: When A1C May Not Be Reliable. Diabetes Spectrum. 21(1):46-49. Winter 2008.

This article, from a series that presents patient cases using an evidence-based practice framework, describes a situation in which glycosylated hemoglobin (A1C) measures may not be a reliable marker for glycemic control and hemoglobinopathy. The case patient was an 11-year-old African-American girl newly diagnosed with type 1 diabetes and Hashimoto’s thyroiditis, who was being followed up after her initial hospitalization for diabetic ketoacidosis 2 weeks previously. The author describes her medication compliance, symptoms, concerns about preprandial hypoglycemia, and vital signs. The review of the patient’s laboratory records show that A1C was not measured by the laboratory because of an abnormal hemoglobin peak. The author considers whether hemoglobinopathies affect the clinical reliability of A1C measurement and, if so, what alternate method of assessment should be used for monitoring these patients. The author reports the results of a literature review, discussing hemoglobinopathy in patients with diabetes, variation by laboratory method, assessment of glycemic control using fructosamine, and an evidence grading system for clinical practice recommendations. The author concludes with an overview of the case patient’s present situation and recommendations for improvement of care and ongoing measurement of the child’s blood glucose levels. 33 references.

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Glycemic Variability: Should We and Can We Prevent it?. Diabetes Care. 31(Suppl 2): S150-S154. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, reviews the issue of blood glucose variability in patients with diabetes. The authors note that diabetes is characterized by glycemic disorders that include both sustained chronic hyperglycemia and acute glucose fluctuations. Ample evidence exists regarding the complications associated with chronic hyperglycemia, but there is less documentation about the role of glucose variability. The authors hypothesize that both upward, or postprandial, and downward, or interprandial, acute fluctuations of glucose around a mean value will activate the oxidative stress. They suggest that a comprehensive antidiabetes strategy should be aimed at reducing to a minimum the different components of dysglycemia, which can include A1C , fasting and postprandial glucose, as well as glucose variability. They conclude with a brief discussion of the newer treatment options including the glucagon-like peptide (GLP-1) agonists and the DPP-IV inhibitors that act through the incretin pathway. 2 figures. 36 references.

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Hyperinsulinemic Hypoglycemia Following Roux-en-Y Gastric Bypass Surgery. Practical Diabetology. 27(11): 10-18. March 2008.

This article describes the problem of hyperinsulinemic hypoglycemia following Roux-en-Y gastric bypass (RYGB) surgery for obesity. The RYGB procedure combines a restrictive and malabsorptive approach to reduce caloric intake. The authors briefly review issues of patient selection, the surgery itself, and peri- and postoperative complications. They present two case series of patients who developed hyperinsulinemic hypoglycemia 1 to 2 years after their RYGB procedure. They describe nesidioblastosis, defined as excessive function of pancreatic beta cells, and hypoglycemia, including the pathophysiology of these conditions, their interplay, presentation and differential diagnosis, diagnostic tests, and treatment approaches. The authors caution that symptoms resemble dumping syndrome, so clinicians must remain cognizant of the possibility of hyperinsulinemia in this patient population. Treatment consists of dietary and pharmacologic therapies that aim to blunt the insulin response to meals or inhibit insulin secretion altogether. After dietary strategies, drug therapies are used, notably alpha-glucosidase inhibitors such as acarbose or miglitol. If a patient cannot tolerate or is refractory to medical therapy, surgical intervention in the form of a partial pancreatectomy is the next step. 8 figures. 4 references.

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Hypoglycemia And Employment/Licensure. Diabetes Care. 31(Suppl 1): S94. January 2008.

This brief position statement on hypoglycemia and employment or licensure is from the special supplement issue of Diabetes Care journal that contains the latest update of the American Diabetes Association’s (ADA) major position statement, “Standards of Medical Care in Diabetes.” Selected position statements are provided about certain topics not adequately covered in the standards. This position statement reprints the 1984 ADA policy on employment, which states that “any person with diabetes, whether insulin dependent or non-insulin dependent, should be eligible for any employment for which he/she is otherwise qualified.” The position statement notes that discrimination in employment and licensure against people with diabetes still occurs. The effects of diabetes, notably hypoglycemia, are unique to each individual. The position statement considers the incidence and impact of hypoglycemia on daily activities, concluding that people with diabetes should be individually considered for employment based on the requirements of the specific job. Factors to be considered in this decision should include the individual’s medical condition, treatment regimen, and medical history. 1 reference.

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Hypoglycemia in Type 1 Diabetes: A Still Unresolved Problem in the Era of Insulin Analogs And Pump Therapy. Diabetes Care. 31(Suppl 2): S121-S124. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, considers the problem of hypoglycemia in patients with type 1 diabetes. The authors remind readers of the benefits of tight blood glucose control, in terms of reducing long-term complications of diabetes, but note that strict control carries an increased risk of severe hypoglycemia. Recurrent episodes of hypoglycemia, especially at young ages, can lead to hypoglycemia unawareness, can exert adverse effects on neurocognitive function, and can cause significant emotional morbidity in the child and parents. The authors discuss hypoglycemia and insulin analog therapy, as well as hypoglycemia in patients using continuous subcutaneous insulin infusion—CSII or insulin pumps—therapy. They note that, unfortunately, the newer modalities have not resulted in the expected drop in rates of hypoglycemic episodes. The authors conclude with a brief discussion of the ideal solution, an “artificial pancreas,” noting that the technology required for such a device is still under development. 42 references.

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Insulin And Incretins. Clinical Diabetes. 26(1): 35-39. Winter 2008.

This article is part of a 12-part series for physicians in training that reviews the fundamentals of diabetes care; this article summarizes the use of insulin and Incretins. The author notes that insulin has been combined with additives and modified at the molecular level to changes its pharmacokinetic properties. Some insulin preparations accelerate insulin’s effects in the bloodstream, and others prolong the pharmacokinetic profile. The author describes specific drugs, including regular insulin, insulin analogs, inhaled insulin, protamine solutions, zinc solutions, and long-acting insulin analogs, including glargine and detemir. The article outlines standard insulin regimens, newer insulin regimens, the approach to initiating insulin therapy, and the use of incretins, such as exenatide, and the amylin analog, pramlintide. The author emphasizes that good understanding of the pharmacokinetics of insulin action and proper management on insulin regimens allow health care providers and patients to control blood glucose levels and safely avoid hypoglycemia and hyperglycemia. 32 references.

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Insulin as a First-Line Therapy in Type 2 Diabetes: Should the Use of Sulfonylureas be Halted?. Diabetes Care. 31(Suppl 2): S136-S139. February 2008.

This article, from a special supplement of Diabetes Care magazine that reports the proceedings of the 1st World Congress on Controversies in Diabetes, Obesity, and Hypertension (CODHy) held in Berlin in 2006, considers the use of insulin as a first-line therapy in patients with type 2 diabetes, supplanting the use of sulfonylurea compounds. The authors explore the advantages and drawbacks to each therapy, focusing on the evidence base, the limitations of present information, other treatment options, pathogenesis, and the impact of specific drug regimens on cardiovascular disease (CVD). The authors conclude that it is not easy to recommend a simple treatment regimen for patients with type 2 diabetes, and the complexities are not only based on whether or not insulin should be a first-line therapy. They stress that appropriate therapy of type 2 diabetes needs to be highly individualized, taking contraindications and potential downsides of treatment options into account and trying to define and target the leading pathogenetic defects behind the prevailing metabolic phenotype. Cost considerations must be figured into the decision. A patient care algorithm for the management of hyperglycemia in type 2 diabetes is presented. 1 figure. 23 references.

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Intensive Insulin Therapy for the Critically Ill Patient. IN: Vanhorebeek, I.; Van den Berghe, G. Controversies in Treating Diabetes: Clinical and Research Aspects. Totowa, NJ: Humana Press. 2008. pp 157-178.

This chapter about intensive insulin therapy for the critically ill patient is from a book that addresses diabetes controversies, specifically in the etiology and management of the disease. The authors of this chapter consider the clinical complications associated with critical illness (CI), hyperglycemia in CI, blood glucose control with intensive insulin therapy in CI, the risk of hypoglycemia, the mechanism by which intensive insulin therapy achieves blood glucose control, and mechanisms explaining the improved outcome with intensive insulin therapy in these CI patients. The authors conclude that the simple metabolic intervention of maintaining normal blood glucose levels with intensive insulin therapy improves the survival of critically ill patients and reduces morbidity. Both strict glycemic control itself and other metabolic and nonmetabolic effects of the insulin administered contribute to these benefits. 3 figures. 101 references.

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