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

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Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children with Type 1 Diabetes. Diabetes Care. 27(10): 2293-2298. October 2004.

This article reports on a study undertaken to determine the impact of changes to treatment on the incidence of severe hypoglycemia (low blood glucose) and its risk factors in a large population-based cohort of children with Type 1 diabetes (n = 1,335, mean age at entry was 9.5 years). The mean follow-up period was 4.7 years (plus or minus 3.1 years), yielding 6,928 patient-years of data. Patients were reviewed every 3 months for a period between 1992 and 2002; prospected assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made. A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29 percent per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA1c (glycosylated hemoglobin, a measure of blood glucose over time) significantly decreased (by 0.2 percent per year) over the entire follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA1c, younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia. The authors conclude that severe hypoglycemia remains a major problem for children and adolescents with Type 1 diabetes. 2 figures. 3 tables. 25 references.

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Insulin Glulisine Provides Improved Glycemic Control in Patients With Type 2 Diabetes. Diabetes Care. 27(10): 2363-2368. October 2004.

Insulin glulisine is a new analog of human insulin designed for use as a rapid-acting insulin. This article reports on a study that compared the safety and effectiveness of glulisine with regular human insulin (RHI) in combination with NPH insulin. The authors studied 876 relatively well-controlled patients with type 2 diabetes (mean HbA1c levels 7.55 percent). Patients were treated with glulisine and NPH (n = 435) or RHI and NPH (n = 441) for up to 26 weeks in this randomized, multicenter, open label, parallel group study. Subjects continued to use the same dose of prestudy regimens of oral antidiabetes agents, unless hypoglycemia necessitated a dose change. Results showed a slightly greater reduction from baseline to end point HbA1c in the glulisine group versus RHI. Also at end point, lower postbreakfast and postdinner blood glucose levels were noted. Symptomatic hypoglycemia and weight gain were comparable between the two treatment groups. The authors conclude that twice-daily glulisine associated with NPH can provide small improvements in glycemic control compared with RHI in patients with type 2 diabetes who are already relatively well controlled on insulin alone or insulin plus oral antidiabetes drugs. 2 figures. 1 table. 14 references.

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Insulin Therapy. In: Harmel, A.P. and Mathur, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 109-145.

More types of insulin are becoming available, ranging from the traditional insulins to insulin analogues. This diversity of choice, in terms of onset and duration of action, allows use of exogenous insulin to mimic normal physiology more closely, thereby allowing for improvements in glycemic control with less hypoglycemia. This chapter on insulin therapy is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. The beginning of the chapter focuses on choosing the concentrations and types of insulin to use. Other characteristics of insulin preparations, such as species source and purity, are discussed later in conjunction with a description of the immunologic responses to insulin therapy. Other topics covered include insulin allergy, insulin resistance, and insulin-induced lipoatrophy. One section also considers initiation of insulin therapy in hospitalized patients. The chapter includes illustrative case reports. 10 figures. 11 tables. 109 references.

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Management of Diabetes and Hyperglycemia in Hospitals. Diabetes Care: 27(2): 553-591. February 2004.

Diabetes increases the risk for disorders that predispose individuals to hospitalization, including coronary artery, cerebrovascular and peripheral vascular disease, nephropathy (kidney disease), infection, and lower-extremity amputations. The management of diabetes in the hospital is generally considered secondary in importance compared with the condition that prompted admission. Recent studies have focused attention to the possibility that hyperglycemia (high blood glucose levels) in the hospital is not necessarily a benign condition and that aggressive treatment of diabetes and hyperglycemia results in reduced mortality and morbidity. This article presents a technical review that evaluates the evidence relating to the management of hyperglycemia in hospitals, with particular focus on the issue of glycemic control and its possible impact on hospital outcomes. The review encompasses adult nonpregnant patients who do not have diabetic ketoacidosis or hyperglycemic crises. 2 figures. 11 tables. 449 references.

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Management of Diabetes and Hyperglycemia in Hospitals. Appendix 1: Example of Standardized Subcutaneous Insulin Orders. Diabetes Care: 27(2): 553 Data Supplement. February 2004.

This fact sheet reprints an example of standardized subcutaneous insulin orders used for patients with diabetes who are in the hospital. The orders include space to individualize the blood glucose monitoring tests (when they should take place), prandial (meal time) insulin orders, and basal insulin orders. The treatment for low blood glucose levels (hypoglycemia) are also noted. The second page of the fact sheet lists suggested low dose, medium dose, and high dose approaches to patient care management. A final section offers general insulin dosing recommendations. The author stresses that individual insulin doses vary widely and adjustments should be based on the bedside and laboratory glucose levels. This information serves as an appendix to a related article (Diabetes Care, 27:2, February 2004). 5 tables.

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Management of Diabetes and Hyperglycemia in Hospitals. Appendix 2: Example of a Standardized Intravenous Insulin Infusion. Diabetes Care: 27(2): 553 Data Supplement. February 2004.

This fact sheet reprints an example of standardized intravenous insulin infusion orders used for patients with diabetes who are in the hospital. The fact sheet offers general guidelines, then considers intravenous fluids, initiating the infusion, moving from lower to higher algorithms, patient monitoring, treatment of hypoglycemia (low blood glucose levels), and when to notify the physician. These orders are designed for nursing care. One chart summarizes the different levels of patient care. This information serves as an appendix to a related article (Diabetes Care, 27:2, February 2004). 1 table.

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Medical Approaches to Treatment of the Obese Patient. IN: Obesity and Diabetes. Totowa, NJ: Humana Press. 2006. pp. 457-470.

This chapter on medical approaches to the treatment of obesity is from a comprehensive textbook on diabetes and obesity. The authors note that because even modest weight reduction can produce substantial health benefits, physicians must develop effective office-based approaches to the management of obesity. The authors discuss the realities of treatment, classification and risk assessment of obesity, evaluation of the obese patient, the metabolic syndrome, initiation of pharmacological therapy, medication as adjunctive treatment, strategies for the prevention of relapse following weight loss, drugs approved for clinical use in the treatment of obesity, other drugs still in clinical trials, and special issues in patients with diabetes. The approved drugs are sibutramine and orlistat; drugs still in clinical trials are buproprion, topiramate, zonisamide, rimonabant, leptin, and axokine. Regarding patients with diabetes, management of the disease improves with weight reduction, but hypoglycemia becomes a possibility for those patients taking insulin or oral hypoglycemic medications. Physicians must remember to monitor blood glucose carefully and to reduce or stop diabetes medications as weight loss occurs. The authors stress that medications for the treatment of obesity are considered adjuncts to the overall management plan which should include the use of meal replacements (i.e., shakes, bars, frozen entrees) as means of portion and calorie control, counseling on how to reduce fat and calorie intake, an exercise program that increases activities such as walking, and the use of techniques for positive behavior modification. 8 tables. 28 references.

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Office Management of the Diabetic Patient. In: Hormel, A.P. and Mother, R. Davidson's Diabetes Mellitus: Diagnosis and Treatment. 5th ed. Orlando, FL: W.B. Saunders Company. 2004. p. 259-297.

The mainstay of the treatment of patients with diabetes occurs in an office setting. More than with most diseases, diabetes care requires an ongoing dialogue between patient and physician, and, unlike individuals with other diseases, patients with diabetes themselves make many important decisions about their care. No matter how experienced and dedicated a physician is, both patients' knowledge of diabetes and their appropriate judgments in soliciting help from a physician are usually the critical factors that prevent minor problems from becoming major. This chapter on the office management of the patient with diabetes is from a textbook that provides readers with current information on the diagnosis and treatment of patients with diabetes, including the latest advances, medications, and research studies. In this chapter, the author stresses that a team approach to the management of patients with a chronic disease such as diabetes is crucial. Topics covered in this chapter include the initial patient evaluation and general follow-up, monitoring diabetic control, self-monitoring of blood glucose (SMBG), glycosylated hemoglobin (a measure of blood glucose levels over time), monitoring patients who take insulin, fasting hyperglycemia, monitoring patients who do not take insulin, the 'honeymoon phase' of type 1 diabetes, weight reduction in obese patients with diabetes, hypoglycemia (low blood glucose levels), starvation ketosis, sick day rules, exercise, foot care, travel, dental procedures, surgical and postoperative management, infections in patients with diabetes, and guidelines for influenza and pneumococcal vaccines. 3 figures. 8 tables. 118 references.

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Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries. Diabetes Care. 27(10): 2306-2311. October 2004.

The prevalence of diabetes in several countries with large Muslim populations appears to be similar to the rates observed in western countries and is increasing by 10 percent per year as a result of urbanization and socioeconomic development. There are more than 1 billion Muslims in the world, and the majority of them observe an absolute fast (no food or water) between dawn and sunset 1 lunar month a year (the Holy Month of Ramadan). This article reports on a study that assessed the characteristics and care of patients with diabetes in countries with a sizable Muslim population. The authors studied diabetes features during Ramadan and the effect of fasting on diabetes care. The population-based, retrospective, transversal survey study was conducted in 13 countries. A total of 12,243 patients with diabetes were included in the analysis: 1,070 patients with Type 1 diabetes and 11,173 patients with Type 2 patients. During Ramadan, 42.8 percent of patients with Type 1 diabetes and 78.7 percent with Type 2 diabetes fasted for at least 15 days. Less than 50 percent of the whole population changed their treatment dose. Severe hypoglycemic (low blood glucose) episodes were significantly more frequent during Ramadan compared with other months. Severe hypoglycemia was also more frequent in patients who changed their dose of oral antidiabetic drugs or insulin or who modified their level of physical activity. The authors conclude that the large proportion of both Type 1 and Type 2 diabetes patients who fast during Ramadan represent a significant challenge to their physicians. There is a need to provide more intensive patient education before fasting and a need for more studies assessing the impact of fasting on morbidity and mortality. 3 tables. 34 references.

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Quick Guide to Medications. Chicago, IL: American Association of Diabetes Educators. 2004. 19 p.

Approximately 90 percent of people with diabetes require oral glucose-lowering medications, insulin injections, or both, to reach blood glucose goals. This lengthy brochure is designed to provide in quick reference format an overview of the oral medications used to manage diabetes mellitus. In addition to oral medications and insulin, the drug therapies for a person with diabetes often include other medications to treat the associated conditions or complications of diabetes. The drugs are considered in separate categories: oral glucose-lowering agents, insulins available in the United States, major classes of agents used to treat high blood pressure, and lipid-lowering therapies. Other charts cover a comparison of human insulins and analogs, guidelines for mixing insulin or prefilling syringes, the use of glucagons injection for severe hypoglycemia, drug-food interactions of diabetes medications, adverse effects of drugs on body systems, drug-disease and drug-drug interactions, and drug therapies for the treatment of dyslipidemia in people with diabetes. The brochure emphasizes that health care professionals must be knowledgeable of the total range of therapies that are available for comprehensive diabetes care, not just the therapies that are used for glycemic control. 2 figures. 6 tables. 1 reference.

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