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

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Considerations for the Pharmacological Treatment of Diabetes in Older Adults. Diabetes Spectrum. 20(4): 329-247. Fall 2007.

This article reviews the normal physiological and pharmacodynamic changes of aging and relates this information to the process of making good therapeutic decisions for the pharmacological treatment of diabetes in older adults. The authors discuss the evidence basis for treatment of older adults, or the lack of said evidence, and suggest a general approach to therapy. They note that aging is associated with defects in glucose metabolism and utilization. The primary risk of aggressive diabetes treatment in older adults is hypoglycemia. However, this can often be successfully managed with careful monitoring and effective communication between health care providers and patients. One detailed chart lists specific drugs commonly used by people with type 2 diabetes, along with hepatic, renal, and geriatric considerations for the use of these drugs. Drugs included are metformin, glimeperide, glipizide, glyburide, repaglinide, nateglinide, acarbose, miglitol, pioglitazone, rosiglitazone, sitagliptin, exenatide, and pramlintide. The authors recommend the use of a four-step approach to older adults with type 2 diabetes: achievement of glycemic goals; initial therapy with lifestyle and metformin; rapid addition of medications when goals are not met; and early addition of insulin therapy when glycemic goals are not met. 1 figure. 2 tables. 42 references.

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Contribution of Medications to Hypoglycemia Unawareness. Diabetes Spectrum. 20 (2): 77-80. Spring 2007.

This article reviews hypoglycemia unawareness and summarizes the effects of medications that may influence a patient’s perception of their own hypoglycemia. The author notes that much is known regarding risk factors, biochemical causes, and populations at greatest risk for the development of hypoglycemia unawareness. The article begins by discussing hypoglycemia counterregulation, the role of insulin, and the symptoms of hypoglycemia. The author then considers the effects of specific medication groups on hypoglycemia unawareness, including beta-adrenergic antagonists, beta-adrenergic agonists, methylxanthines, and selective serotonin reuptake inhibitors (SSRIs). Beta blockers may have a slight moderating effect on the adrenergic symptoms of hypoglycemia; as they are also reasonable choices for the management of hypertension and for their cardioprotective effects in patients with diabetes, they should not be discouraged. Beta-adrenergic agonists, methylxanthines, and the amino acid alanine may cause an upregulation of hypoglycemia awareness and should be studied further. SSRIs should be used in patients with diabetes when the risk-benefit considerations include the possibility of reduction in hypoglycemia awareness. 1 figure. 1 table. 21 references.

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Counterregulatory Deficiencies in Diabetes. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 121-140.

This chapter on counterregulatory deficiencies in diabetes is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors discuss normal glucose counterregulation; defective hormonal glucose counterregulation; the role of glucagon, catecholamines, cortisol, and growth hormone; mechanisms of counterregulatory failure; the systemic mediator theory; brain fuel transport; brain metabolism; the impact of age and obesity on glucose counterregulation; human insulin and counterregulation; and treatment of counterregulatory failure. They conclude that people with diabetes almost inevitably lose their ability to release glucagon in response to a fall in blood glucose within 5 years of diagnosis. After 10 years, a significant proportion of patients has deficient epinephrine responses and is at increased risk of more protracted hypoglycemia and neuroglycopenia. 12 figures. 67 references.

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Current and Future Perspectives on the Role of Hormonal Interplay in Glucose Homeostasis. Diabetes Educator. 33 (Suppl 2): S32-S46. February 2007.

This special supplement to the Diabetes Educator journal provides a continuing education program on the role of hormonal interplay in glucose homeostasis. This program was first presented at the American Association of Diabetes Educators' (AADE) 2006 Annual Meeting in Los Angeles, CA. The program covers the physiology of glucose regulation and describes various barriers to achieving glycemic control, including patients' fear of insulin-induced hypoglycemia, inadequate postprandial glucose control, excessive glucose fluctuations, and unwanted weight gain. The authors then provide clinical trial data that demonstrate the effectiveness and safety of pramlintide, a synthetic analog of human amylin, that is used in conjunction with insulin to help overcome these obstacles to normalizing glucose levels in patients with type 1 or type 2 diabetes. Pramlintide has been administered to more than 5,300 individuals in clinical studies, leading to its approval by the Food and Drug Administration (FDA). The authors conclude that appropriate patient selection, careful patient instruction, and insulin dose adjustments help reduce the increased risk of insulin-induced severe hypoglycemia that has been associated with pramlintide use. The document includes a posttest with which readers can qualify for continuing education credits for nurses, dietitians, or pharmacists. 14 figures. 4 tables. 28 references.

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Diabetes Care at Diabetes Camps. Diabetes Care. 30 (Suppl 1): S74-S76. January 2007.

The mission of camps specialized for children and youth with diabetes is to facilitate a traditional camping experience in a medically safe environment. This supplement to the Diabetes Care journal contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. This section of the supplement presents a position statement on Diabetes Care at Diabetes Camps. Readers are reminded that camps are also designed to enable children with diabetes to meet and share their experiences with one another while they learn to be more responsible for their condition. Topics covered include daily diabetes management at camp, medical staff composition and staff training, the treatment of diabetes-related emergencies such as hypoglycemia and ketosis, the use of a written camp management plan, diabetes education and psychological issues at camp, and clinical research projects conducted at diabetes camps. 10 references.

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Diabetes Management in Correctional Institutions. Diabetes Care. 30 (Suppl 1): S77-S84. January 2007.

There are approximately 80,000 inmates incarcerated in prisons and jails in the United States who have diabetes—prevalence of 4.8 percent of the total incarcerated population. This supplement to the Diabetes Care journal contains the American Diabetes Association’s (ADA) Standards of Medical Care in Diabetes, the major position statement of the organization. This section of the supplement presents a Position Statement on Diabetes Management in Correctional Institutions. The Statement emphasizes that people with diabetes in correctional facilities should receive care that meets national standards. Diabetes management is based on having access to needed medical personnel and equipment, particularly for self-management of diabetes. This Statement provides a general set of guidelines for diabetes care in correctional institutions, not an overall diabetes management manual. Topics include the intake medical assessment, including the components of reception screening, intake screening, intake physical examination, and laboratory tests; screening for diabetes; a management plan; nutrition and food services; urgent and emergency issues, including hyperglycemia and hypoglycemia; medication; the routine screening for and management of diabetes complications; blood glucose monitoring and other tests of glycemia; self-management education; staff education; alcohol and drugs; transfer and discharge; sharing of medical information and records; children and adolescents with diabetes; and pregnancy. 1 figure. 2 tables. 15 references.

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Diabetes Medications Supplement: Working Together to Manage Diabetes. Rev. ed. Bethesda, MD: National Diabetes Education Program. 2007. 8 p.

This medication supplement guide is to help health care professionals understand the medications commonly used for people with diabetes. The guide consists of nine detailed charts: oral agents used to treat type 2 diabetes; oral agents with glucose-lowering activity; insulins; recommended storage for different types of insulin; incretins and amylins; hypoglycemia treatment, notably glucagon; recommended control measures; medications to lower high blood pressure; and medications for the treatment of dyslipidemia. Most of the charts include the drug category, generic name and brand name of the drug, recommended dosage limits, side effects, and special considerations. The insulin chart notes type of insulin, onset of action, peak of action, effective duration, maximal duration, and comments for each type. Readers are referred to the National Diabetes Education Program (NDEP) contact sites at 1–800-438-5383 or www.ndep.nih.gov for more information.

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Diabetic Encephalopathy. IN: Veves, A.; Malik, R.A., eds. Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. pp 187-205.

This chapter on diabetic encephalopathy is from a comprehensive textbook that provides general practitioners details on the latest techniques for the clinical management of diabetic neuropathy. The author notes that diabetes and its treatments are associated with both functional and structural disturbances in the brain. Acute disturbances, related to acute hypoglycemia or hyperglycemia and stroke, are not covered in this chapter. The author focuses on changes in cerebral function and structure that develop more insidiously. The term diabetic encephalopathy is used to encompass functional impairment of cognition, cerebral signal conduction, neurotransmission and synaptic plasticity, and underlying structural pathology associated with diabetes. The author reviews relevant animal studies, focusing on the cellular and molecular events that underlie changes in cognition. The author also reviews human studies, providing an overview of the nature and severity of the changes in cognition that occur in diabetes; neurophysiological and neuroimaging studies of patients with diabetes are covered. The chapter concludes with a practical guide for the clinical care of a person with diabetes who has complaints of cognitive dysfunction. As with other diabetes complications, the maintenance of adequate glycemic control while avoiding hypoglycemia, and the treatment of vascular risk factors, appear to be the most practical means of preventing end-organ damage to the brain. 3 figures. 2 tables. 116 references.

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Diabetic Neuropathy: Clinical Management. 2nd ed. Totowa, NJ: Humana Press. 2007. 516 p.

This comprehensive textbook provides general practitioners details about the latest techniques for the clinical management of diabetic neuropathy. The text offers 28 chapters, covering the historical aspects of diabetic neuropathies, epidemiology, genomics, hyperglycemia-initiated mechanisms, neuronal and Schwann cell death, animal studies, the structure and function of the spinal cord in diabetes mellitus, diabetic encephalopathy, microangiopathy, the peripheral nervous system, the pathogenesis of human diabetic neuropathy, clinical features of diabetic polyneuropathy, microvascular disease, macrovascular disease, clinical diagnosis of diabetic neuropathy, punch skin biopsy, the use of aldose reductase inhibitors, other therapeutic agents, the pathophysiology of neuropathic pain, treatment of painful diabetic neuropathy, focal and multifocal diabetic neuropathy, hypoglycemia and the autonomic nervous system, cardiovascular autonomic neuropathy, postural hypotension and anhidrosis, gastrointestinal syndromes due to diabetes mellitus, genitourinary complications, and the management of diabetes-related foot complications. Each chapter includes a summary, a list of key words, and an extensive list of references. A subject index concludes the volume.

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DPP-4 Inhibitors: Review of Vildagliptin Phase 3 Data. Review of Endocrinology. 1(2): 47-51. June 2007.

This article reports on the Phase 3 research data on the DPP-4 inhibitor called vildagliptin. The authors note that the extensive clinical trial program has provided evidence of the consistent glucose-lowering efficacy of vildagliptin across a wide range of clinical uses. They describe monotherapy trials of vildagliptin in drug naïve patients, as well as combination therapy trials in which vildagliptin was added to existing oral antidiabetes therapy. Vildagliptin has also been added to existing insulin therapy with good results in patients with long-standing disease. Vildagliptin therapy was weight-neutral and well tolerated, with a low incidence of hypoglycemia. The authors conclude that vildagliptin has the potential to be a useful addition to the treatment options for people with type 2 diabetes. 2 figures. 1 table. 17 references.

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