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

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Mortality, Cardiovascular Morbidity and Possible Effects of Hypoglycaemia on Diabetic Complications. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 265-284.

This chapter on mortality, cardiovascular morbidity, and possible effects of hypoglycemia on diabetes complications is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors examine the epidemiology and causes of death from hypoglycemia in patients with diabetes, including those risk factors that appear to be associated with sudden death. They explore the “dead in bed” syndrome in detail, drawing comparisons with other syndromes of sudden death in people who do not have diabetes. Putative mechanisms and risk factors for sudden death are described. Hypoglycemia may cause significant cardiovascular morbidity in people with diabetes, and the effects on heart disease and cardiovascular disease are examined. The authors conclude with a discussion of the hypothesis that hypoglycemia may worsen the chronic microvascular complications of diabetes. Although hypoglycemia occurs commonly in people with type 1 diabetes, and even severe episodes are not infrequent, sudden and unexpected deaths from hypoglycemia are rare. 5 figures. 6 tables. 60 references.

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Nocturnal Hypoglycaemia. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 82-100.

This chapter on nocturnal hypoglycemia is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The author notes that people with type 1 diabetes are often as concerned about episodes of hypoglycemia as they are worried about the prospect of developing complications of their disease. The author considers nocturnal hypoglycemia, noting that even asymptomatic episodes may have consequences beyond the immediate situation. Asymptomatic episodes may contribute to hypoglycemia unawareness and deficient counterregulation and may be associated with cognitive impairment and the increased risk of sudden death during sleep in young people with type 1 diabetes. Topics include the epidemiology of nocturnal hypoglycemia; the causes of nocturnal hypoglycemia, which can include impaired counterregulatory responses, supine posture, and sleep itself; the consequences of nocturnal hypoglycemia, including impaired awareness of hypoglycemia, sudden death, and neurological consequences; the prediction of nocturnal hypoglycemia; the Somogyi phenomenon of rebound hyperglycemia; and clinical solutions, including dietary measures, pharmaceutical interventions, the timing and type of insulin, and the use of continuous subcutaneous insulin infusion (CSII). 4 figures. 5 tables. 64 references.

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Normal Glucose Metabolism And Responses to Hypoglycaemia. IN: Frier, B. and Fisher, M., eds. Hypoglycaemia in Clinical Diabetes. 2nd ed. Somerset, NJ: John Wiley & Sons. 2007. pp 1-24.

This chapter on normal glucose metabolism and responses to hypoglycemia is from a textbook that provides in-depth information for the understanding and management of hypoglycemia in clinical diabetes care. The authors note that blood glucose concentrations are normally regulated within a narrow range, despite wide variability in carbohydrate intake and physical activity. They focus on the mechanisms that protect against hypoglycemia in healthy individuals and the physiological consequences of low glucose concentrations. Topics include normal glucose homeostasis, fasting and fed states, the effects of glucose deprivation on central nervous system metabolism, counterregulation during hypoglycemia, hormonal changes during hypoglycemia, activation of the autonomic nervous system, neuroendocrine activation, hemodynamic changes during hypoglycemia, changes in regional blood flow, and functional changes in hypoglycemia. The authors conclude that many symptoms of hypoglycemia result from the activation of the autonomic nervous system and help to warn the individual that blood glucose is low. This encourages the ingestion of carbohydrates, thus helping to restore glucose concentrations. Activation of the autonomic nervous system increases sweating, and together with the inhibition of sweating, this predisposes to hypothermia, which may be neuroprotective. 10 figures. 6 tables. 48 references.

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Oral Antidiabetic Drugs in Pregnancy: The Other Alternative. Diabetes Spectrum. 20(2): 101-105. Spring 2007.

This article reviews the use of oral antidiabetic drugs in pregnancy, an accepted treatment option for women with gestational diabetes mellitus (GDM). The author outlines the intensified management approach and describes the use of oral antidiabetic agents, primarily glyburide, to prevent glycemic extremes of hypoglycemia and hyperglycemia in pregnant women with GDM and type 2 diabetes. The author stresses that, regardless of the mode of therapy, whole patient care consisting of glucose monitoring, patient education, diet adherence and exercise, will determine overall success in managing this disease and maximizing perinatal outcome. A patient care algorithm is also included. 36 references.

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Overcoming Barriers to the Initiation of Insulin Therapy. Clinical Diabetes. 25(1): 36-38. Winter 2007.

This article explores some of the barriers to the initiation of insulin therapy in patients with type 2 diabetes, noting that new recommendations for these patients call for more rapid use of both oral medications and insulin therapy. Although most health care providers agree that insulin is an effective therapy for the management of type 2 diabetes, many still consider insulin therapy as the last resort and indicate that their patients are hesitant to take insulin. The author of this article recommends physicians first assess the patient‘s perspective regarding insulin therapy; many barriers can be identified from this discussion. The author briefly discusses some of these barriers, which include beliefs that the insulin use demonstrates personal failure, insulin is not effective, insulin injections are painful, insulin causes complications or death, fear of hypoglycemia, insulin causes weight gain, and insulin use will have a negative impact on lifestyle. The next section considers provider-identified barriers to insulin therapy and how to address each of them. These suggestions include referring patients for diabetes self-management education and medical nutrition therapy (MNT), providing ongoing self-management support, using strategies already proven successful, and addressing emotional issues. 4 references.

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Owning Up: Chris Matthews. Diabetes Forecast. 60(13): 40-44. November 2007.

This article shares the story of Chris Matthews, the MSNBC host and commentator, who recently experienced a serious health episode that included being diagnosed with diabetes. The author interviews Mr. Matthews about his years of ignoring diabetes, even though he was prescribed metformin, and how a high blood glucose scare in Thanksgiving of 2007 sent him to the hospital. The interview covers topics including the symptoms of his high blood glucose; small changes in dietary behaviors that have resulted in better care of his diabetes; the use of other medications including insulin; the difference between changing dietary habits and giving up alcohol, which he did 14 years ago; the role of denial even in patients who have been diagnosed with diabetes; coping with hypoglycemia; the importance of stress awareness and stress reduction; and ways to share his knowledge with others. A sidebar lists Mr. Matthew’s current shows and new book, Life’s A Campaign: What Politics Has Taught Me About Friendship, Rivalry, Reputation, and Success. 2 figures.

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Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment. Clinical Diabetes. 25(2): 57-62. Spring 2007.

Gestational diabetes mellitus (GDM) affects approximately 7 percent of all pregnancies and is defined as carbohydrate intolerance during gestation. This review article addresses screening recommendations, diagnosis, and treatment of GDM. The authors stress that it is important to detect women with GDM because the condition can be associated with several maternal and fetal complications, including macrosomia, birth trauma, cesarean section, and problems in the newborn, such as hypocalcemia, hypoglycemia, and hyperbilirubinemia. The authors discuss several treatment options as well as the need for long-term risk modification and postpartum follow-up care. Several agents that are both effective and safe can be used to treat women with GDM if diet and exercise alone are not enough; these include human insulin, insulin analogs, and glyburide. Patients who have experienced GDM during their pregnancy have a higher risk of developing type 2 diabetes in the future, so it is important to continue screening these patients and to educate them about their risk factors. 3 tables. 58 references.

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Physiologic Insulin Replacement Therapy. IN: Unger, J. Diabetes Management in Primary Care. Philadelphia, PA: Lippincott Williams and Wilkins. 2007. p. 192-264.

This lengthy chapter about physiologic insulin replacement therapy is from a textbook that offers primary care physicians evidence-based guidelines for evaluating and treating all patients with diabetes. In this chapter, the author stresses that understanding the pharmacokinetics and glucodynamic profiles of different insulin preparations is necessary to direct patients toward the treatment protocols that will allow them to maintain a safe and practical level of hemoglobin A1C. Patients with type 2 diabetes may be able to attain their target goal of A1C using “treat-to-target” protocols that use either basal insulin or mixed insulin analog in addition to oral agents. Most patients with type 1 diabetes should optimize their management using basal-bolus insulin. The author covers the history of insulin, the pathogenesis of type 1 diabetes, determining appropriate glycemic targets, strategies to reduce the costs of managing diabetes, the psychological impact of introducing insulin therapy, hypoglycemia, reducing hyperglycemia, ways to optimize patient adherence and remove barriers to insulin therapy, and insulin analogue formulations. The chapter includes a list of “take-home points” that summarize the concepts discussed, as well as case reports that illustrate the topics covered. 13 figures. 18 tables. 101 references.

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Picture This: Looking at the Diabetic Brain. Diabetes Forecast. 60(11): 23. October 2007.

This article summarizes a recent study that focused on how blood glucose levels, particularly in people with diabetes, affect the brain. In this study, brain images using magnetic resonance imaging (MRI) were taken of people with and without diabetes to see whether and how their brains differ. The images were then subjected to a computerized imaging technology called voxel-based morphometry, which measures subtle changes in brain density. The results showed that people with diabetes had lower brain density in certain regions compared with those without diabetes. Those with worse blood glucose control had lower brain density in some regions than those with better control. The author discusses these results and some follow-up research that investigates how the brain responds to changes in blood glucose levels in real time. Another issue under study is the presence of hypoglycemia unawareness.

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Pills for Type 2 Diabetes: A Guide for Adults. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). 2007. 14 p.

This patient education guide provides information about the various drugs that may be used to treat type 2 diabetes. In type 2 diabetes, the body either does not make enough insulin or it does not use insulin as effectively as it should. The guide reviews the common kinds of diabetes medications, how they work in type 2 diabetes, their side effects, and costs. The authors remind readers that different kinds of diabetes pills work in different ways to control blood glucose levels, and sometimes combining two different kinds of diabetes pills can work better to lower blood glucose than a single medication can. Specific medications covered include biguanides, sulfonylureas, meglitinides, thiazolidinediones, and alpha-glucosidase inhibitors. The guide also describes self-monitoring of blood glucose (SMBG) tests, and readers are encouraged to perform an SMBG test and to have their glycosylated hemoglobin levels checked a few times a year. Some common side effects of diabetes medications include weight gain, stomach problems, swelling, effects on cholesterol levels, hypoglycemia, lactic acidosis, and congestive heart failure. The guide does not cover the other components of treating type 2 diabetes, including diet and exercise. Readers are encouraged to consult the Agency for Healthcare Research and Quality’s website at www.effectivehealthcare.ahrq.gov or the Medline Plus website at www.nlm.nih.gov/medlineplus/diabetes.html for more information.

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