Frequent Blood Glucose Monitoring Research Articles

Approach to Management

This paper describes a physiologic approach to diabetes management called pattern therapy and compares it with the sliding scale or "catch-up" type of management. Pattern therapy differs from the sliding scale approach in that it anticipates rather than reflects insulin needs, and it relies heavily on intensive patient education and intelligent self-management. Frequent blood glucose monitoring is also a key aspect of pattern therapy.

Phaeochromocytoma removal and postoperative hypoglycaemia

A case of postoperative hypoglycaemia following removal of a phaeochromocytoma is presented. The hypoglycaemia is due to a reactive rise in insulin and is augmented by alpha adrenoceptor blocking agents. Beta adrenoceptor blockers impair recovery from this hypoglycaemia. Frequent monitoring of blood glucose and the administration of an appropriate solution of dextrose both during and after this operation is recommended.

Diabetic ketoacidosis during long-term treatment with continuous subcutaneous insulin infusion.

During 1880 patient-months of treatment with continuous subcutaneous insulin infusion in 101 patients with IDDM, 36 episodes of acute, severe loss of glycemic control, including 29 with significant ketoacidosis, occurred in 20 patients. Fifteen episodes were attributable to failure of insulin delivery to the patient while 13 were precipitated by infection. Insufficiently frequent blood glucose monitoring, failure by patients to detect mechanical and technical problems with infusion systems, failure to adhere to "sick day" regimens, and delay in seeking medical help all contributed to the progression of a number of episodes. Thirst, nausea, and vomiting were the common clinical manifestations of decompensation; and the degree of acidemia was often mild in relation to the degree of hyperglycemia. Response to conventional management was usually prompt.

Childhood Diabetes and Intensive Insulin Therapy

To the Editor.— The article by Geffner et al 1 stressed the importance of self-monitoring of blood glucose levels and intensified insulin administration in achieving improved glycemic control. However, I wish to take issue with the impression created that multiple insulin injections daily were mandatory in attaining this goal. In my own pediatric diabetic population, there exists a group of patients whose conditions are well controlled with single daily injections of combined intermediate- and short-acting insulin. These patients have had the following characteristics: (1) nonbrittle diabetes, (2) well-motivated and well-informed parents, (3) carefully planned diets, (4) frequent home blood glucose monitoring, (5) regular glycosylated hemoglobin assays, and (6) close physician supervision. Additional doses of regular insulin are occasionally required as indicated by the blood glucose values. Multiple doses of insulin daily can be a traumatic experience to the parent and child, especially in the 1- to 5-year age group. If

Continuous subcutaneous insulin infusion (CSII) in insulin-dependent diabetes.

Six patients with insulin-dependent diabetes mellitus were treated by continuous subcutaneous insulin infusion for a period of 24–64 weeks. Diabetic control improved, indicated by a fall in the mean preprandial blood glucose and haemoglobin A1 levels. Renal function was unaltered in one patient with diabetic nephropathy but background retinopathy deteriorated in another. However, all patients reported an improved sense of well-being and expressed a reluctance to revert to conventional twice daily insulin despite the inconvenience of wearing the device and need for frequent blood glucose monitoring. Continuous subcutaneous insulin infusion is an acceptable means of managing insulin-dependent diabetes. *** DIRECT SUPPORT *** A00IA373 00004

Multiple daily self-glucose monitoring: its essential role in long-term glucose control in insulin-dependent diabetic patients treated with pump and multiple subcutaneous injections.

Twenty-one insulin-dependent diabetic patients, previously treated with continuous subcutaneous insulin infusion (CSII), multiple subcutaneous insulin injections (MSI), and a combination of CSII and MSI (combined CSII-MSI) all supported by frequent capillary self-blood glucose (CBG) determinations (5-7 times daily) participated in a program to assess the importance of frequent CBG monitoring. We used a crossover design where diabetic control as measured by mean blood glucose and glycosylated hemoglobin were compared during periods of frequent and infrequent capillary blood glucose monitoring. Diabetic control was significantly better during periods of frequent self-glucose monitoring. We conclude that in compliant, motivated young adults with insulin-dependent diabetes, frequent self-glucose monitoring is critical for the long-term maintenance of glycemic control.

Hyperglycemia and Glucagon Suppression: Possible Importance of the Vagus and Enteric Humoral Factors

Augmentation of insulin release after oral glucose by a gastrointestinal humoral mechanism is well accepted. The suggestion of a similar mechanism for suppression of glucagon release after oral glucose has not been previously tested. In this study, plasma glucagon levels have been estimated in five normal subjects after both oral and iv administration of glucose. A variable iv glucose infusion rate with frequent monitoring of blood glucose was used to match the hyperglycemia produced by the 50 g oral glucose and the iv glucose loads. Virtually complete suppression of plasma glucagon levels was seen in both cases (nadir of glucagon levels 16 +/- 6 pg/ml for oral glucose; 11.4 +/- 3 pg/ml for iv glucose). Thus, enteric humoral factors did not facilitate glucagon suppression after oral glucose ingestion in man. The vagus nerve is also involved in mediating the alpha-cell response to hypoglycemia and, thus, to examine whether hyperglycemia suppresses glucagon release through a vagal mechanism, iv atropine (15 microgram/kg) was given 20 min before administration of oral or iv glucose. Atropinization delayed the glucagon suppression after oral glucose, but this delay was probably related to delayed glucose absorption from the gut. With iv glucose, atropinization did not affect the degree of suppression of glucagon levels. It is concluded that alpha-cell suppression in response to hyperglycemia is not mediated via the vagus.

Neonatal hypoglycemia and hyperglycemia: two unique perinatal metabolic problems.

Hypoglycemia is a frequent, potentially morbid disease in the newborn. Most infants who are at risk can be identified either prior to or immediately after birth. A knowledge of those factors that cause or potentiate the development of hypoglycemia can alert the physician as to which infants require close observation and frequent monitoring of blood glucose. Care in interpretation of laboratory data is important in establishing the diagnosis. Prompt treatment can prevent permanent damage and promote intact survival in these infants. Hyperglycemia has been reported with the use of parenteral glucose in infants of very low birth weight. Rate of glucose infusion appears to be a critical factor in the development of hyperglycemia in these infants. The hazards of allowing fasting hypoglycemia to develop by inappropriate withholding of early calories and of causing hyperglycemia by injudicious use of parenteral glucose infusions in the tiny neonate show the critical need for constant monitoring of blood glucose both by screening techniques and by laboratory determinations.

Drug-induced hypoglycemia. A review based on 473 cases.

Both recognition and prevention of drug-induced hypoglycemia require awareness of the clinical conditions favoring its occurrence and the drugs and drug combinations most likely to cause it. Restricted food intake, age, hepatic disease and renal disease are the main predisposing factors, individually and even more so in combination. Everyone in general, and insulin-requiring diabetics in particular, should always eat carbohydrate whenever they drink alcohol. Sulfonylurea hypoglycemia has been reported often in diabetics older than fifty years, with more cases treated with chlorpropamide being reported than cases treated with other sulfonylureas ; it should therefore be used warily in older patients, and only when they are under daily observation by family or friends. In elderly diabetics taking any sulfonylurea agent, warfarin should be used for anticoagulation instead of bishydroxycoumarin, indomethacin for arthritic pain instead of phenylbutazone, and another agent than sulfisoxazole for urinary tract infections. Also in elderly diabetics using sulfonylureas, therapeutic doses of salicylates, monoamine-oxidase inhibitors and probably pro-pranolol should be co-administered with caution, including frequent blood glucose monitoring as long as necessary. Finally, the danger of refractory hypoglycemia in the newborn .proscribes the mother's use of sulfonylureas during the last month of pregnancy. Drug-induced hypoglycemia is now so relatively common that virtually every unconscious patient should be considered hypoglycemie until immediate estimation of the blood sugar level rules the condition in or out. If it is ruled in, the clinician should promptly start 10 per cent glucose by vein and plan to maintain it uninterruptedly for one or more days, with added hydrocortisone and glucagon if necessary, until persistent hyperglycemia guarantees that all drug effects have worn off.

SERUM INSULIN IN NEWBORN INFANTS WITH ERYTHROBLASTOSIS FETALIS

Serum insulin and glucose measurements were performed soon after birth in 12 infants with erythroblastosis fetalis (EBF) and 14 normal neonates. In addition, in eight infants with EBF, insulin levels were determined at birth and again prior to exchange transfusion. Significant elevation of serum immunoreactive insulin (29.6 ± 5.1 versus 10.1 ± 2.2 µU/ml, mean ± SEM) was found in the EBF group and was not related to bilirubin levels or hematocrits. Comparison between immunoreactive insulin level at birth and prior to exchange transfusion showed no difference. The possibility of predisposition to hypoglycemia in EBF should lead to frequent monitoring of blood glucose and appropriate measures to prevent or treat this complication.