Frequent Blood Glucose Monitoring Research Articles

Monitoring nutrition and glucose in acute brain injury.

The metabolic response to injury is well described; however, very little is understood about optimal markers to measure this response. This summary will address the current evidence about monitoring nutritional status including blood glucose after acute brain injury (ABI). An electronic literature search was conducted for English language articles describing the testing, utility, and optimal methods to measure nutritional status and blood glucose levels in the neurocritical care population. A total of 45 articles were included in this review. Providing adequate and timely nutritional support can help improve outcome after ABI. However, the optimal content and total nutrition requirements remain unclear. In addition, how best to monitor the nutritional status in ABI is still being elucidated, and at present, there is no validated optimal method to monitor the global response to nutritional support on a day-to-day basis in ABI patients. Nitrogen balance may be monitored to assess the adequacy of caloric intake as it relates to protein energy metabolism, but indirect calorimetry, anthropometric measurement, or serum biomarker requires further validation. The adverse effects of hyperglycemia in ABI are well described, and data indicate that blood glucose should be carefully controlled in critically ill patients. However, the optimal frequency or duration for blood glucose monitoring after ABI remains poorly defined. There are significant knowledge gaps about monitoring nutritional status and response to nutritional interventions in ABI; these need to be addressed and hence few recommendations can be made. The optimal frequency and duration of blood glucose monitoring need further study.

Check it! A randomized pilot of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes.

The purpose of the current study was to pilot-test a positive psychology intervention to improve adherence to diabetes management in adolescents with type 1 diabetes. A total of 39 adolescents (ages, 13-17 years) with type 1 diabetes and their caregivers were randomized to a positive psychology intervention (n = 20) or an attention control (education) intervention (n = 19). The intervention condition used positive psychology exercises (eg, gratitude, self-affirmation), small gifts, and parent affirmations to boost positive affect. Outcomes included frequency of blood glucose monitoring, quality of life, and glycemic control. No main effects for treatment were observed at the 6-month follow-up. However, there was a significant association between adolescents' levels of positive affect and measures of adherence, including self-report and meter downloads of glucose monitoring. The results from the current study support the assertion that positive affect in the context of diabetes education is an important factor to consider in adolescents with type 1 diabetes.

Frequency of mealtime insulin bolus predicts glycated hemoglobin in youths with type 1 diabetes.

Within pediatric diabetes management, two electronic measures of adherence exist: frequency of daily blood glucose monitoring (BGM) and the BOLUS score, a measure of frequency of mealtime insulin bolusing. Past research has demonstrated that the BOLUS score is superior to daily BGM in predicting youths' glycated hemoglobin (HbA1c) in a cross-sectional study. We present data comparing the two adherence measures in predicting HbA1c using a prospective, longitudinal design. Blood glucose meter data and insulin pump records were collected from a clinical database of 175 youths with type 1 diabetes (mean age, 11.7 ± 3.6 years at baseline). Youths' HbA1c levels occurring at the download time and at 3, 6, 9, and 12 months post-downloads were also collected. We calculated youths' mean BGM and BOLUS score using a standardized protocol. Intraclass correlations (ICCs) revealed significant absolute equivalence between youths' predicted HbA1c values using BOLUS and BGM scores and future actual HbA1c values up to 12 months post-download. However, the ICCs of BOLUS scores with future HbA1c values were consistently higher than those of the BGM scores. Also, the predictions of the BOLUS scores were significantly more accurate (P ≤ 0.002) than those of the BGM scores based on the root mean squared error of predictions. In a prospective, longitudinal design, youths' BOLUS scores were superior to youths' daily BGM in predicting future values of HbA1c. Calculating a BOLUS score versus BGM can help researchers and clinicians achieve a better prediction of youths' HbA1c.

Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes.Design and main outcome measures: Ninety-nine AYAs (ages 15–20 years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling.Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (ΔR2 = .23, p < .01) and adherence to emergency precautions at Time 1 (ΔR2 = .07, p = .03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (ΔR2 = .08, p = .01), adherence to recommendations for insulin and food (ΔR2 = .08, p = .02) and exercise (ΔR2 = .10, p < .01), and adherence to emergency precautions (ΔR2 = .16, p < .01) at Time 2.Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.

Effect of blood glucose monitoring frequency on blood glucose control in type 2 diabetes meilitus patientswith intensive insulin therapy

Objective To explore the effect of different blood glucose monitoring frequency on blood glucose fluctuation and control in type 2 diabetes mellitus patients with intensive insulin therapy. Methods One hundred and twenty type 2 diabetes mellitus patients With intensive insulin therapy were chosen and randomly divided into three groups. The three times group received 3 times monitoring including fasting, after breakfast and bedtime, and the five times group received 5 times monitoring including fasting, after breakfast, before supper, bedtime and before dawn, and the eight times group received the 8 times monitoring including before and after every meal, bedtime and before dawn, and the changes of the hemoglobin Alc （I-IbAlc） were observed for 4 weeks before and after the treatment. Results The average levels of HbA1 c in the three groups were decreased 4 weeks after treatment in the three groups, and the difference was not statistically significant （ F = 0. 301, P 〉0.05 ）. No difference was found in the fasting blood glucose and blood glucose before supper in the three groups （ F = 1. 450, t = 1. 760 ; P 〉 0.05 ）. The levels of blood glucose after breakfast were respectively （ 8.78 ± 0.90）, （9.08 ± 0.63 ）, （7.49 ± 1.01 ） mmol/L in the three groups, and the level of blood glucose in the eight times group was better than those of the three and five times groups, and the difference was statistically significant （F = 23. 340, P 〈 0.05 ）. The levels of bedtime blood glucose were respectively （ 8.07 ± 0.59 ）, （8.32 ± 0.75）, （7.28 ± 0.54） mmol/L in the three groups, and the blood glucose fluctuatian range in the eight times group was lowest, and the difference was statistically significant （F = 32.880, P 〈 0.0.5）. The levelof blood glucose before dawn in the eight times group was （6. 68 ± 0.59 ） mmol/L, and was better than （7.75 ±0.77） mmol/L in the five times group, and the difference was statistically significant （t =4. 170, P 〈 0.01 ）. The average levels of 24 h blood glucose in the three groups were respectively （8.33 ± 1.20）, （8.26 ± 0.97）, （7.84 ± 1.15 ） mmol/L, and the blood glucose control in the eight times group was best, and the difference was statistically significant （ F = 22.36, P 〈 0.05 ）, and the detection rate of hypoglycemia was 33.3% in the small hours. Conclusions The blood glucose fluctuation range in the eight times group is minimum. The many times blood glucose monitoring in type 2 diabetic patients with intensive insulin therapy, at least 3 times daily, can reduce and prevent the incidence of hypoglycemia. Key words: Diabetes mellitus, type 2 ; Blood glucose self monitoring; Frequency ; Intensiveinsulin therapy; Blood glucose control

Effect of mobile phone short text messages on glycaemic control in children with type 1 diabetes

We conducted a feasibility study of a mobile phone messaging service for children and adolescents with type 1 diabetes. Two hundred children with type 1 diabetes took part in a six-month trial. The children were provided – through their parents – with daily information messages, with weekly interactive messages, and on request, with multimedia video messages about procedures related to diabetes care. During the study, approximately 30,000 information messages and 2800 interactive messages were sent. One month before the trial, the mean fasting blood glucose level of the children was 150 mg/dl. After the trial, the mean fasting blood glucose level was 133 mg/dl (P < 0.001). There were also significant reductions in post prandial blood glucose level, HbA1c, frequency of simple hypoglycaemic attacks and frequency of blood glucose monitoring. A before and after questionnaire showed that the parents' knowledge of diabetes had improved significantly during the trial. Mobile phone text messaging offers a useful means of contact between clinic visits. The results of the trial suggest that it increases adherence to diabetes therapy and improves clinical outcomes in children and adolescents with type 1 diabetes.

Blood glucose monitoring in diabetes

While the prevalence of all types of chronic conditions is increasing, diabetes is one of the few long-term conditions that individuals can successfully manage and control on a day-to-day basis, providing that they have access to appropriate advice and support. Blood glucose monitoring and patient education are essential in diabetes care and management, and if used appropriately, can help to achieve maximum benefit for the patient and diabetes care team. This article considers the link between blood glucose levels and the incidence of diabetes-related complications. It explores the different blood glucose monitoring strategies, particularly self-monitoring of blood glucose in people with type 2 diabetes. The frequency of blood glucose monitoring, and the identification of patterns and trends in blood glucose control are highlighted and applied to practice.

Recurrent hypoglycaemia in type 1 diabetes mellitus resulting from intensive academic activity: an illustrative case report

Abstract We report a common diabetes management problem illustrated by an adolescent female university student with recurrent episodes of hypoglycaemia on Tuesdays when she has intensive academic activity lasting most of the day. Steps taken to reduce the risk of hypoglycaemia were patient education and empowerment, frequent self monitoring of blood glucose, reduction in insulin dose on Tuesdays and emphasizing availability of ongoing professional guidance and support anytime she may need it. One of the challenges encountered in the management of this patient was her family’s inability to afford the cost of basal-bolus regimen or continuous subcutaneous insulin infusion via insulin pump; the two insulin regimens that best fit into university lifestyle. Conclusion: Adolescents with diabetes mellitus attending tertiary educational institutions may be at increased risk of hypoglycaemia, particularly on days when they have intensive academic activities.

Caudal Occipital Malformation Syndrome in a 6-Year-Old Female Huacaya Alpaca

A 58-kg, 6-year-old, female Huacaya alpaca presented to the Washington State University Veterinary Teaching Hospital with a history of gradual developing lethargy, reluctance to rise, anorexia, blindness, and respiratory distress. A presumptive diagnosis of dorsal displacement of the soft palate was made and a tracheostomy tube was surgically placed by the referring veterinarian. Supportive treatment included crystalloid fluids (lactated Ringer’s solution) administered IV and antimicrobial (certiofur sodium, unknown dose) therapy. The tracheotomy tube was removed and the respiratory distress appeared to have resolved. For the 2 months prior, the alpaca had been housed at an out-of-state breeding facility. Marginal feed quality during this period was believed to be related to the alpaca’s poor body condition score (1/5). The alpaca’s vaccination (Clostridium perfringens C/D, Cl. tetani toxoids) and deworming (Ivermectin) history were deemed appropriate and current. The owner thought that the alpaca might be pregnant. Upon examination, the alpaca was dull, lethargic (reluctant to rise when stimulated), and had not eaten for at least 1 day. The alpaca was thin (body condition score 1/5) and adequately hydrated. Vital signs (heart rate, respiratory rate, and temperature), capillary refill time, and mucus membrane color were normal. The alpaca urinated and defecated normally and had normal compartment 1 (C1) contractions upon auscultation. The tracheostomy site was patent, healing, and no abnormal respiratory sounds were asculted. Neurologic examination revealed an absent menace response in the left eye, with normal palpebral reflexes and pupilary light reflexes (direct and consensual). No other abnormal cranial nerve signs were detected. The alpaca held her head in an abnormally low position and moved her head slowly in response to stimuli. There were no signs of pain upon neck manipulation. Although it was difficult to maintain the alpaca in a standing position, conscious proprioceptive (CP) deficits were observed in all 4 legs. Flexor reflexes (thoracic and pelvic) and patellar reflexes were normal. Abnormalities identified on clinical pathology included decreased serum activity of SDH and AST and serum concentration of cholesterol, BUN, and albumin, most likely a result of decreased feed intake. No fecal parasite ova were observed and serum bile acids were within the normal limits. Virus neutralization testing for EHV-1, West Nile virus, and cELISA for Bluetongue virus from blood were all negative. CSF protein concentration, cell count, and cell morphology were within normal limits. Because of the continued anorexia, the alpaca was transfaunated with 2 L of rumen fluid and administered IV lactated Ringer’s solution supplemented with KCl (20 mEqs/L) and Vitamin B complex (2 mls/L) at 1.39 maintenance (4 L/d). Ceftiofur sodium (1.1 mg/kg IV q12h) and flunixin meglumine (1.1 mg/kg IV q12h) were administered. Because of the dam’s lack of milk production and substantial time spent in recumbency, the cria was weaned. Magnetic resonance imaging (MRI) examination revealed malformation of the caudal occipital bone with herniation/caudal displacement of the caudal cerebellum through the foramen magnum. There was also a T2-weighted hyperintensity within the cervical spinal cord (from C1-C3) that became hypointense on the T1-weighted images consistent with syringohydromyelia (Fig 1). Follow-up neurologic examination findings were consistent with the changes found on MRI examination. CP deficits were most likely caused by the extensive syringohydromyelia in the cervical spinal From the Department of Veterinary Clinical Sciences, Washington State University, Pullman, WA (Allen, Chen, Barrington); and is presently affiliated with Department of Veterinary Clinical Sciences, Iowa State University (Bagley). Corresponding author: Andrew J. Allen, Department of Veterinary Clinical Sciences Veterinary Teaching Hospital, P.O. Box 647060, Pullman, WA 99164-7060; e-mail: aja@vetmed.wsu.edu. Submitted August 15, 2013; Revised November 26, 2013; Accepted December 31, 2013. Copyright © 2014 by the American College of Veterinary Internal Medicine 10.1111/jvim.12316 Abbreviations:

The Relations of Sleep and Quality of Life to School Performance in Youth With Type 1 Diabetes

This study examined parent and youth self-reports to test the hypothesis that perceived insufficient sleep duration, inconsistent sleep habits, reduced quality of life, less frequent blood glucose monitoring, and higher hemoglobin A1c would predict poorer school functioning among 50 youth with type 1 diabetes. The data suggested that a delay in bedtime on non–school nights compared with school nights was consistently related to lower grade point averages and lower reading, math, and writing test scores. Sleep duration on school nights related to writing performance and absences. Perceived disease burden predicted grade point averages and absences. These findings support the need for school psychologists to target sleep problems and quality of life in youth with diabetes as a way to help improve their school performance.

Autonomy support and responsibility-sharing predict blood glucose monitoring frequency among youth with diabetes.

Adolescence poses a number of special challenges for youth and their families managing the Type 1 diabetes medical regimen. Little is known on how family and youth factors and management of the regimen change over the course of early adolescence and predict adherence to the regimen during this developmental period. Youth with Type 1 diabetes (n = 239) and their maternal caregivers completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency (BGMF) at 4 timepoints over a 3-year period. Autonomy support and BGMF significantly decreased over time and responsibility for the diabetes regimen shifted from the caregiver toward youth over time. Significant changes in perceived family conflict over time differed depending on the reporter. Baseline BGMF, changes in caregiver autonomy support, and changes in responsibility for the regimen significantly predicted changes in BGMF over time. This study documents changes in autonomy support, youth responsibility for the diabetes regimen, and BGMF during the transition into early adolescence. Higher levels of caregiver autonomy support preserve BGMF during a developmental period in which BGMF typically deteriorates.

Identification and prediction of group-based glycemic control trajectories during the transition to adolescence.

To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership. This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership. These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.

Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes

Aim: To explore the longer term blood glucose self-monitoring outcomes and frequency of monitoring for outpatients with diabetes type 1 after completion of the Dose Adjustment for Normal Eating (DAFNE) course. The hypothesis was that DAFNE outcomes would differ according to frequency of glucose monitoring.Methods: A sequential data-triangulation design using existing baseline (T0) and 12-months (T12) DAFNE course data and interview data from 12 randomly selected participants who had completed the course two years ago. Results: Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0 and 6.1% to 11.4% at T12. Comparisons of HbA1c, PAID, HAD subscales anxiety and depression, and covariate data between T0 and T12indicatedsignificant reductions in the mean depression and PAID scores (both P 0 and T12 was downwards for change in mean blood glucose level and all survey scales. The proportion of all participants with T12 HbA1c at or below their T0 value was greater than 50% (Proportion = 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a significant difference (P = 0.003). There was an average decrease in the incidence of hypoglycaemic events of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean decrease of 0.8. The interview data suggested that DAFNE graduates experimented more with food, exercise, and insulin; gained knowledge; learnt personal body needs; increased awareness of blood glucose level; gained confidence and improved their quality of life. Conclusions: There was insufficient evidence to conclude that frequency of blood glucose monitoring influenced metabolic control. However, people with type 1 diabetes who undertake the less restricted DAFNE approach to diabetes self-management can improve their quality of life and glycaemic control.

A randomized controlled trial of an internet-based mentoring program for type 1 diabetes patients with inadequate glycemic control.

BackgroundTo determine whether an internet-based mentoring program can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM).MethodsSubjects with T1DM on intensive insulin therapy and with hemoglobin A1c (HbA1c) ≥8.0% were randomized to mentored (glucometer transmission with feedback from mentors) or control (glucometer transmission without feedback) groups and were examined for 12 weeks. Five mentors were interviewed and selected, of which two were T1DM patients themselves and three were parents with at least one child diagnosed with T1DM since more than 5 years ago.ResultsA total of 57 T1DM adult subjects with a mean duration after being diagnosed with diabetes of 7.4 years were recruited from Samsung Medical Center. Unfortunately, the mentored group failed to show significant improvements in HbA1c levels or other outcomes, including the quality of life, after completion of the study. However, the mentored group monitored their blood glucose (1.41 vs. 0.30) and logged into our website (http://ubisens.co.kr/) more frequently (20.59 times vs. 5.07 times) than the control group.ConclusionA 12-week internet-based mentoring program for T1DM patients with inadequate glycemic control did not prove to be superior to the usual follow-up. However, the noted increase in the subjects' frequency of blood glucose monitoring may lead to clinical benefits.

Dress, Type 1 Diabetes, and Adolescent Development

The purpose of this white paper is to call for research on the intersection of dress, type 1 diabetes (T1D), and adolescent development. Management of T1D requires frequent blood glucose monitoring, and the individual is dependent on regular delivery of insulin through injections or an insulin pump. Much of the literature on T1D focuses on fostering healthy habits. The role of dress and identity is rarely addressed. The example of an adolescent teen with T1D is employed to demonstrate how equipment for blood glucose control fulfills the definition of dress. A review of literature reveals a body of knowledge on dress and identity, T1D and adolescent development, and T1D and identity. Interdisciplinary research on the intersection of these three factors is needed. At a point in life when most teens want to look unique but not too different from friends, managing the gear that maintains health and communicates diabetic identity must be better understood to support the patient.

Improving Depression Screening for Adolescents With Type 1 Diabetes

Depression is common among adolescents, but rates increase significantly in the presence of chronic health conditions. Outpatient screening for depression is recommended but rarely formally conducted due to barriers of implementation. To provide a model for depression screening of youth with chronic health conditions, a standard process using a self-administered electronic version of the Children's Depression Inventory (CDI) was developed. Quality improvement methodology and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients 13 to 17 years of age with type 1 diabetes. Of the 528 eligible adolescents, 509 (96%) received at least 1 depression screen during the first year. The process was tested and refined in over 1200 patient encounters, which resulted in an increase in depression screening rates from <5% to a median of 85% over the initial 12 months. Both patients and staff reported acceptance of screening on qualitative surveys. Elevated CDI scores (≥ 16) were found in 8% of the sample; moderate scores (10-15) in 12% of the sample. Low risk scores were found in 80% of the sample. Higher CDI scores correlated with lower blood glucose monitoring frequency and higher hemoglobin A1c, confirming the link between more depression symptoms and poorer diabetes management and control. Suicidal ideation was endorsed in 7% of the population. Systematic depression screening in adolescents with type 1 diabetes can be reliably implemented with clinically significant results. A systematic approach, such as described in this study, can serve as a model for other chronic health conditions.

Glycemic control and diabetes management in hospitalized patients in Brazil

BackgroundThe importance of tight blood glucose control among outpatients with diabetes mellitus is well established, however, the management of diabetes in the hospital setting is generally considered secondary in importance. This study sought to assess glycemic control and diabetes management in adult patients admitted to hospitals in Brazil.MethodsA cross-sectional and nationwide survey was conducted from July 2010 to January 2012. Eligible cases were 18 years of age or older, had a diagnosis of diabetes and a hospitalization length of stay ≥72 hours. Socio-demographic information, hospitalization details, and data on diabetes diagnosis, management and treatment were collected for all patients by chart review. Information on all blood glucose (BG) readings for a maximum of 20 consecutive days of hospitalization was recorded for each patient.ResultsOverall, 2,399 patients were surveyed in 24 hospitals located in 13 cities from all five Brazilian regions. The prevalence of patients presenting hyperglycemic (BG >180 mg/dL) or hypoglycemic (BG <70 mg/dL) events was 89.4% and 30.9% in patients in general wards, and 88.2% and 27.7% in those in Intensive Care Units (ICUs), respectively. In addition, a BG measure >180 mg/dL was recorded in two-thirds of the patient-days. A high proportion of patients were treated with sliding-scale insulin regimen alone in the general wards (52.0%) and in the ICUs (69.2%), and only 35.7% and 3.9% received appropriate insulin therapy in general wards (basal + bolus insulin) and in ICUs (continuous IV insulin), respectively.ConclusionsInpatient glycemic control and diabetes management needs improvement. Opportunities to improve care in Brazilian hospitals include expanded use of intravenous insulin and subcutaneous basal-bolus insulin protocols, avoiding use of sliding-scale insulin alone, increased frequency of blood glucose monitoring, and institution wide quality improvement efforts targeting both physician and nursing behavior.

Glycemic Control and Blood Glucose Monitoring Over Time in a Sample of Young Australians With Type 1 Diabetes

OBJECTIVETo determine whether personality traits (conscientiousness, agreeableness, emotional regulation, extraversion, and openness to experience) are associated with glycemic control and blood glucose monitoring behavior, and change or stability of these outcomes over time, in young people with type 1 diabetes.RESEARCH DESIGN AND METHODSA 3-year longitudinal study was conducted using data from 142 individuals with type 1 diabetes, 8–19 years of age. Personality was assessed at baseline using the Five-Factor Personality Inventory for Children. Data relating to glycemic control (HbA1c) and frequency of blood glucose monitoring (based on meter memory) were collected annually. Relationships between personality traits and HbA1c and monitoring frequency were examined using regression models and mixed-design ANOVA.RESULTSThree of the Five-Factor domains were independently associated with glycemic control. Individuals high in conscientiousness and agreeableness had a lower and more stable HbA1c across the 3-year study period. In contrast, the HbA1c of individuals scoring low on these traits was either consistently worse or deteriorated over time. Low or high emotional regulation scores were also associated with worse glycemic control. By the third year, these domains, together with initial HbA1c, accounted for 39% of HbA1c variance. Conscientiousness was the only personality factor associated with blood glucose monitoring behavior.CONCLUSIONSResults of this study underline the importance of personality in contributing to diabetes outcomes. Attention to a young person’s personality, and appropriate tailoring of diabetes management to ensure an individualized approach, may help to optimize diabetes outcomes.

Problem Based Review: The patient who has taken an overdose of long-acting insulin analogue

Insulin overdose can cause harm due to hypoglycaemia, effects on electrolytes and acute hepatic injury. The established long-acting insulin analogue preparations (detemir and glargine) can present specific management problems because, in overdose, their effects are extremely prolonged, often lasting 48-96 hours. The primary treatment is continuous intravenous 10% or 20% glucose infusion with frequent capillary blood glucose monitoring. Surgical excision of the insulin injection site has been used successfully, even days after the overdose occurred. Once the effects of overdose have receded, diabetes treatment must be restarted with care, especially in patients with type 1 diabetes. Monitoring serum insulin concentration has been successfully used to predict when the effects of the overdose will cease.

Importance of Manually Entering Blood Glucose Readings When Wireless-Compatible Meters are Not Being Used with an Insulin Pump

The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group). Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps. There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings. Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.