Management Of Hypoglycemia In Patients Research Articles

Protocolo terapéutico de la hipoglucemia en el paciente con diabetes mellitus tipo 1

This clinical protocol for the management of hypoglycemia in patients with type 1 diabetes mellitus details intervention strategies that are especially focused on the treatment of hypoglycemic episodes. In addition, it emphasizes the importance of patient and medical team education in order to optimize the management and prevention of severe hypoglycemia, which can have serious implications.

633-P: Impact of Simulation-Based CME on Clinicians’ Knowledge and Competence Related to Hypoglycemia Management

We sought to determine if real-time patient simulation technology, designed to mimic a patient visit, could improve clinicians’ knowledge/competence regarding the management of hypoglycemia in patients with type 2 diabetes (T2D). The patient simulation technology, DecisionSim, was incorporated as part of a live symposium, and changes in competence and knowledge were evaluated using pre-/post-assessment questions. A Chi-Square test was used to analyze the percentage of correct responses and determine statistical significance (p <0.05 indicated statistical significance). The live activity took place on October 26, 2018. In total, 66 allied health professionals (PAs, RNs, NPs, PharmDs, CDE/RDs) and 41 MDs/DOs answered the assessment questions. An increase in knowledge was observed, albeit not statistically significant (4% relative increase compared to baseline, p = 0.6). A significant increase in competence in selecting the most appropriate treatment to address hypoglycemia risk for a patient with T2D was observed (120% relative increase compared to baseline, p <0.0001). 82% selected the correct treatment decisions in the branching simulation platform, including the intensification of therapy that addresses HbA1c goals while minimizing the risk of hypoglycemia in a virtual patient with T2D. Additionally, 83% indicated in the post-activity survey that they would make changes to practice based on information received, including to provide patient-centered care, assess the current diabetes guidelines, and use diabetes treatments that minimize hypoglycemia. Continued educational gaps were identified: lack of knowledge about the benefits of GLP-1RA/insulin combinations (17%), and lack of competence in individualizing T2D therapy in the context of hypoglycemia risk (21%). These results indicate that simulation-based CME can lead to significant improvements in competence related to hypoglycemia management, as well as commitment to change among learners. Disclosure S. Karandrea: None. N. Agarwal: None. A. Jamrogiewicz: None. Funding Sanofi US (IME-2017-12078)

Management of Hypoglycemia in Patients with Type 2 Diabetes

The rate limiting step of intensive diabetes management for patients with diabetes is treatment induced hypoglycemia. Thus, hypoglycemia remains a significant barrier in optimizing glycemic control and reducing long-term diabetes related complications including cardiovascular death, stroke, and all cause-mortality [1]. Cardiovascular (CV) events are the leading cause of death among patients with diabetes. The risk of CV death is twice that of patients without diabetes [2]. Severe hypoglycemia (resulting in cognitive impairment) can occur across a broad spectrum of A1C levels. Patients achieving near-normal glycemia

Lung abscess without sepsis in a patient with diabetes with refractory episodes of spontaneous hypoglycemia: a case report and review of the literature

IntroductionHypoglycemia is a cause of considerable morbidity. Although hypoglycemia has been documented in the setting of septic shock and has been associated with higher mortality, hypoglycemia in infection without sepsis has not been reported in the literature.Case presentationA 72-year-old Japanese woman treated with high-dose glucocorticoids for autoimmune hemolytic anemia, as well as intensive insulin therapy for type 2 diabetes, presented with severe hypoglycemia. A lung abscess was diagnosed by imaging studies and treated with intravenous antibiotics. Hypoglycemia spontaneously recurred during lung abscess exacerbations, despite appropriate de-escalation of antidiabetic therapy. Only mild sporadic episodes of hypoglycemia occurred after the lung abscess was controlled. Infection accompanied with malnutrition and immunosuppression, although in the absence of sepsis, may have contributed to hypoglycemia.ConclusionsCaution is warranted in the management of hypoglycemia in patients with diabetes with the conditions described here, that is malnutrition and immunosuppression, as infection may be a contributing factor.

Position statement: Hypoglycemia management in patients with diabetes mellitus. Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition

Abstract Objective To provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. Participants Members of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. Methods Recommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. Conclusions The document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.

Non-diabetic Hypoglycemia

Objective: To describe the evaluation and management of hypoglycemia in patients without diabetes mellitus. Methods: Review of the literature for the evaluation and management of non-diabetic hypoglycemia using Medline and PubMed. Results: Hypoglycemia (glucose WWW.ENDOTEXT.ORG .

Documento de posicionamiento: evaluación y manejo de la hipoglucemia en el paciente concon diabetes mellitus. Grupo de Trabajo de Diabetes Mellitus de la Sociedad Española de Endocrinología y Nutrición

ObjectiveTo provide practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus. ParticipantsMembers of the Diabetes Mellitus Working Group of the Spanish Society of Endocrinology and Nutrition. MethodsRecommendations were formulated according to the Grading of Recommendations, Assessment, Development, and Evaluation system to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (PubMed). Papers in English and Spanish with publication date before 15 February 2013 were included. For recommendations about drugs only those approved by the European Medicines Agency were included. After formulation of recommendations, they were discussed by the Working Group. ConclusionsThe document provides evidence-based practical recommendations for evaluation and management of hypoglycemia in patients with diabetes mellitus.

Uncovering undetected hypoglycemic events

Hypoglycemia is the rate-limiting factor that often prevents patients with diabetes from safely and effectively achieving their glycemic goals. Recent studies have reported that severe hypoglycemia is associated with a significant increase in the adjusted risks of major macrovascular events, major microvascular events, and mortality. Minor hypoglycemic episodes can also have serious implications for patient health, psychological well being, and adherence to treatment regimens. Hypoglycemic events can impact the health economics of the patient, their employer, and third-party payers. Insulin treatment is a key predictor of hypoglycemia, with one large population-based study reporting an overall prevalence of 7.1% (type 1 diabetes mellitus) and 7.3% (type 2 diabetes mellitus) in insulin-treated patients, compared with 0.8% in patients with type 2 diabetes treated with an oral sulfonylurea. Patients with type 1 diabetes typically experience symptomatic hypoglycemia on average twice weekly and severe hypoglycemia once annually. The progressive loss of islet cell function in patients with type 2 diabetes results in a higher risk of both symptomatic and unrecognized hypoglycemia over time. Patients with diabetes who become hypoglycemic are also more susceptible to developing defective counter-regulation, also known as hypoglycemia awareness autonomic failure, which is life-threatening and must be aggressively addressed. In patients unable to recognize hypoglycemia symptoms, frequent home monitoring or use of continuous glucose sensors are critical. Primary care physicians play a key role in the prevention and management of hypoglycemia in patients with diabetes, particularly in those requiring intensive insulin therapy, yet physicians are often unaware of the multitude of consequences of hypoglycemia or how to deal with them. Careful monitoring, adherence to guidelines, and use of optimal treatment combinations are all important steps toward improving care in patients with diabetes. The most important goals are for primary care physicians to recognize that every patient treated with antihyperglycemic medications is at risk of iatrogenic hypoglycemia and to ask patients about hypoglycemia at every visit.

Recognition, Prevention, and Proactive Management of Hypoglycemia in Patients with Type 1 Diabetes Mellitus

Hypoglycemia is the key barrier that prevents patients from optimizing glycemic control with the use of pharmacotherapeutic interventions. Optimal glycemic control for patients with type 1 diabetes (T1DM) includes methods that provide glucose-regulated physiologic insulin replacement or secretion in association with glucose monitoring methods designed to predict and prevent acute extreme changes in glycemic variability. Patients with T1DM experience an average of 2 episodes of symptomatic hypoglycemia each week and at least 1 episode of severe, disabling hypoglycemia annually. Asymptomatic hypoglycemia is common, as shown in studies using continuous glucose monitoring (CGM). Episodes of hypoglycemia (symptomatic and asymptomatic) impair counterregulatory defenses against subsequent events, resulting in the inability to respond to and recover from serious hypoglycemia. This defective counterregulation is known as hypoglycemic-associated autonomic failure. When patients are prescribed a more intensive medication regimen or reinforcing lifestyle interventions, such as medical nutrition therapy and exercise therapy, providers should also assess their ability to proactively identify and manage hypoglycemia. Although self-monitoring of blood glucose regimens, such as pre- and post-meal and periodic middle-of-the-night glucose testing, can help predict the risk of developing hypoglycemia, CGM technology allows patients to receive real-time notification of impending events either through preset alarms or simply by looking at the device display. This review explores the utility of initiating CGM within the primary care setting for patients at high risk for developing hypoglycemia.

USE OF SOMATOSTATIN IN NESIDIOBLASTOSIS

Description of two cases with severe neonatal hyperinsulinism due to nesidioblastosis in whom intravenous (i.v.). Somatostatin was used to improve their metabolic control. The first case is a newborn with persistent hypoglycemia despite the use of i.v. dextrose(20 mg/Kg/min), diazoxide(22 mg/Kg/day) and prednisone(1.5 mg/Kg/day). Somatostatin in a dosage or 8-10 ug/Kg/h our produced a marked increase in blood glucose concentration, allowed to withdraw the i.v. dextrose and to taper the dose of corticosteroids. Concomitantly the increasing volumes of oral feedings allowed a better nutritional state before subtotal pancreatectomy. The second case is a three months old girl with severe hyperinsulinism were Somatostatin was used, first before pancreatectomy at a dosage of 5 ug/Kg/hour with reduction of i.v. dextrose from 20 to 10 mg/Kg/min. After surgery the patient persisted with hypoglycemia and again Somatostatin allowed to mantain euglycemia when parenteral nutrition with increasing concentration of aminoacids was introduced. Finally after a second pancreatectomy and with persistent hypoglycemia Somatostatin in a dosage of 4 to 8 ug/Kg/hour produced a marked reduction of i.v. dextrose from 15 to 4 mg/Kg/min. In summary in accordance with previous reports, i.v. Somatostatin has proved to be useful in reducing the amount of i.v. dextrose, and in the management of hypoglycemia in patients with severe hyperinsulinism.