Monitoring Of Blood Glucose Concentration Research Articles

Evaluation of Compliance with a Paper-based, Multiplication-factor, Intravenous Insulin Protocol

Hyperglycemia is common in critically ill patients and is an independent risk factor for in-hospital morbidity and mortality. To assess compliance with a paper-based, multiplication-factor, intravenous insulin protocol. A retrospective chart review was conducted in a 720-bed urban, academic medical center in Boston, Massachusetts. During a 1-month period, compliance with and the consequent safety and efficacy of the Brigham and Women's Hospital paper-based, multiplication-factor, intravenous insulin protocol was evaluated. The primary endpoint of protocol compliance, defined as correct adjustment to insulin infusion rate and correct timing of bedside blood glucose concentration (BBGC) checks +/-10 minutes of prespecified BBGC check according to the Brigham and Women's Hospital Intravenous Insulin Protocol (BHIP), was 47.2%. Seventy-two patients met inclusion criteria. Appropriate adjustment of infusion rates occurred 68.2% (1206/1768) of the time. Compliance with the timing of BBGC checks was found to be the majority of protocol violations. BBGCs were monitored +/-5 minutes of indicated time per the protocol 26.2% (463/1768) of the time. Blood glucose concentration checks within extended timing of +/-10 minutes of indicated time per the protocol occurred 793 (44.8%) times. Blood glucose concentration monitoring took place greater than 20 minutes past indicated time 450 (25.5%) times. In 1768 measurements, blood glucose concentrations between 40 and 60 mg/dL occurred 23 (1.3%) times in 12 (16.7%) patients. Blood glucose concentrations 40 mg/dL or less were detected 3 (0.17%) times in 2 (2.7%) patients. None of these hypoglycemic events led to documented complications. Overall, a rather low level of compliance with a paper-based, multiplication-factor, intravenous insulin protocol was observed, which warrants further investigation. Compliance rates in this evaluation were found to be similar to the rates observed in previously evaluated fixed-dose intravenous insulin protocols. Protocol noncompliance may be associated with hypo- and hyperglycemia.

Hypoglycemic effect of quassinoids from Brucea javanica (L.) Merr (Simaroubaceae) seeds

Ethnopharmacological relevance The seeds of Brucea javanica (L.) Merr (Simaroubaceae) are recommended by traditional practitioners for the treatment of diabetes mellitus. Aim of the study To identify the compounds responsible for blood glucose lowering effect and evaluate the acute toxicity of the compounds. Materials and methods Extracts, fractions and subfractions were administered to normoglycemic mice and the blood glucose concentration was monitored for 8 h. Bioactive compounds isolated through column chromatography were administered to normoglycemic mice and streptozotocin (STZ) rats with monitoring of blood glucose concentration at 0–8 h. The acute toxicity was evaluated in mice. Results Bioactivity-guided fractionation led to the isolation of bruceines E ( 1) and D ( 2). Normoglycemic mice administered with 1 mg/kg of 1 and 2 exhibited significant blood glucose concentration reduction of 40.07 ± 11.45% and 48.82 ± 13.34%, respectively. STZ induced diabetic rats administered with 1 and 2 exhibited significant blood glucose concentration reduction of 73.57 ± 13.64% and 87.99 ± 2.91%, respectively. Conclusion The reduction of blood glucose concentration by both bruceines was comparable to glibenclamide and they might act as an insulin secretagogue. The presence of a hydroxyl moiety at C 2 in 1 reduced the toxic effect by 9-fold compared to 2.

Peri‐operative iv fluids in diabetic patients – don’t forget the salt

Peri‐operative iv fluids in diabetic patients – don’t forget the salt

Optical Absorption Glucose Measurements Using 2.3-$\mu$m Vertical-Cavity Semiconductor Lasers

Continuous glucose monitoring has been shown to help diabetes mellitus patients stabilize their glucose levels, leading to improved patient health. One promising technique for monitoring blood glucose concentration is to use optical absorption spectroscopy. This letter proposes the use of thermally tunable 2.3-mum vertical-cavity surface-emitting lasers to obtain blood absorption spectra. The partial least squares technique is used to determine the glucose concentration from the spectra obtained in aqueous glucose solutions.

Efficacy of self monitoring of blood glucose in patients with newly diagnosed type 2 diabetes (ESMON study): randomised controlled trial

Objectives To assess the effect of self monitoring of blood glucose concentrations on glycaemic control and psychological indices in patients with newly diagnosed type 2 diabetes mellitus.Design Prospective randomised controlled...

Noninvasive blood glucose monitoring using the optical signal of pulsatile microcirculation: a pilot study in subjects with diabetes

Objective The objective of this study was to determine the conditions for optimizing measurements obtained with a noninvasive blood glucose monitor using the optical signal of pulsatile microcirculation (OSPM) in both prediabetic and diabetic subjects receiving medication. Research design and methods Eighteen subjects (3 prediabetic, 15 diabetic) aged 61.8 [15.9] years (mean [S.D.]) were studied. OSPM was the pulsatile component (P) of the signal obtained and analyzed by a blood glucose monitor. The measurement was calibrated to the fingerstick meter for each subject for personal calibration. Data were obtained from all subjects using both meters. Results A total of 179 data pairs were measured and analyzed. The validity of the position of the tested finger was assessed using the position criterion, which resulted in the removal of 38 data pairs. The criterion for the intensity of the P signal was satisfied by 141 data pairs, with nonconforming data (with a much lower P signal) mainly occurring below 26°C. A total of 113 data points passed both criteria, and 100% of them fell within Zones A and B of the Clarke error grid. Data in Zones A and B exhibited a linear relationship ( r=.81; slope=0.82; intercept=28.0) between noninvasive and fingerstick measurements. Conclusions Environmental temperature has the greatest influence on the capability of the OSPM technique to monitoring blood glucose concentration, which is subject dependent. The position of the tested finger is the second major factor, hence a carefully designed finger adaptor is essential.

Tear Glucose Analysis for the Noninvasive Detection and Monitoring of Diabetes Mellitus

One approach to the noninvasive monitoring of blood glucose concentration is to monitor glucose concentrations in tear fluid. While several methods for sensing glucose in tear fluid have been proposed, controversy remains as to the precise concentrations of tear glucose in normal and diabetic subjects and as to whether tear fluid glucose concentrations correlate with blood glucose concentrations. This review covers the present understanding of the physiology of glucose transport in tears, the regulation of the aqueous tear fraction, and studies of tear glucose concentration over the last 80 years. The various tear collection methods employed greatly influence the measured tear glucose concentrations. Studies that involve mechanical irritation of the conjunctiva during sampling measure the highest tear glucose concentrations, while studies that avoid tear stimulation measure the lowest concentrations. Attempts to monitor tear glucose concentration in situ by using contact lens-based sensing devices are discussed, and new observations are presented of tear glucose concentration obtained by a method designed to avoid tear stimulation. These studies indicate the importance of the sampling method in determining tear glucose concentrations. On the basis of these results, we discuss the future of in vivo tear glucose sensing and outline the studies needed to resolve the remaining questions about the relationship between tear and blood glucose concentrations.

Glucose control in critical illness using a web-based insulin dose calculator

Objective We describe a modified version of a web-based insulin calculator for the control of blood glucose in critical care. Design We modified a previously described calculator by incorporating bolus doses of insulin to be given. The calculator is now also able to store blood glucose concentrations, insulin rates, bed number and the date and time of calculation. We modified our feeding protocol to restrict the target enteral feed from 1800 to 1500 kcal per day and removed the night time rest period. Setting A 16-bedded intensive care unit. Patients and participants All patients admitted to the ICU between June 2005 and May 2006. Measurements and results Six hundred and sixty-one patients admitted (mean APACHE II score 16 [S.D. 7]), mean age 51 years [S.D. 17]. One hundred and forty-six patients died prior to ICU discharge. Total of 5573 patient days with 13,029 recorded calculation data points. Mean blood glucose concentration was 6.7 mmol (95CI 3.7–12.1). There were 34 episodes of treated hypoglycaemia of which 11 were on an insulin infusion. There were two troughs in the time of data entry that corresponded with staff handover. There was no evidence of diurnal variation in blood glucose concentration. The mean value of the insulin infusion rate was 4.3 units/h (S.D. 3.7). Conclusions The web-based insulin calculator facilitates the dosing of insulin in critical care. The lack of diurnal blood glucose concentrations suggests that once daily estimation of blood glucose may be an acceptable method of monitoring blood glucose concentrations in critical care.

Prediction Capability of Optical Coherence Tomography for Blood Glucose Concentration Monitoring

Optical coherence tomography (OCT) has been shown to be a promising optical approach to noninvasive monitoring of blood glucose concentration because of its capability of probing optical properties at different depths in tissue with high resolution. This article investigates the capability of OCT to predict changes in blood glucose concentration. We varied blood glucose concentration in the physiological range in three sets of experiments. In the first set, we investigated large variations of blood glucose concentration ( approximately 400 mg/dl) and used 2100 OCT A scans for signal averaging. In the second set, we varied blood glucose concentration by approximately 200 mg/dl and used 8400 A scans for signal averaging. In the third set, we improved OCT blood glucose monitoring by increasing and controlling skin temperature under the OCT probe. In this set of experiments we increased the glucose concentration by approximately 300 mg/dl and used 4200 A scans for averaging. The predicted glucose concentrations in the first two sets were lower than actual glucose concentration by 10-20% (the mean shift), while the heating and temperature control in the third set of experiments reduced the mean shift down to 1.5%. Therefore, the mean shift was reduced substantially by tissue heating and temperature control. However, it did not depend on the number of A scans to be averaged. In contrast, the uncertainty in OCT prediction of glucose concentration (the standard deviation) did not depend on heating and temperature control, but was reduced substantially from 56 to 24 mg/dl by increasing the number of A scans from 2100 to 8400, respectively. These results suggest that the accuracy of OCT-based glucose monitoring is approaching that of standard invasive and minimally invasive techniques.

How should clinicians interpret results reflecting the effect of an intervention on composite end points: should I dump this lump?

In this issue, Evidence-Based Medicine highlights and comments on a landmark randomised trial, the ACHOIS trial.1 In this trial, Crowther and her colleagues enrolled 1000 pregnant women with mild gestational...

Hemoglobin (Hb) Stanleyville II Causes Gross Overestimation of the Hb A1c Proportion in Routine HPLC

To the Editor: Hemoglobin (Hb) A1c is widely used for retrospective monitoring of blood glucose concentrations for the past 2–3 months. Repeated measurements of Hb A1c are recommended in the management of patients with diabetes. Hemoglobinopathies are known to interfere with measurement of Hb A1c in various ways, depending on the test method used (1)(2). Either falsely increased or decreased values may occur. HPLC, usually performed on analyzers specifically designed for this purpose, is a common method to determine Hb A1c values relative to total Hb A. Alternatively, immunoassays or boronate affinity chromatography are used. The influence of Hb variants on HPLC assays is well recognized, and the interaction of numerous Hb variants have been described previously (3). We report here the findings in a case of Hb Stanleyville II that caused gross overestimation of Hb A1c in our routine HPLC …

The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: A blinded, randomized trial

The effect of self monitoring of blood glucose concentrations on glycated hemoglobin levels in diabetic patients not taking insulin: A blinded, randomized trial

Progress in Boronic Acid-Based Fluorescent Glucose Sensors

Effective management of diabetes relies on the frequent monitoring of blood glucose concentrations. The current approach of blood sampling and glucose concentration determination in vitro) presents many problems. Therefore, there is a drive for the development of non-invasive and continuous monitoring of glucose concentrations. The use of implanted glucose fluorescent sensors represents a promising approach. Due to its strong interaction with diol moieties, the boronic acid group often plays a critical role in the design of such glucose sensors. This paper reviews the progress in this area during the last ten years.

Home monitoring of blood glucose concentrations by owners of diabetic dogs and cats

Generation of blood glucose curves is essential to monitor glycemic control in dogs and cats with diabetes mellitus. Up till now blood collection and blood glucose measurements could only be performed in a hospital. However, glucose concentrations measured in a hospital environment can markedly differ from concentrations measured at home, due to reduced appetite, different activity level and stressful handling. At the Clinic of Small Animal Internal Medicine, University of Zurich, a new method to collect capillary blood from the ear and to measure blood glucose by means of a portable glucose meter has been developed. This method enables owners of diabetic dogs or cats to determine blood glucose concentrations and generate blood glucose curves at home. Three cases demonstrate, how much blood glucose concentrations at home may differ from those in the hospital and how home monitoring can help to establish diabetic control in dogs and cats.

Abstract

Home monitoring of blood glucose in diabetic dogs Casella, M., Wess, G., Hassig, M. & Reusch, C. E. (2003) Home monitoring of blood glucose concentration by owners of diabetic dogs....

Specificity of noninvasive blood glucose sensing using optical coherence tomography technique: a pilot study

Noninvasive monitoring of blood glucose concentration in diabetic patients would significantly reduce complications and mortality associated with this disease. In this paper, we experimentally and theoretically studied specificity of noninvasive blood glucose monitoring with the optical coherence tomography (OCT) technique. OCT images and signals were obtained from skin of Yucatan micropigs and New Zealand rabbits. Obtained results demonstrate that: (1) several body osmolytes may change the refractive index mismatch between the interstitial fluid (ISF) and scattering centres in tissue, however the effect of the glucose is approximately one to two orders of magnitude higher; (2) an increase of the ISF glucose concentration in the physiological range (3–30 mM) may decrease the scattering coefficient by 0.22% mM−1 due to cell volume change; (3) stability of the OCT signal slope is dependent on tissue heterogeneity and motion artefacts; and (4) moderate skin temperature fluctuations (±1 °C) do not decrease accuracy and specificity of the OCT-based glucose sensor, however substantial skin heating or cooling (several °C) significantly change the OCT signal slope. These results suggest that the OCT technique may provide blood glucose concentration monitoring with sufficient specificity under normal physiological conditions.

Modifying cardiovascular risk in diabetes mellitus.

DIABETES mellitus affects an estimated 35 million people in the United States, and the disease prevalence is predicted to increase by nearly 200% in the next several decades. As a result, anesthesiologists will be confronted with an increasing population of patients undergoing anesthesia and surgery who are at risk for ischemic heart disease. Hyperglycemia Predicts Cardiovascular Risk Diabetes is a significant predictor of perioperative cardiovascular morbidity and mortality, but few studies have evaluated methods to modify this risk. Compelling evidence indicates that aggressive management of diabetes may substantially decrease the adverse consequences of myocardial ischemia and infarction. The direct impact of hyperglycemia on cardiovascular mortality in patients with and without diabetes is a central theme of current research, and several investigations conducted during the past 20 yr demonstrated that mortality resulting from acute myocardial infarction (AMI) is increased if blood glucose concentration is elevated at the time of hospital admission. 1 These findings were confirmed in a recent prospective analysis of 336 consecutive patients admitted with AMI. 2 One-year mortality was 9% for patients with AMI and normal admission blood glucose values. In contrast, patients with hyperglycemia (blood glucose concentrations of 121 15, 168 13, and 282 65 mg/dl) on admission demonstrated substantial increases (P 0.005) in mortality to 13, 30, and 44%, respectively. 2 The Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial addressed the prognostic significance of hyperglycemia in patients with type 1 and 2 diabetes and AMI. 3 A nearly linear relationship between blood glucose concentration on admission and long-term mortality was observed in conventionally treated patients in this randomized clinical trial (mortality rates of 35, 40, and 55% at blood glucose concentrations of 235, 235–298, and 298 mg/dl, respectively). A direct relationship between fasting blood glucose concentration and the risk of sustaining a cardiovascular event (e.g., sudden cardiac death, AMI, or cerebrovascular accident) has been demonstrated in a meta-regression analysis of data from 20 studies involving more than 95,000 patients. 4 The risk associated with fasting blood glucose concentrations was linear and extended below the threshold used to define diabetes. A fasting blood glucose value of only 110 mg/dl was associated with an increased relative risk of a cardiovascular event. Similarly, the odds ratio of AMI was increased to 1.5, 3.4, and 6.0 at fasting blood glucose concentrations of approximately 90, 110, and greater than 115 mg/dl, respectively. 5 Another large cohort study indicated that glycosylated hemoglobin (HbA1c) concentration, but not the presence of diabetes, predicted an increase in mortality. 6 The risk of all-cause mortality increased by a factor of 1.46 for every 1% increase in HbA 1c when male patients with diabetes, those with HbA 1c concentrations greater than 7%, or patients with a history of heart disease or stroke were excluded from the multivariate regression model. Similarly, creatinine kinase concentrations were higher in patients with hyperglycemia admitted with AMI compared with those with normal blood glucose levels. 2 These data demonstrate a striking relationship

The effects of birth weight discordance and prematurity on twin neonatal outcome.

The purpose of this study was to determine the effect of birth weight discordance (BWD) and prematurity on twin neonatal outcome by measuring Apgar scores and blood glucose concentrations at birth. This was a retrospective cross-sectional study. All twins born at NY Methodist Hospital between January 1998 and December 2001 were eligible. Excluded were fetal deaths, maternal systemic disease, maternal infections, major neonatal malformations, neonates with birth weight < 500 g and multiple gestation greater than 2. BWD was defined as intrapair difference in birth weight expressed as percentage of the larger twin greater than 20% and prematurity as gestation of less than 37 weeks. Hypoglycemia was defined as blood glucose concentration < 40 mg/dl. There were 75 (48%) preterm and 80 (52%) term twin pairs. Nineteen (12%) of the preterm and 15 (9.6%) of the term showed BWD. Mean Apgar scores at 1 and 5 minutes were higher for the term twins as expected. Neither prematurity nor hypoglycemia was present predominantly in BWD twins. Twelve of the preterm and six of the term BWD twins showed evidence of hypoglycemia. Hypoglycemia in the early hours of postnatal life is relatively common in preterm BWD twins. Blood glucose measurement using reagent strips is an efficient way of monitoring blood glucose concentrations in these infants.

A gene knockout approach in mice to identify glucose sensors controlling glucose homeostasis.

A key aspect of glucose homeostasis is the constant monitoring of blood glucose concentrations by specific glucose sensing units. These sensors, via stimulation of hormone secretion and activation of the autonomic nervous system (ANS), regulate tissue glucose uptake, utilization or production. The best described glucose detection system is that of the pancreatic beta-cells which controls insulin secretion. Secretion of other hormones, in particular glucagon, and activation of the ANS, are regulated by glucose through sensing mechanisms which are much less well characterized. Here I review some of the studies we have performed over the recent years on a mouse model of impaired glucose sensing generated by inactivation of the gene for the glucose transporter GLUT2. This transporter catalyzes glucose uptake by pancreatic beta-cells, the first step in the signaling cascade leading to glucose-stimulated insulin secretion. Inactivation of its gene leads to a loss of glucose sensing and impaired insulin secretion. Transgenic reexpression of the transporter in GLUT2/beta-cells restores their normal secretory function and rescues the mice from early death. As GLUT2 is also expressed in other tissues, these mice were then studied for the presence of other physiological defects due to absence of this transporter. These studies led to the identification of extra-pancreatic, GLUT2-dependent, glucose sensors controlling glucagon secretion and glucose utilization by peripheral tissues, in part through a control of the autonomic nervous system.

Conditioning and hyperalgesia in newborns exposed to repeated heel lances.

Hospitalized infants undergo repeated invasive procedures. It is unknown whether cumulative experiences with pain lead to anticipatory pain behaviors and hyperalgesia. To determine whether newborns who are born to mothers with diabetes and undergo repeated pain learn to anticipate pain and exhibit more pain during a painful procedure than normal infants. Prospective cohort study of 21 full-term newborns born to mothers with diabetes and 21 born to mothers with uneventful pregnancies, at a university teaching hospital between August 1999 and October 2000. Infants of diabetic mothers underwent repeated heel lances in the first 24 to 36 hours of life for monitoring of blood glucose concentrations. Pain responses of all infants undergoing a venipuncture on the dorsum of the hand to obtain blood for the newborn screening test after the first day of life were compared. In addition, from September through November 2001, 12 infants of diabetic mothers and 12 normal infants were compared for pain reactions to intramuscular vitamin K injection after birth. Percentages of time observed grimacing and crying and visual analog scale (VAS) scores. Raters were blinded to exposure group. Median baseline scores for grimacing, crying time, and VAS did not differ significantly between groups (P =.27, P =.32, and P =.32, respectively). Median scores (interquartile range) for grimacing during skin cleansing were higher in infants of diabetic mothers (22.2% [77.5%] vs 0% [15%]; P =.03). The VAS scores for both groups were zero, but the distribution of the scores was significantly different (86% of normal infants vs 52% of infants of diabetic mothers had scores of zero) (P =.04). During venipuncture, infants of diabetic mothers had higher median scores for grimacing (81.7% [32.5%] vs 40% [73.4%]; P =.01), VAS (69% [27.5%] vs 5% [60.5%]; P =.002), and crying (40.2% [77%] vs 0% [54.8%]; P =.03) compared with normal infants. There were no differences between groups on any pain measure in response to intramuscular injection. Newborns who had diabetic mothers and were exposed to repeated heel lances in the first 24 to 36 hours of life learned to anticipate pain and exhibited more intense pain responses during venipuncture than normal infants.