Unstable Blood Glucose Levels Research Articles

Well-being, diabetes management and breastfeeding in mothers with type 1 diabetes – An explorative analysis

ObjectivesThe aim was to explore and investigate associations between well-being, diabetes management and breastfeeding in mothers with type 1 diabetes mellitus (T1DM) up to six months postpartum. MethodsAn explorative analysis of self-reported questionnaires measuring general well-being, sense of coherence, self-efficacy of diabetes management and experiences of diabetes management during breastfeeding, which were distributed to 155 mothers with T1DM at two months and at six months after childbirth. The questionnaires were answered by 128 (82.5%) at two months and 137 (88.4%) at six months after birth. Statistical analysis included; descriptive statistics, Wilcoxon sign-rank test, sign test and Spearman’s correlation coefficient (rs). ResultsThe majority of the mothers had fairly high levels of general well-being and diabetes management but a quarter had a low sense of coherence at both two and six months after birth. A weak association was found between more unstable blood glucose levels and lower general well-being at two months postpartum, but no other associations with erratic glycaemia was found. Those with lower grades of general well-being and sense of coherence had a higher need of professional support to manage their diabetes than they were offered, at both two and six months. ConclusionTo develop more optimal care routines for mothers with T1DM after childbirth, further studies are needed to identify those most in need of additional support.

Risk factors for unstable blood glucose level: integrative review of the risk factors related to the nursing diagnosis.

ABSTRACTObjective:to identify evidence in the literature on the possible risk factors for the risk of unstable blood glucose diagnosis in individuals with type 2 diabetes mellitus, and to compare them with the risk factors described by NANDA International. Method:an integrative literature review guided by the question: what are the risk factors for unstable blood glucose level in people with type 2 diabetes mellitus? Primary studies were included whose outcomes were variations in glycemic levels, published in English, Portuguese or Spanish, in PubMed or CINAHL between 2010 and 2015. Results:altered levels of glycated hemoglobin, body mass index>31 kg/m2, previous history of hypoglycemia, cognitive deficit/dementia, autonomic cardiovascular neuropathy, comorbidities and weight loss corresponded to risk factors described in NANDA International. Other risk factors identified were: advanced age, black skin color, longer length of diabetes diagnosis, daytime sleepiness, macroalbuminuria, genetic polymorphisms, insulin therapy, use of oral antidiabetics, and use of metoclopramide, inadequate physical activity and low fasting glycemia. Conclusions:risk factors for the diagnosis, risk for unstable blood glucose level, for persons with type 2 diabetes mellitus were identified, and 42% of them corresponded to those of NANDA International. These findings may contribute to the practice of clinical nurses in preventing the deleterious effects of glycemic variation.

Cost effectiveness and value of information analyses of islet cell transplantation in the management of 'unstable' type 1 diabetes mellitus.

BackgroundIslet cell transplantation is a method to stabilize type 1 diabetes patients with hypoglycemia unawareness and unstable blood glucose levels by reducing insulin dependency and protecting against severe hypoglycemia through restoring endogenous insulin secretion. This study analyses the current cost-effectiveness of this technology and estimates the value of further research to reduce uncertainty around cost-effectiveness.MethodsWe performed a cost-utility analysis using a Markov cohort model with a mean patient age of 49 to simulate costs and health outcomes over a life-time horizon. Our analysis used intensive insulin therapy (IIT) as comparator and took the provincial healthcare provider perspective. Cost and effectiveness data for up to four transplantations per patient came from the University of Alberta hospital.Costs are expressed in 2012 Canadian dollars and effectiveness in quality-adjusted life-years (QALYs) and life years. To characterize the uncertainty around expected outcomes, we carried out a probabilistic sensitivity analysis within the Bayesian decision-analytic framework. We performed a value-of-information analysis to identify priority areas for future research under various scenarios. We applied a structural sensitivity analysis to assess the dependence of outcomes on model characteristics.ResultsCompared to IIT, islet cell transplantation using non-generic (generic) immunosuppression had additional costs of $150,006 ($112,023) per additional QALY, an average gain of 3.3 life years, and a probability of being cost-effective of 0.5 % (28.3 %) at a willingness-to-pay threshold of $100,000 per QALY. At this threshold the non-generic technology has an expected value of perfect information (EVPI) of $260,744 for Alberta. This increases substantially in cost-reduction scenarios. The research areas with the highest partial EVPI are costs, followed by natural history, and effectiveness and safety.ConclusionsCurrent transplantation technology provides substantial improvements in health outcomes over conventional therapy for highly selected patients with ‘unstable’ type 1 diabetes. However, it is much more costly and so is not cost-effective. The value of further research into the cost-effectiveness is dependent upon treatment costs. Further, we suggest the value of information should not only be derived from current data alone when knowing that this data will most likely change in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-016-0097-7) contains supplementary material, which is available to authorized users.

Pediatric endocrinologists' practices in screening for celiac disease in patients with type 1 diabetes

Background: Undiagnosed CD may lead to unstable blood glucose levels, weight loss, growth failure, osteopenia. The primary objective of the study was to review CD screening practices in one center, describe symptoms at the time of diagnosis, and implement screening guidelines. The secondary objective was to carry out an educational intervention, to review practices after screening guidelines were established. Methods: A total of 532 charts of patients with T1D treated in our center from 2007-2009 were reviewed. Data collected included times of screenings for CD, results of serologic tests, symptoms, and intestinal biopsy results. Two hundred and fifty charts from 2010-2012 were reviewed after an educational intervention with the same group of physicians. Results: After the educational intervention to encourage implementation of screening guidelines, there was a statistically significant reduction in the interval between the diagnosis of T1D and first screening for CD. The majority were diagnosed in the first year after T1D diagnosis, only 30% were symptomatic. Conclusion: Our results suggest that patients with T1D should be screened within the first several months after diagnosis, on an annual basis thereafter, even in the absence of gastroenterologic symptoms of CD. This will allow early dietary intervention and reduce morbidities in this high-risk population.

Glucose and the Gut: A Case Report of Acute Gastric Dilatation in Type I Diabetes Mellitus

This case report details the complex management of gastroparesis in a 23 year old female with long standing type I diabetes mellitus (T1DM). Despite substantial efforts to control her diabetes and gastrointestinal symptomology, the disease course prevailed and a vicious cycle ensued of unstable blood glucose levels and gut instability. Her gastroparesis deteriorated despite meticulous evidence-based medical and surgical management. The patient’s demise eventuated from acute colonic dilatation requiring pancolectomy followed by acute gastric dilatation that ultimately resulted in her death.

Diagnoses and nursing Interventions in hypertensive and diabetic individuals according to Orem’s Theory

This study aimed to identify the most prevalent nursing diagnoses in hypertensive and diabetic patients in the Family Health Care Unit, according to Orem’s conceptual model. A descriptive study was conducted from April to November 2013, using a nursing assessment based on Orem’s theory and NANDA-I taxonomy. 16 nursing diagnoses were identified on Universal self-care requisites, nine on Health deviation requisites and two on Developmental self-care requisites, the most prevalent being: “Risk for unstable blood glucose level” (60%), “Ineffective self-care management” (50%) and “Disposition for improved knowledge” (36.6%). Teaching (83.3%) and support/instruction (100%) actions were implemented in nursing care planning. It can be concluded that there is a need to implement nursing activities directed to offering education on Family Health practices.

Breastfeeding and its impact on daily life in women with type 1 diabetes during the first six months after childbirth: a prospective cohort study

BackgroundFor mothers with diabetes, breastfeeding is a great challenge due to their struggle with potentially unstable blood glucose levels. This paper explores breastfeeding attitudes and impact of breastfeeding on the daily life of mothers with type 1 diabetes compared with non-diabetic mothers.MethodsWe performed a prospective cohort study of 108 mothers with type 1 diabetes and a reference group of 104 mothers in the west of Sweden. Data were collected through medical records and structured telephone interviews at 2 and 6 months after childbirth.ResultsWomen in both the diabetes group and the reference group had high levels of confidence (84% and 93% respectively) in their breastfeeding capacity before childbirth, and 90% assessed breastfeeding as a positive and an important experience during the six months of follow-up. About 80% assessed breastfeeding as influencing daily life ‘very much’ or ‘quite a lot’ at 2 months as did 60% at 6 months, with no difference between the groups. In mothers with diabetes, the impact of breastfeeding on the priority of other duties decreased over time, as did feelings of time pressure and negative effects on patterns of sleep. Compared to the reference group, mothers with diabetes at 6 months remained more affected by disruptions in daily life and they felt more worried about their health both at 2 and 6 months after childbirth. For the reference group mothers’ sensitivity to unexpected disruptions in daily routines decreased between 2 and 6 months after childbirth, and they expressed a greater need to organize their time than mothers with diabetes.ConclusionMothers with diabetes type 1 express more worry for own health and are more sensitive to distruptions. To balance their everyday life and to reduce the risk of stress and illhealth they are therefor, compared to other mothers, likely to need additional professional and peer support.

The effectiveness of methods of off-loading to prevent diabetic foot ulcers in adults with diabetes: A Systematic Review

The effectiveness of methods of off-loading to prevent diabetic foot ulcers in adults with diabetes: A Systematic Review

Tantangan dalam Perawatan Oral Lichen Planus pada Pasien Diabetes Melitus (Laporan Kasus)

Oral lichen planus (OLP) is a chronic inflammatory condition that effects oral mucous membranes with a variety of clinical presentations including reticular, atrophic, plaque and ulcerative lesions. Corticosteroid is one of the effective therapy for OLP in reducing the sign and symptoms of this disease, but this therapy have a serious side effect, therefore to administering one must consider the patient’s systemic condition. We reported a case of OLP in 52 years old female patient who has no history of diabetes mellitus and unknown glucose level. Management of this patient included application of corticosteroid swish, topical 0.05% clobetasol propionate and 0,1% triamcinolone acetonide, antimycotics, improvement the oral hygiene status and referral to internal medicine specialist. The next treatments plan challenging because unstable blood glucose level which in turn effects the drug choice and teeth extraction plan. We concluded that the treatment of OLP requires a complete assessment of medical status and lab studies specially on the first visit so the drug selection with corticosteroid therapy and the treatment planning of predisposing factor are effective in reducing the sign and symptoms of OLP with minimum systemic side effect. DOI: 10.14693/jdi.v16i1.19

Variable adsorption of insulin at catheter materials used in intensive care units: polyethylene vs polyurethane – possible cause for hypoglycemia during intensive insulin treatment?

Intensive insulin therapy reduces morbidity and mortality in postoperative critical care; however, this treatment also increases the risk of hypoglycemia. A possible cause for unstable blood glucose (BG) levels could be a variable adsorption of insulin at plastic material of infusion tubings. We evaluated in vitro and in vivo the adsorption of insulin at standard tubing materials (polyethylene (PE) and polyurethane (PU)) and the effects of this adsorption process on blood glucose levels.

Refractive errors in patients with newly diagnosed diabetes mellitus.

Background and Objective:Diabetes mellitus is a complex metabolic disorder that involves the small blood vessels, often causing widespread damage to tissues, including the eyes’ optic refractive error. In patients with newly diagnosed diabetes mellitus who have unstable blood glucose levels, refraction may be incorrect. We aimed to investigate refraction in patients who were recently diagnosed with diabetes and treated at our centre.Methods:This prospective study was performed from February 2013 to January 2014. Patients were diagnosed with diabetes mellitus using laboratory biochemical tests and clinical examination. Venous fasting plasma glucose (fpg) levels were measured along with refractive errors. Two measurements were taken: initially and after four weeks. The last difference between the initial and end refractive measurements were evaluated.Results:Our patients were 100 males and 30 females who had been newly diagnosed with type II DM. The refractive and fpg levels were measured twice in all patients. The average values of the initial measurements were as follows: fpg level, 415 mg/dl; average refractive value, +2.5 D (Dioptres). The average end of period measurements were fpg, 203 mg/dl; average refractive value, +0.75 D. There is a statistically significant difference between after four weeks measurements with initially measurements of fasting plasma glucose (fpg) levels (p<0.05) and there is a statistically significant relationship between changes in fpg changes with glasses ID (p<0.05) and the disappearance of blurred vision (to be greater than 50% success rate) were statistically significant (p<0.05). Also, were detected upon all these results the absence of any age and sex effects (p>0.05).Conclusions:Refractive error is affected in patients with newly diagnosed diabetes mellitus; therefore, plasma glucose levels should be considered in the selection of glasses.