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Introduction: The control and evaluation of glycemic levels in critically ill patients is a challenge and a responsibility of the nursing team; therefore, determining the consequences of this during hospitalization is key to demonstrate the importance of timely management.Objective: To determine the relationship between unstable glycemia (hyperglycemia and hypoglycemia), hospital length of stay, and the hospitalization outcome of patients in an Intensive Care Unit (ICU).Methods: A prospective cohort study conducted with 62 critically ill patients by convenience sampling between March and July 2017. Daily blood samples were collected to measure glycemia. The correlation of unstable glycemia with the hospital length of stay and the hospitalization outcome was assessed using Pearson's chi-square. A p-value <0.05 was considered significant.Results: Among the 62 patients, 50% were male and 50% were female. The mean age was 63.3 years (±21.4 years). The incidence of unstable glycemia was 45.2% and was associated with a longer ICU stay (p<0.001) and a progression to death as a hospitalization outcome (p=0.03).Conclusion:Among critically ill patients, unstable glycemia was associated with an extended hospital length of stay and a progression to death, emphasizing the importance of nursing intervention to prevent its occurrence., Introdução: O controle e avaliação dos níveis glicêmicos em pacientes críticos é um desafio e uma competência da equipe de enfermagem. Portanto, determinar as consequências da glicemia instável durante a hospitalização é chave para evidenciar a importância da gestão oportuna. Métodos:Um estudo de coorte prospectivo realizado com 62 pacientes a conveniência em estado crítico entre março e julho de 2017. Foram coletadas amostras diariamente de sangue para medir a glicemia. A associação entre a glicemia instável com o tempo de permanência e o desfecho da hospitalização foi avaliada pelo teste qui-quadrado de Pearson. O valor de p <0,05 foi considerado significativo.Resultados:Das 62 pessoas participantes, 50% eram homens e 50% mulheres. A idade média foi de 63,3 anos (±21,4 anos). A incidência de glicemia instável foi de 45,2% e se associou a um tempo de permanência mais prolongado na UTI (p <0,001) e uma progressão para óbito como desfecho da hospitalização (p = 0,03). Conclusão:Entre os participantes, a glicemia instável se associou a um tempo mais longo de permanência e com progressão para óbito, enfatizando a importância da actuação da equipe de enfermagem para prevenir sua ocorrência., Introducción: El control y la evaluación de los niveles glucémicos de pacientes en estado críticos es un desafío y una competencia del equipo de enfermería. Por lo que, determinar las consecuencias de esta durante la hospitalización es clave para evidenciar la importancia del oportuno manejo. Objetivo: Determinar la asociación entre la glucemia inestable (hiperglucemia e hipoglucemia), el resultado de la hospitalización y la duración de la estancia de los pacientes en una unidad de cuidados intensivos. Metodología :Estudio de cohorte prospectivo realizado con 62 pacientes a conveniencia en estado crítico entre marzo y julio de 2017. Se recogieron muestras diarias de sangre para medir la glucemia. Se evaluó la asociación de la glucemia inestable con la duración de la estancia y el resultado de la hospitalización mediante ji al cuadrado de Pearson. El valor de p<0.05 fue considerado significativo. Resultados: De las 62 personas participantes, 50 % eran hombres y 50 % mujeres. La edad media fue de 63.3 años (±21.4 años). La incidencia de glucemia inestable fue del 45.2 % y se asoció con una mayor duración de la estancia en la UCI (p<0.001) y una progresión a la muerte como resultado de la hospitalización (p=0.03).Conclusión: Entre quienes participaron, la glucemia inestable se asoció con una mayor duración de la estancia más prolongada y con progresión hacia la muerte, lo que refuerza la importancia de la actuación de enfermería para prevenir su aparición.

BACKGROUND: American Indian and Alaska Native people (AI/AN) bear a disproportionate burden of diabetes. Growing evidence shows significant associations between several acute diabetes complications and dementia among diabetes patients. However, little is known about these relationships among AI/AN adults. Here, we aim to investigate these associations among AI/AN adults. METHODS: This cross-sectional study extracted data from the Indian Health Services (IHS) National Data Warehouse and related administrative databases. A total of 29,337 IHS actual users with diabetes who were 45+ years old during fiscal year 2013 were included. All-cause dementia and diabetes complications were identified using ICD-9 diagnostic codes. Negative binomial regression models were used to evaluate the associations of interest. RESULTS: Nearly 3% of AI/AN diabetes patients had a dementia diagnosis. After controlling for covariates, dementia was associated with a 94% higher rate of severe hypoglycemia (Incidence Rate Ratio [IRR = 1.94, 95% CI:1.50-2.51), 52% higher rate of severe hyperglycemia (IRR = 1.52, 95% CI, 1.11-2.08), and 92% higher rate of any acute complication (IRR = 1.92, 95% CI:1.53-2.41). CONCLUSIONS: AI/AN diabetes patients with dementia suffered from considerably higher rates of acute diabetes complications than their counterparts without dementia. The clinical management of patients with comorbid diabetes and dementia is particularly challenging and may require individualized treatment approaches.

This paper discusses the vulnerability of diabetic individuals when they are subjected to arrest procedures in criminal law. It analyzes the wrongful arrest theory as a device for individuals with disabilities to bring claims against law enforcement when their rights under Title II of the Americans with Disabilities Act (ADA) are violated. Individuals with diabetes constitute more than 10% of the United States population, meaning that many individuals are at risk for police misconduct because of their disability. The symptoms that come about with having diabetes, such as fruity-smelling breath and loss of coordination, can be mistaken for illegal activity leading to a wrongful arrest. No case involving ADA Title II violation claims against law enforcement relying on the wrongful arrest theory has been brought by an individual with diabetes. This paper explores the possibility of its potential success. To accomplish this, this paper first defines disability under the law, including diabetes. It then conducts a thorough analysis of the wrongful arrest theory in various case studies consisting of non-diabetic and diabetic plaintiffs. In a final case study, I apply the wrongful arrest theory to a case hypothetically to illustrate the plaintiff's potential success if he claims a wrongful arrest. Lastly, I explore some of the theory’s limitations and propose a potential solution. I hope that my findings will emphasize the lack of discourse surrounding individuals with diabetes in disability law and encourage further research and education on the wrongful arrest theory as a successful claim against Title II violations committed by law enforcement.

Bakgrund: Diabetes är ett samlingsnamn för en grupp metabola sjukdomar med den gemensamma nämnaren att kroppen har en oförmåga att producera eller ta upp insulin Diabetes medför, bland annat, en risk för akuta glykemiska episoder relaterat till kroppens oförmåga att vidmakthålla en normal blodglukosnivå. Syfte: Att sammanställa kunskap om hur personer med insulinbehandlad diabetes upplever att medvetenheten om akuta glykemiska episoder påverkar det dagliga livet. Metod: En kvalitativ litteraturstudie baserad på elva vetenskapliga primärstudier inhämtade från databaserna PubMed respektive CINAHL. Resultat: Tre kategorier och sex underkategorier genererades; ”En förändrad vardag” med underkategorierna; ”Planera eller ge upp”, ”Ett behov av andras stöd” samt ”Ofrånkomliga utmaningar”, ”Att leva med oro” med underkategorierna; ”Varierande syn på lämplig blodglukosnivå”, ”Självkritik och skam” samt ”Rädsla för liv och hälsa” och ”Varierande strategier i vardagen” utan underkategorier. Slutsats: Personer med insulinbehandlad diabetes möter en mängd utmaningar i vardagen relaterat till medvetenhet om akuta glykemiska episoder. Utmaningarna inkluderar särskilda krav på minutiös planering och inte sällan förändringar i vardagen. Förändringar i vardagslivet kräver i de flesta fall implementering av nya strategier för att kunna hantera de utmaningar diabetessjukdomen medför. Utmaningarna är inte enbart av praktisk natur utan även av en mer psykosocial natur som leder till att många upplever att stigmatisering från omgivningen och orealistiska krav på sig själva resulterar i ohälsosam självkritik och ibland skam relaterat till de akuta glykemiska episoder de ofrånkomligen drabbas av i olika utsträckning., Background: Diabetes is a collective name for a group of metabolic diseases with the denominator that the body experience an inability to produce, or absorb, insulin in sufficient quantities. Diabetes entails, amongst other potential problems, a non-unsubstantiated risk of acute glycemic episodes due to the body´s inadequate ability to maintain a normal blood glucose level. Aim: To compile knowledge on how persons suffering from insulin treated diabetes manage the awareness of the threat that acute glycemic episodes impose on everyday life. Method: A qualitative study based on eleven primary scientific studies that was obtained from the databases PubMed and CINAHL. Result: Three categories and six sub-categories emerged; “A change in everyday life” containing the sub-categories “plan or give up”, “A need for others” and “Unavoidable changes” “Living with worry” containing the sub-categories “Different views on blood glucose levels”, Self-criticism and shame” and “Fear for life and health” and lastly “Various strategies in day-to-day life” which was without sub-categories. Conclusion: People with insulin treated diabetes faces a variety of challenges in everyday life related to acute glycemic episodes. The variety of challenges include special requirements when it comes to planning and scheduling everyday life. Changes in everyday life often requires the implementation of new strategies to handle the challenges imposed by diabetes and it´s symptoms. Challenges which are not only practical in nature but also entails a more psychosocial aspect that can lead to feelings of stigmatization and unrealistic demands on one self. Feelings that can result in unhealthy self-criticism, and sometimes shame, related to the symptoms of inevitable acute glycemic episodes.

Introduktion: Typ 1-diabetes innebär ett betydande behov av egenvård, där hantering avhypoglykemi utgör en central del. För att underlätta denna egenvård ges patienter med typ 1-diabetes tillgång till kontinuerlig glukosmätning (CGM), där diabetessjuksköterskan spelar enviktig roll genom att erbjuda relevant undervisning och stöd. Syfte: Syftet med studien var att utforska upplevelser och hantering av hypoglykemi hospersoner med typ 1 diabetes som använder kontinuerlig glukosmätning. Metod: Kvalitativ intervjustudie med induktiv ansats valdes för att besvara syftet. Åttasemistrukturerade intervjuer genomfördes antingen på plats eller via telefon på två olikadiabetesmottagningar. Intervjuerna transkriberades ordagrant och analyserades med hjälp avkvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier samt sex subkategorier, därhuvudkategorierna var: “Hypoglykemi- en del av vardagen”, “Hantering av hypoglykemi”och “Integrering av CGM i vardagen”. Det framkom att samtliga deltagare hade erfarenheterav hypoglykemi, och hade hittat olika strategier för att hantera detta. CGM upplevdes som enstor hjälp i vardagen samt vid hypoglykemihantering, och stödet från sjukvården samtnärstående var också väsentligt för att känna sig trygg i sin hantering. Slutsats: Deltagarnas varierande upplevelser av hypoglykemi resulterade i olika strategier förhantering i vardagen. Kontinuerlig glukosmätning utgör ett värdefullt stöd vid hanteringen avdiabetes och kan bidra till att upptäcka hypoglykemi innan den blir allvarlig., Introduction: Type 1 diabetes is a disease that places great demands on self-care, wherehypoglycemia and its management are included. To help manage self-care, patients with type1 diabetes are offered continuous glucose monitoring (CGM), where the diabetes nurseshould offer relevant education and support. Aim: The aim of the study was to explore the experiences and management of hypoglycemiain people with type 1 diabetes using continuous glucose monitoring. Methods: Qualitative interview study with an inductive approach was chosen to answer thepurpose. Eight semistructured interviews were conducted on site or via telephone at twodifferent diabetes clinics. The interviews were transcribed verbatim and analyzed usingqualitative content analysis. Results: The analysis yielded three main categories and six subcategories. These maincategories included: "Hypoglycemia - a facet of daily life," "Management of hypoglycemia,"and "Integration of CGM in daily life." It was evident that all participants had experiencedhypoglycemia and had adopted various strategies to cope with it. CGM was experienced as agreat help in everyday life and in hypoglycemia management, and the support from thehealthcare system and relatives was also essential to feel confident in their management. Conclusion: The diverse experiences of hypoglycemia among participants have led to thedevelopment of various strategies for coping with hypoglycemia in their daily lives.Continuous glucose monitoring serves as a valuable tool in diabetes management and can aidindividuals with type 1 diabetes in detecting hypoglycemia before it becomes severe.

Bakgrund Rädsla för hypoglykemi hos föräldrar med barn som har diabetes mellitus typ 1 är ett folkhälsoproblem. Hypoglykemi är en vanlig komplikation vid insulinbehandling och kan leda till allvarliga konsekvenser om det inte behandlas. Detta kan skapa en stor rädsla hos föräldrarna som gör allt för att förhindra att det inträffar. Det finns därför ett behov av att sammanställa aktuell forskning för att öka vårdpersonalens kunskap och förståelse för föräldrars rädsla för hypoglykemi hos barn med diabetes mellitus typ 1. Syfte Syftet med denna litteraturöversikt var att belysa hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Metod En icke-systematisk litteraturöversikt som baserades på 14 vetenskapliga originalartiklar med både en kvantitativ och kvalitativ ansats har skrivits. De vetenskapliga artiklarna inhämtades från PubMed och CINAHL med hjälp av olika sökordskombinationer, samt att en artikel hittades via manuell sökning. De vetenskapliga artiklarna har genomgått kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet sammanställdes och analyserades utifrån integrerad dataanalys. Resultat I sammanställningen av resultatet identifierades två huvudteman: “Rädslans påverkan på föräldrars livskvalitet” samt “Rädslans påverkan på föräldrars sjukdomshantering”. Resultatet visade att föräldrars rädsla var ett omfattande problem som baserades på en bristande kunskap från vården vid diagnostiseringen. Det resulterade i att föräldrarna själva skapade hanteringsstrategier för att undvika att barnet skulle få hypoglykemi. Slutsats Litteraturöversikten belyste hur föräldrar upplevde att leva med rädsla för hypoglykemi när barnet hade diabetes mellitus typ 1. Rädslan hade en stor påverkan på föräldrarnas liv och rädslan berodde på flera faktorer. Föräldrarna lindrade sin rädsla genom att utveckla egna hanteringsstrategier. Sjuksköterskor med rätt kunskap, Background Fear of hypoglycemia among parents of children with diabetes mellitus type 1 is a public health concern. Hypoglycemia is a common complication of insulin therapy and could lead to serious consequences if left untreated. This creates a great fear in parents who do everything to prevent it from happening. Therefore, there is a need to gather and compile current research to increase healthcare professionals’ knowledge and understanding of parents’ fear of hypoglycemia when the child diabetes mellitus type 1. Aim The aim of this literature review was to elucidate how parents experienced living with fear of hypoglycemia when their child had diabetes mellitus type 1. Method A non-systematic literature review based on 14 scientific original articles with quantitative and qualitative approaches has been written. The scientific articles were collected from PubMed and CINAHL using combinations of search terms. One article was found through manual search. The scientific articles underwent quality assessment based on Sophiahemmet University’s criteria for scientific classification and quality. The results were gathered and analyzed using integrated data analysis. Results In aggregating the results, two main themes were identified: “The impact of fear on parents’ quality of life”, and “The impact of fear on parents’ disease management”. The results showed that parental fear was a significant issue, based on a lack of knowledge from healthcare professionals at the time of diagnosis. This resulted in parents creating their own management strategies to avoid their child experiencing hypoglycemia. Conclusions The literature review highlighted how parents experienced living with fear of hypoglycemia when the child had diabetes mellitus type 1. The fear had a substantial impact on the parents’ lives and the fear was due to various factors. The parents alleviated their fear by developing their own coping strategies. Nurses with appropriate knowledge can reduce parents’ fear

Background: Hypoglycemia is a common adverse effect to anti-hyperglycemic treatment for diabetes mellitus, it is characterized by a plasma glucose level of 79 mg/dl (3,9 mmol/l) or lower. Hypoglycemia has an abundance of symptoms, both neurogenic and neuroglycopenic which can result in loss of consciousness, seizure, and death if left untreated. General nurses have shown they are lacking in information regarding symptoms of hypoglycemia and as such experiences Aim: The aim of this study was to elucidate the lived experiences of hypoglycemia in patients diagnosed with diabetes mellitus. Method: A general literature review with an inductive approach. Results: The results of this study found that patients diagnosed with diabetes experienced challenges associated with hypoglycemia such as fear, particularly associated with nocturnal hypoglycemia. Patients diagnosed with diabetes also experienced helplessness, a lack of control, avoidance, restrictions and stress factors associated with hypoglycemia. Patients diagnosed with diabetes experienced hypoglycemic confidence primarily based on preventing recurrence and successful treatment, and for some through hope. Conclusion: The findings of this study indicate a need for nurses to understand the experiences patients diagnosed with diabetes have of hypoglycemia, to properly assist patients in health promotion and achieving a self-care balance., Bakgrund: Hypoglykemi är en vanlig biverkning av anti-hyperglykemibehandling vid diabetes mellitus, hypoglykemi karakteriseras av ett plasmaglukosvärde på 79 mg/dl (3,9 mmol/l) eller lägre. Hypoglykemi har många symtom, båda neurogena och neuroglykopeniska som kan resultera i medvetslöshet, samt anfall och mortalitet om tillståndet är obehandlat. Generella sjuksköterskor har visat bristande kunskap gällande vanliga symtom vid hypoglykemi och patienters erfarenheter. Syfte: Syftet var att belysa levda erfarenheter av hypoglykemi hos patienter diagnostiserade med diabetes mellitus. Metod: En allmän litteraturstudie med induktiv ansats. Resultat: Denna litteraturstudie visar att patienter med diabetes har erfarenheter av svårigheter associerade med hypoglykemi som rädsla, särskilt rädsla för nattlig hypoglykemi. Patienter med diabetes upplevde hjälplöshet, bristande kontroll och undvikande, samt restriktioner och stressfaktorer associerade med hypoglykemi. Patienter med diabetes och hypoglykemi upplevde självförtroende främst relaterat till förhindrande av återfall, och för visa, genom hopp. Konklusion: Litteraturstudiens resultat indikerar att sjuksköterskor behöver förstå erfarenheter av hypoglykemi hos patienter med diabetes för att främja patienters hälsa och egenvårdsbalans.

Currently, the field of phytopharmacology has demonstrated the antidiabetic potential of several traditional plants, including Pseudoelephantopus spicatus (amargon); however, studies demonstrating the hypoglycemic effect of this plant are little known. Therefore, in the present study, its glycemia-regulating effect was evaluated in a Wistar rat model. The experiments were performed as a pilot test and were validated in a kinetic of 0, 1, 1, 2, 6 and 24 hours using five experimental groups (control, diabetics induced with alloxan, diabetics treated with metformin and diabetics treated with P. spicatus extract with doses of 250 and 500 mg/kg). The treatments were applied for 1, 5 and 21 days and the data obtained were validated by ANOVA/Neuman-Keuls (p< 0.05) using the GraphPad Prism V.5. statistical package. The results showed that alloxan at 120 mg/kg induced diabetes mellitus in 100 % of the rats. The extract at 250 and 500 mg/kg achieved a significant reduction in blood glucose levels compared to diabetic rats, showing no significant difference between doses. The reduction in blood glucose levels caused by metformin at 500 mg/kg p< 0,05, and the different doses of the extract showed no significant differences. According to the results of the study, the extract of P. spicatus induces a hypoglycemic effect in rats., En la actualidad, el campo de la fitofarmacología ha demostrado el potencial antidiabético de distintas plantas tradicionales, entre las que se encuentra el Pseudoelephantopus spicatus (amargón) sin embargo, los estudios que demuestran el efecto hipoglucemiante de esta planta son poco conocidos. Por ello, en el presente estudio se evaluó su efecto regulador de la glicemia en un modelo de rata Wistar. Los experimentos se realizaron como prueba piloto y se validaron en una cinética de 0, 1, 2, 6 y 24 horas mediante cinco grupos experimentales (control, diabéticos inducidos con alloxan, diabéticos tratados con metformina y diabéticos tratados con extracto de P. spicatus con dosis de 250 y 500 mg/kg). Los tratamientos se aplicaron durante 1, 5 y 21 días y los datos obtenidos se validaron por ANOVA/Neuman-Keuls (p< 0,05) usando el paquete estadístico GraphPad Prism V.5. Los resultados demostraron que el alloxan a 120 mg/kg indujo la diabetes mellitus en el 100 % de las ratas. El extracto a 250 y 500 mg/kg logró una reducción significativa de los niveles de glucosa en sangre en comparación con las ratas diabéticas p< 0,05, sin mostrar diferencias significativas entre las dosis. La reducción de los niveles de glucosa en sangre provocada por la metformina a 500 mg/kg y las distintas dosis del extracto no mostraron diferencias significativas. Según los resultados del estudio, el extracto de P. spicatus induce un efecto hipoglucémico en las ratas.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) lead to lower fasting glucose concentrations, but might cause higher glycemic variability (GV) and increased risk of hypoglycemia. However, it has been sparsely studied in patients without preoperative diabetes under normal living conditions. OBJECTIVES: To study 24-hour interstitial glucose (IG) concentrations, GV, the occurrence of hypoglycemia and dietary intake before and after laparoscopic RYGB and SG in females without diabetes. SETTING: Outpatient bariatric units at a community and a university hospital. METHODS: Continuous glucose monitoring and open-ended food recording over 4 days in 4 study periods: at baseline, during the preoperative low-energy diet (LED) regimen, and at 6 and 12 months postoperatively. RESULTS: Of 47 patients included at baseline, 83%, 81%, and 79% completed the remaining 3 study periods. The mean 24-hour IG concentration was similar during the preoperative LED regimen and after surgery and significantly lower compared to baseline in both surgical groups. GV was significantly increased 6 and 12 months after surgery compared to baseline. The self-reported carbohydrate intake was positively associated with GV after surgery. IG concentrations below 3.9 mmol/L were observed in 14/25 (56%) of RYGB- and 9/12 (75%) of SG-treated patients 12 months after surgery. About 70% of patients with low IG concentrations also reported hypoglycemic symptoms. CONCLUSIONS: The lower IG concentration in combination with the higher GV after surgery, might create a lower margin to hypoglycemia. This could help explain the increased occurrence of hypoglycemic episodes after RYGB and SG.

Oral antidiabetic drug (OAD) failure is an indication for starting insulin therapy, butthere is still a dilemma as to whether basal insulin or a premixed/co-formulation analog shouldbe the choice. Aim: To compare the safety and efficacy of once daily (OD) insulin degludec/insulin aspart (IDegAsp) to OD insulin glargine (IGlar U100) in insulin-naïve Indian subjectswith type 2 diabetes mellitus (T2DM), inadequately controlled with OADs alone. Setting anddesign: Retrospective study. Methods and material: Data was retrieved from the author’sclinic database of OAD failure patients (18-80 years), who were started either with (IGlar U100,n = 120) or IDegAsp (n = 89) OD over and above the standard of care. Data of fasting plasmaglucose (FPG), postprandial plasma glucose (PPG) and glycated hemoglobin (HbA1c) frombaseline and at last follow-up visits were collected. Statistical analysis used: Baselinecharacteristics and change in study parameters during the follow-up period were computedbetween two groups (IGlar U100 vs. IDegAsp) by unpaired t-test and paired t-test, respectively.ANCOVA test was used to compute percentage reduction in body weight, body mass index(BMI), FPG, PPG and HbA1c in between two groups (IGlar U100 vs. IDegAsp). Results:IDegAsp caused a significantly greater reduction in FPG, PPG and HbA1c as compared tothe IGlar U100 arm. There was no significant difference in the proportion of patients withhypoglycemia between IDegAsp and IGlar U100 groups (p = 0.208). No episodes of severehypoglycemia were reported. Conclusion: Comparison of IDegAsp and IGlar U100 OD inT2DM patients indicated that both were relatively safe but the former controlled FPG andPPG levels more effectively.

Neonatal Graves disease is the most common cause of hyperthyroidism during the newborn period. Maternal Graves disease increases the risk of intrauterine growth restriction, small for gestational age, and neonatal Graves disease. Intrauterine growth restriction and small for gestational age are associated with hypoglycemia and transient neonatal hyperinsulinism. Neonatal Graves disease with severe persistent hypoglycemia has not been well described. We present the case of a female patient born at 34 weeks and 3 days with a birth weight of 1.6 kg (fifth percentile) to a mother with recent treatment for Graves disease. Prenatal ultrasounds were significant for intrauterine growth restriction and small for gestational age. The mother did not begin hyperthyroidism medical therapy until 23 weeks and 2 days of gestation. After the infant was born, the infant not only had symptoms of hyperthyroidism such as tachycardia and abnormal thyroid values but also had persistent hypoglycemia, which could be due to maternal propranolol usage, prematurity, IUGR, increased metabolism due to neonatal Graves, and transient stress-induced hyperinsulinism. The infant was started on methimazole for hyperthyroidism and propranolol for tachycardia. She was also started on diazoxide for persistent hypoglycemia. By 6 months of age, the hyperthyroidism and hypoglycemia had resolved. This is an interesting case of neonatal Graves disease with severe persistent hypoglycemia which we suspect is due to transient neonatal hyperinsulinism induced by multiple stress responses.

During fasting, the oxidation of fatty acids and the formation of ketone bodies are necessary for energy production. Carnitine is essential for long-chain fatty acids to be transferred to the mitochondria for fatty acid oxidation. Primary carnitine deficiency is a recessive defect that is expressed with a broad clinical spectrum that includes metabolic decompensation, hypoketotic hypoglycemia or cardiomyopathy in childhood, fatiguability in adulthood or absence of symptoms. In our country there are no publications on the subject, so this article reports the case of a child who had carnitine deficiency expressed as hypoketotic hypoglycemia and its clinical, biochemical and histopathological findings are analyzed, Durante el ayuno, la oxidación de ácidos grasos y la formación de cuerpos cetónicos son necesarios para la producción de energía. La carnitina es esencial para que los ácidos grasos de cadena larga se transfieran a la mitocondria para la oxidación de ácidos grasos. La deficiencia primaria de carnitina es un defecto recesivo que se expresa con un espectro clínico amplio que incluye descompensación metabólica, hipoglicemia hipocetósica o cardiomiopatía en la niñez, fatigabilidad en la adultez o ausencia de síntomas. En nuestro país no hay publicaciones sobre el tema, por lo que en el presente artículo se reporta el caso de un niño que presentó una deficiencia de carnitina expresada como hipoglicemia hipocetósica y se analiza sus hallazgos clínicos, bioquímicos e histopatológicos

The study was designed to determine whether urocortin 2 (Ucn2) gene transfer is as safe and effective as metformin in insulin-resistant mice. Four groups of insulin-resistant db/db mice and a nondiabetic group were studied: (1) metformin; (2) Ucn2 gene transfer; (3) metformin + Ucn2 gene transfer; (4) saline; and (5) nondiabetic mice. After completion of the 15-week protocol, glucose disposal was quantified, safety assessed, and gene expression documented. Ucn2 gene transfer was superior to metformin, providing reductions in fasting glucose and glycated hemoglobin and enhanced glucose tolerance. The combination of metformin + Ucn2 gene transfer provided no better glucose control than Ucn2 gene transfer alone and was not associated with hypoglycemia. Metformin alone, Ucn2 gene transfer alone, and metformin + Ucn2 gene transfer together reduced fatty infiltration of the liver. Serum alanine transaminase concentration was elevated in all db/db groups (vs. nondiabetic controls), but the metformin + Ucn2 gene transfer combined group had the lowest alanine transaminase levels. No group differences in fibrosis were detected. In a hepatoma cell line, activation of AMP kinase showed a rank order of combined metformin + Ucn2 peptide > Ucn2 peptide > metformin. We conclude (1) The combination of metformin + Ucn2 gene transfer does not result in hypoglycemia. (2) Ucn2 gene transfer alone provides superior glucose disposal versus metformin alone. (3) The combination of Ucn2 gene transfer and metformin is safe and has additive effects in reducing serum alanine transaminase concentration, activating AMP kinase activity, and increasing Ucn2 expression, but is no more efficacious than Ucn2 gene transfer alone in reducing hyperglycemia. These data indicate that Ucn2 gene transfer is more effective than metformin in the db/db model of insulin resistance and combined treatment with metformin + Ucn2 gene transfer appears to have favorable effects on liver function and Ucn2 express

In the Recommendations of the European Society of Cardiology and the European Society for the Study of  Diabetes 2007 it is emphasized that the use of angiotensin converting enzyme inhibitors (ACE inhibitors) and adrenoblockers (BAB) is the basis for the treatment of chronic heart failure (CHF) in patients with diabetes mellitus (DM).  For the first time, doctors' attention is drawn to the fact that the appointment of ACE inhibitors to DM patients receiving hypoglycemic therapy may increase the risk of hypoglycemic conditions. Attention to this side of the action of ACE inhibitors is due to the fact that hypoglycemia is an independent risk factor for cardiovascular mortality. The above Recommendations emphasize the urgent need for careful monitoring of the level of glycemia when prescribing ACE inhibitors to patients with diabetes. This is especially necessary in the initial period of combined cardiac and hypoglycemic therapy. The risk of hypoglycemia depends on many factors and, apparently, varies in different contingents of patients with diabetes. According to available data, patients with CHF have an increased tendency to hypoglycemia due to a decrease in the body's tolerance to a decrease in blood glucose levels. Such functional insufficiency is largely determined by a violation of the processes of gluconeogenesis in the liver and the secretion of glucagon by the pancreas, which are normally included in the body's defense system against a pronounced decrease in blood glucose.

In a developing country like India, systemic chronic diseases reach unsustainable heights as the population grows. According to WHO, diabetes affects an estimated 28.7 million people worldwide, or 28.5% of the population. Diabetes affects around 8.5 million people who have yet to be diagnosed (2022). Diabetes is one of these metabolic systemic chronic diseases that has captured the world's attention. The primary goal of our research is to develop non-invasive blood glucose monitoring technology that will benefit a large number of patients. We analyze the research progress and significant problems of non-invasive blood glucose detecting technologies in our project evaluation. In our study, we present an effective NIR-based optical detecting system. The existing non-invasive glucose monitoring device had a 60% accuracy level, however the proposed model will have an accuracy of 80% and will have a significant advantage over the existing system. Furthermore, the information is continuously delivered to the personal computer via serial communication via the UART protocol.

Purpose Obesity is characterized by chronic inflammation that may contribute to insulin resistance and promote type 2 diabetes. We have investigated whether inflammatory responses to glycemic and insulinemic variations are altered in obese individuals. Methods Eight obese and eight lean individuals without diabetes had undergone hyperinsulinemic-euglycemic-hypoglycemic and hyperglycemic clamps in a previous study. Using Proximity Extension Assay, 92 inflammatory markers were analyzed from plasma samples at fasting, hyperinsulinemia-euglycemia, hypoglycemia and hyperglycemia. Results In all participants, hyperinsulinemia, hypoglycemia and hyperglycemia led to reductions of 11, 19 and 62 out of the 70 fully evaluable biomarkers, respectively. FGF-21 increased during both hypoglycemia and hyperglycemia while IL-6 and IL-10 increased during hypoglycemia. In obese vs lean participants, Oncostatin-M, Caspase-8 and 4E-BP1 were more markedly suppressed during hypoglycemia, whereas VEGF-A was more markedly suppressed during hyperglycemia. BMI correlated inversely with changes of PD-L1 and CD40 during hyperinsulinemia, Oncostatin-M, TNFSF14, FGF-21 and 4EBP-1 during hypoglycemia and CCL23, VEGF-A and CDCP1 during hyperglycemia (Rho & LE; -0.50). HbA1c correlated positively with changes of MCP-2 and IL-15-RA during hyperinsulinemia (Rho & GE; 0.51) and inversely with changes of CXCL1, MMP-1 and Axin-1 during hypoglycemia (Rho & LE; -0.55). M-value correlated positively with changes of IL-12B and VEGF-A during hyperglycemia (Rho & GE; 0.51). Results above were significant (p < 0.05). Conclusion Overall, hyperinsulinemia, hypo- and hyperglycemia led to suppression of several inflammatory markers and this tended to be more marked in individuals with obesity, insulin resistance and dysglycemia. Thus, acute glycemic or insulinemic variations do not seem to potentiate possible inflammatory pathways in the development of insulin resistance and disturbed glucose met

According to the current paradigm, the development of type 2 diabetes is driven by insulin resistance and the gradual failure of beta cells to compensate for this by secreting adequate amounts of insulin. Obesity is an important risk factor for type 2 diabetes and is considered to influence disease development primarily by induction of insulin resistance, via mechanisms that have not been fully elucidated. Insulin-antagonistic, counter-regulatory neurohormonal pathways, including glucagon, cortisol (stimulated by the pituitary hormone ACTH), growth hormone and the autonomic nervous system have glucose-raising properties and constitute a physiological defense to hypoglycemia that is coordinated from the brain and brainstem. Glucose variations also trigger responses of several inflammatory mediators, that may also oppose the actions of insulin. The overarching aim of this thesis was to explore the importance of glucose-dependent dysregulation of these counter-regulatory pathways – hormonal, neural and inflammatory – in the development of type 2 diabetes. All selected papers in this thesis are based on data obtained during stepwise hyperinsulinemic-euglycemic-hypoglycemic clamps and hyperglycemic clamps, in which glucose levels are lowered or raised to prespecified target levels. In papers I and II, we found that overweight and insulin resistance was associated with cortisol/ACTH hyperreactivity to hypoglycemia and general hyperglucagonemia, insensitive to glucose-dependent suppression. Furthermore, in paper I, the autonomic nervous system was more rigid to glucose variations in overweight and insulin resistant individuals, with a failure to inhibit parasympathetic activity during hypoglycemia and an attenuated activity of sympathetic relative to parasympathetic activity during hyperglycemia. In paper III, cortisol/ACTH hyperreactivity was present already in individuals with prediabetes, with no further exacerbation in individuals with type 2 diabetes. By contrast, h

Hypoglycemia is defined by a low blood glucose level associated with clinical symptoms. Hypoglycemia may be related to treatment of diabetes, but also to drugs, alcohol, critical illness, cortisol insufficiency including hypopituitarism, insulinoma, bariatric or gastric surgery, pancreas transplantation or glucagon deficiency, or may be surreptitious. Some hypoglycemic episodes remain unexplained, and a proper drug history should be sought. Though various drugs have been implicated as a cause of hypoglycemia; herein, we report a case of recurrent nonsteroidal anti-inflammatory drugs (NSAIDs)-induced hypoglycemia in a nondiabetic patient.

ObjectiveTo determine the benefit of starting continuous glucose monitoring (CGM) in adult-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) with regard to longer-term glucose control and serious clinical events.Research design and methodsA retrospective observational cohort study within the Veterans Affairs Health Care System was used to compare glucose control and hypoglycemia- or hyperglycemia-related admission to an emergency room or hospital and all-cause hospitalization between propensity score overlap weighted initiators of CGM and nonusers over 12 months.ResultsCGM users receiving insulin (n = 5,015 with T1D and n = 15,706 with T2D) and similar numbers of nonusers were identified from 1 January 2015 to 31 December 2020. Declines in HbA1c were significantly greater in CGM users with T1D (-0.26%; 95% CI -0.33, -0.19%) and T2D (-0.35%; 95% CI -0.40, -0.31%) than in nonusers at 12 months. Percentages of patients achieving HbA1c <8 and <9% after 12 months were greater in CGM users. In T1D, CGM initiation was associated with significantly reduced risk of hypoglycemia (hazard ratio [HR] 0.69; 95% CI 0.48, 0.98) and all-cause hospitalization (HR 0.75; 95% CI 0.63, 0.90). In patients with T2D, there was a reduction in risk of hyperglycemia in CGM users (HR 0.87; 95% CI 0.77, 0.99) and all-cause hospitalization (HR 0.89; 95% CI 0.83, 0.97). Several subgroups (based on baseline age, HbA1c, hypoglycemic risk, or follow-up CGM use) had even greater responses.ConclusionsIn a large national cohort, initiation of CGM was associated with sustained improvement in HbA1c in patients with later-onset T1D and patients with T2D using insulin. This was accompanied by a clear pattern of reduced risk of admission to an emergency room or hospital for hypoglycemia or hyperglycemia and of all-cause hospitalization.

Introduction: Percheron syndrome is the cause of bilateral thalamic ischemic lesions, causing a series of clinical abnormalities such as an altered state of consciousness, ophthalmoplegia, and memory alterations. Clinical case: We present the case of 49-year-old woman with diabetes mellitus, poor metabolic control, and repetitive hypoglycemic and hyperglycemic episodes with nonspecific symptoms, non-invasive imaging studies were performed, which documented bilateral thalamic lesions. Conclusions: Subacute and partial ischemic symptoms that involve the paramedian region of the bilateral thalamus could have some relationship with repetitive hypoglycemic and hyperglycemic episodes, and can lead to mild and nonspecific symptoms, which makes it a diagnostic challenge for this syndrome., Introducción: el síndrome de Percheron es causa de lesiones isquémicas talamicas bilaterales ocasionando una serie de anomalías clínicas como: alteración del estado de conciencia, oftalmoplejias, y alteraciones de la memoria. Caso clínico: presentamos el caso de una mujer de 49 años con diabetes mellitus, mal control metabólico, episodios hipoglucémicos e hiperglucemicos repetitivos, quien cursa con sintomatología inespecífica, se realizan estudios imagenológicos no invasivos documentado lesiones talamica bilaterales. Conclusiones: los cuadros subagudos e isquémicos parciales que involucran la región paramediana del Talamo bilateral podrían tener alguna relación con episodios hipoglucémicos e hiperglucemicos repetitivos, que pueden llegar a cursar con sintomatología leve e inespecífica, lo cual lo convierte un reto diagnóstico para este síndrome.

Overview: We want to wake people with type 1 diabetes to prevent dead in bed syndrome caused by alarm fatigue leading to the lack of emergency glucagon administration that prevents death.

Introduction: Hypoglycemia composes an always present risk in the treatment of type 1 diabetes (T1D) and can be a fatal complication. Many studies on hypoglycemic events are based on self-reported data or focused on the aggregated time below range. We have processed continuous glucose monitoring (CGM) data in children and adolescents with T1D in order to examine all occurring hypoglycemic events. Research design and methods: CGM data (mean 168 +/- 3 days) from 214 children and adolescents with T1D were analyzed using computer-based algorithms. Patients were divided into three groups based on estimated HbA1c (eHbA1c): (1) <= 48 mmol/mol (n=58); (2) 49-64 mmol/ mol (n=113); (3) >= 65 mmol/mol (n=43). The groups were compared concerning descriptive data and CGM metrics with emphasis on the frequency of hypoglycemic events. Results: Only one self-reported event of severe hypoglycemia was registered, while 54 390 hypoglycemic events (<3.9 mmol/L (<70 mg/dL)) were identified from CGM data out of which 11 740 were serious (<3.0 mmol/L (<54 mg/dL)). On average there were 1.5 +/- 0.1 hypoglycemic events per 24 hours out of which 1.2 +/- 0.1 were mild (3.0-3.9 mmol/L) and 0.3 +/- 0.02 serious. Group 1 had a higher frequency of both total and mild hypoglycemic events compared with both groups 2 and 3. However, the frequency of serious hypoglycemic events was similar in all groups. A negative correlation was observed for eHbA1c and total daily and mild hypoglycemic events (r=-0.57 and r=-0.66, respectively, p<0.0001), whereas for serious hypoglycemic events there was only a borderline significance (r=-0.13, p=0.05). Conclusions: This study shows that hypoglycemic events are a frequent phenomenon in children and adolescents with T1D, occurring regardless of overall metabolic control. Although patients with an HbA1c =48 mmol/mol had a higher frequency of mild hypoglycemic events there was no increase in serious hypoglycemic events.

BACKGROUND: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clini

Headache or migraine has emerged as a common health issue among university students. However, breakfast skipping habit is one of the common bad dietary practice among the students that is directly linked with the hypoglycemia. Whereas, hypoglycemia is one of the neglected complication that causes a person to suffer from headache/migraine related headache. Objective: To assess the link of breakfast skipping with hypoglycemia and headache/migraine among undergraduate students. Methods: A cross-sectional study was done in University of Lahore, Lahore from December 2021 to April 2022. The data were collected from 100 students by using convenient sampling method, using a self-formulated questionnaire, MIDAS tool and a glucometer. Results: Almost 69% students were suffering from headache/migraine while 46% students were suffering from hypoglycemia (p-value = 0.040). Approximately 36% students marked family history for headache/migraine. Breakfast skipping frequency among undergraduate students was 84% out of which 71% students were experiencing fatigue and lethargy (p-value = 0.039). Almost 75% students experienced hypoglycemia due to breakfast skipping and 85% students experienced headache/migraine due to hypoglycemia (p-value = 0.019). Conclusions: There is a significant link found between headache/migraine, hypoglycemia and breakfast skipping habit among undergraduate university students.

BACKGROUND: Symptomatic postbariatric hypoglycemia (PBH) is a known complication that can occur a few years after Roux-en-Y gastric bypass (RYGB). There is currently no established rating scale for PBH-associated symptoms developed for use in Swedish populations. The aim of the study was to translate an already existing questionnaire into Swedish and to test its reliability. METHODS: The study included forward and backward translations of the original Dumping Severity Scale (DSS) questionnaire with 8 items regarding symptoms of early dumping and 6 items regarding hypoglycemia, with each item graded on a 4-point Likert scale. The reliability of the Swedish translated questionnaire (DSS-Swe) was estimated using internal consistency and test-retest methods. RESULTS: A total of 200 patients were included in the study. Good internal consistency was demonstrated regarding the items related to early dumping symptoms, with a Cronbach's alpha coefficient of 0.82, and very good agreement in terms of test-retest reliability, with an overall intraclass correlation coefficient (ICC) of 0.91 (95% CI 0.88-0.93). The items related to hypoglycemia yielded a good Cronbach's alpha coefficient of 0.76 and an ICC of 0.89 (95% CI 0.85-0.91). CONCLUSION: The DSS-Swe questionnaire shows good reliability regarding both internal consistency and test-retest performance for use in Swedish populations.

Introduction Hypoglycemia is a major limiting factor in achieving recommended glycemic targets for people with type 1 diabetes. Exposure to recurrent hypoglycemia results in blunted hormonal counter-regulatory and symptomatic responses to hypoglycemia. Limited data on metabolic adaptation to recurrent hypoglycemia are available. This study examined the acute metabolic responses to hypoglycemia and the effect of antecedent hypoglycemia on these responses in type 1 diabetes. Research design and methods Twenty-one outpatients with type 1 diabetes with normal or impaired awareness of hypoglycemia participated in a study assessing the response to hypoglycemia on 2 consecutive days by a hyperinsulinemic glucose clamp. Participants underwent a period of normoglycemia and a period of hypoglycemia during the hyperinsulinemic glucose clamp. Plasma samples were taken during normoglycemia and at the beginning and the end of the hypoglycemic period. Metabolomic analysis of the plasma samples was conducted using comprehensive two-dimensional gas chromatography with time-of-flight mass spectrometry. Results In total, 68 metabolites were studied. On day 1, concentrations of the branched-chain amino acids, leucine (p=3.8×10 -3) and isoleucine (p=2.2×10 -3), decreased during hypoglycemia. On day 2, during hypoglycemia, five amino acids (including leucine and isoleucine) significantly decreased, and two fatty acids (tetradecanoic and oleic acids) significantly increased (p<0.05). Although more metabolites responded to hypoglycemia on day 2, the responses of the single metabolites were not statistically significant between the 2 days. Conclusions In individuals with type 1 diabetes, one episode of hypoglycemia decreases leucine and isoleucine concentrations. Antecedent hypoglycemia results in the decrement of five amino acids and increases the concentrations of two fatty acids, suggesting an alteration between the two hypoglycemic episodes, which could indicate a possible adaptat

Tato bakalářská práce ,,Informovanost veřejnosti a radiologických asistentů o poskytování první pomoci při hypoglykémii se skládá ze dvou částí. V první teoretické části se zabývá onemocněním diabetes mellitus, zejména jeho akutní komplikací zvanou hypoglykémie, její definicí, příznaky, příčinami, léčbou a prevencí. V druhé průzkumné části se věnuje rozboru dotazníku, ve kterém jsou zkoumány znalosti radiologických asistentů (RA) a laické veřejnosti o hypoglykémii. Cílem práce je zjistit povědomí veřejnosti a radiologických asistentů o této akutní komplikaci a řešení v určitých situacích., This bachelor thesis ,,Awareness of the public and radiological assistants on providing first aid in case of hypoglycemia consists of two parts. The first theoretical part deals with the disease diabetes mellitus, especially its acute complication called hypoglycemia, its definition, symptoms, causes, treatment and prevention. In the second practical part, the questionnaire is analyzed, in which the knowledge of radiological assistants (RA) and the lay public about hypoglycemia is examined. The aim of the thesis is to find out the awareness of the public and radiological assistants about this acute complication and solutions in certain situations., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato bakalářská práce je zaměřena na téma hypoglykémie v přednemocniční neodkladné péči. V teoretické části se zabývá anatomií hlavní žlázy - slinivky břišní, která ovlivňuje glykémii, popisem diabetu mellitu, jeho historií, klasifikací, komplikacemi, popisem hypoglykémie, diagnostikou, klinickým obrazem a léčebnými postupy tohoto onemocnění v přednemocniční neodkladné péči. Praktická část se skládá ze dvou částí. První část se zabývá analýzou výjezdových záznamů k hypoglykémickým stavům, které byly vyhledány v archivu zdravotnické záchranné služby s předem stanovenými kritérii i během období 1. 7. 2020 - 1. 7. 2021. Z množství stavů, které byly vyhledány, bylo náhodně vybráno 5 výjezdů. Z těchto výjezdových záznamů byly vytvořeny krátké kazuistiky jako ukázka výjezdu zdravotnické záchranné služby u případu hypoglykémie. Druhou část tvoří dotazníkové šetření se znalostním dotazníkem vlastní tvorby pro studenty třetích ročníků oboru zdravotnický záchranář. Tento dotazník měl zmapovat teoretickou i praktickou připravenost studentů., This bachelor thesis is focused on the topic of hypoglycemia in pre-hospital emergency care. In the theoretical part, he deals with the anatomy of the main gland - the pancreas, which affects glycemia, the description of diabetes mellitus, its history, classification, complications, description of hypoglycemia, diagnostics, clinical picture and treatment of this disease in pre-hospital emergency care. The practical part consists of two parts. The first part deals with the analysis of exit records for hypoglycemic conditions that were searched in the archive of the emergency medical service with predetermined criteria during the period 1.7.2020 - 1.7.2021. From the number of states that were searched, 5 exits were randomly selected. From these exit records, short case reports were created as an example of the emergency medical service trip in a case of hypoglycemia. The second part consists of a questionnaire survey with a knowledge questionnaire of own creation for third-year students in the field of paramedic. This questionnaire was intended to map the theoretical and practical readiness of students., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Tato bakalářská práce s názvem "Zkušenosti pacientů s diabetem mellitem 1. typu s fyzickou aktivitou" se zabývá problematikou hypoglykemií a hyperglykemií u osob s diabetem mellitem 1. typu (dále DM typ 1), kteří se věnují sportovním aktivitám. Teoretická část tvoří oporu části praktické a zabývá se popisem diabetu mellitu typ 1 a jeho komplikací a možné moderní léčbě. V praktické části se za pomoci mnou vytvořeného dotazníku snažím popsat zkušenosti pacientů s diabetem mellitem typ 1 a jejich kolísáním glykemie při sportu. Dále zjišťuji, jestli používání pumpy s hybridní smyčkou souvisí s častější sportovní aktivitou a zda výkyvy glykemie nebo hypoglykemie ovlivňují plánování fyzické aktivity., This bachelor thesis, entitled "The experience of patients with type 1 diabetes mellitus with physical activity", deals with the issue of hypoglycaemia and hyperglycaemia in people with type 1 diabetes mellitus (DM type 1) who engage in sporting activities. The theoretical part supports the practical part and deals with the description of diabetes mellitus type 1, its complications and possible modern treatment. In the practical part, using a questionnaire developed by me, I try to describe the experience of patients with diabetes mellitus type 1 and their glucose fluctuations during sports. Furthermore, I investigate whether the use of a hybrid loop pump is related to more frequent sports activity and whether glycaemic fluctuations or hypoglycaemia affect physical activity planning., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a bakalářskou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Téma bakalářské práce zpracovává hypoglykémii jako akutní komplikaci diabetu mellitu zaměřenou na sektor přednemocniční péče. Dále pak etiologii, klinický obraz diabetu a diagnostiku hypoglykémie. V teoretické části je popsána anatomie a fyziologie slinivky břišní. V praktické části jsou zkoumány praktické a teoretické znalosti zdravotnických záchranářů a studentů 2. a 3. ročníků zdravotnického záchranářství v oblasti hypoglykémie. Jsou zde také zhodnoceny jejich zkušenosti z klinické praxe na výjezdových stanovištích zdravotnické záchranné služby. Tyto informace byly získány za pomoci nestandardizovaného dotazníku vlastní tvorby., This thesis deals with an acute complication of diabetes mellitus, specifically hypoglycemia, focused on the pre-hospital care. The theoretical part deals with the anatomy and physiology of the pancreas. Etiology and clinical picture of diabetes and diagnosis of hypoglycemia are analysed. The practical part focuses on the practical and theoretical knowledge of paramedics, and also students of the 2nd and 3rd year of paramedics in the field of hypoglycemia. We will also assess their experience from clinical practice at call points of the medical emergency service. A non-standardized questionnaire form of author's own design was used to obtained these pieces of information., Fakulta zdravotnických studií, Student/ka úspěšně obhájil/a diplomovou práci, odpověděl/a na doplňující otázky oponenta., Dokončená práce s úspěšnou obhajobou

Aims: We assess the incidence and economic burden of severe and non-severe hypoglycemia in insulin-treated diabetes type 1 and 2 patients in Switzerland. Methods: We developed a health economic model to assess the incidence of hypoglycemia, the subsequent medical costs, and the production losses in insulin-treated diabetes patients. The model distinguishes between severity of hypoglycemia, type of diabetes, and type of medical care. We used survey data, health statistics, and health care utilization data extracted from primary studies. Results: The number of hypoglycemic events in 2017 was estimated at 1.3 million in type 1 diabetes patients and at 0.7 million in insulin-treated type 2 diabetes patients. The subsequent medical costs amount to 38 million Swiss Francs (CHF), 61 % of which occur in type 2 diabetes. Outpatient visits dominate costs in both types of diabetes. Total production losses due to hypoglycemia amount to CHF 11 million. Almost 80 % of medical costs and 39 % of production losses are due to non-severe hypoglycemia. Conclusions: Hypoglycemia leads to substantial socio-economic burden in Switzerland. Greater attention to non-severe hypoglycemic events and to severe hypoglycemia in type 2 diabetes could have a major impact on reducing this burden.

Background: Adequate glucose supply is essential for brain function, therefore hypoglycemic states may lead to seizures. Since blood glucose supply for brain is buffered by liver glycogen, an impairment of liver glycogen synthesis by mutations in the liver glycogen synthase gene (GYS2) might result in a substantial neurological involvement. Here, we describe the phenotypes of affected siblings of two families harboring biallelic mutations in GYS2. Methods: Two suspected families - a multiplex Pakistani family (family A) with three affected siblings and a family of Moroccan origin (family B) with a single affected child who presented with seizures and reduced fasting blood glucose levels were genetically characterized. Whole exome sequencing (WES) was performed on the index patients, followed by Sanger sequencing-based segregation analyses on all available members of both families. Results: The variant prioritization of WES and later Sanger sequencing confirmed three mutations in the GYS2 gene (12p12.1) consistent with an autosomal recessive pattern of inheritance. A homozygous splice acceptor site variant (NM_021957.3, c. 1646 -2A>G) segregated in family A. Two novel compound heterozygous variants (NM_021957.3: c.343G>A; p.Val115Met and NM_021957.3: c.875A>T; p.Glu292Val) were detected in family B, suggesting glycogen storage disorder. A special diet designed to avoid hypoglycemia, in addition to change of the anti-seizure medication led to reduction in seizure frequency. Conclusions: This study suggests that the seizures in patients initially diagnosed with epilepsy might be directly caused, or influenced by hypoglycemia due to pathogenic variants in the GYS2 gene. © 2023 British Epilepsy Association

[eng] Insulinoma, the most common cause of hypoglycemia related to endogenous hyperinsulinism, is a rare neuroendocrine tumor. Its diagnosis is often delayed due to difficulties in identifying and localizing the functioning tumor. We report a case of a woman who suffered from an ectopic insulinoma, where the source of hormonal excess was not the pancreas as one might think, but the left renal mass. A 45-year-old female was admitted for evaluation of recurrent hypoglycaemic episodes she does not have diabetes mellitus. She referred a several-week history of symptoms :palpitations, tremors, sweating altered behavior, and anxiety (CT) scan of the chest and abdomen for localization of insulinoma with dimensions of 12x12 mm. In the left kidney, where a hypodense cortical lesion was observed in the middle part, well-limited, with necrotic areas inside, with dimensions of 62x81 mm which enhances after contrast After renal tissue pathology showed characteristics of a neuroendocrine tumor., [spa] El insulinoma, la causa más frecuente de hipoglucemia relacionada con el hiperinsulinismo endógeno, es un tumor neuroendocrino raro. Su diagnóstico suele retrasarse debido a las dificultades para identificar y localizar el tumor funcionante. Presentamos el caso de una mujer que padecía un insulinoma ectópico, donde el origen del exceso hormonal no era el páncreas como podría pensarse, sino la masa renal izquierda. Una mujer de 45 años ingresó para evaluación de episodios hipoglucémicos recurrentes, no tiene diabetes mellitus. Refería cuadro de sintomatología de varias semanas de evolución: palpitaciones, temblores, alteración de la sudoración y ansiedad (TC) de tórax y abdomen para localización de insulinoma de 12x12 mm. En el riñón izquierdo, donde se observó una lesión cortical hipodensa en la parte media, bien delimitada, con áreas necróticas en su interior, con unas dimensiones de 62x81 mm que realza tras el contraste. Posterior a la patología del tejido renal, presenta características de tumor neuroendocrino.

Background & aims: Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) is emerging as a safe and effective treatment for pancreatic neuroendocrine tumors. We aimed to compare EUS-RFA and surgical resection for the treatment of pancreatic insulinoma (PI). Methods: Patients with sporadic PI who underwent EUS-RFA at 23 centers or surgical resection at 8 high-volume pancreatic surgery institutions between 2014 and 2022 were retrospectively identified and outcomes compared using a propensity-matching analysis. Primary outcome was safety. Secondary outcomes were clinical efficacy, hospital stay, and recurrence rate after EUS-RFA. Results: Using propensity score matching, 89 patients were allocated in each group (1:1), and were evenly distributed in terms of age, sex, Charlson comorbidity index, American Society of Anesthesiologists score, body mass index, distance between lesion and main pancreatic duct, lesion site, size, and grade. Adverse event (AE) rate was 18.0% and 61.8% after EUS-RFA and surgery, respectively (P < .001). No severe AEs were observed in the EUS-RFA group compared with 15.7% after surgery (P < .0001). Clinical efficacy was 100% after surgery and 95.5% after EUS-RFA (P = .160). However, the mean duration of follow-up time was shorter in the EUS-RFA group (median, 23 months; interquartile range, 14-31 months vs 37 months; interquartile range, 17.5-67 months in the surgical group; P < .0001). Hospital stay was significantly longer in the surgical group (11.1 ± 9.7 vs 3.0 ± 2.5 days in the EUS-RFA group; P < .0001). Fifteen lesions (16.9%) recurred after EUS-RFA and underwent a successful repeat EUS-RFA (11 patients) or surgical resection (4 patients). Conclusion: EUS-RFA is safer than surgery and highly effective for the treatment of PI. If confirmed in a randomized study, EUS-RFA treatment can become first-line therapy for sporadic PI.

Introduction: Hemodialysis (HD) induces several physiological changes that can affect plasma glucose levels in patients with diabetes and in turn their glycemic control. Studies using continuous glucose monitoring (CGM) to assess glucose variations on dialysis days compared with nondialysis days report conflicting results. Here, we used CGM to examine glucose variations induced by HD in patients with type 2 diabetes. Methods: Patients with type 2 diabetes undergoing maintenance HD were included. CGM (Ipro2®, Medtronic) was performed at baseline and Week 4, 8, 12, and 16 for up to 7 days at each visit. CGM profiles on days where participants received HD were compared with days without HD using a linear mixed model. Findings: Twenty-seven patients were included. The median number of CGM days performed was 8 (interquartile range [IQR] 6–10) for dialysis days and 16 (IQR 12–17) for nondialysis days. The median sensor glucose was 9.4 (95% confidence interval [CI] 8.8–10.2) mmol/L on dialysis days compared with 9.5 (95% CI 8.9–10.2) mmol/L on nondialysis days (p = 0.58). Nocturnal mean sensor glucose was higher on dialysis days compared with nondialysis days: 8.8 (95% CI 8.0–9.6) mmol/L versus 8.4 (95% CI 7.7–9.2) mmol/L (p = 0.029). Discussion: Similar median sensor glucose values were found for days on and off HD. Nocturnal glucose levels were modestly increased on dialysis days. Our findings indicate that antidiabetic treatment does not need to be differentiated on dialysis versus nondialysis days in patients with type 2 diabetes undergoing maintenance HD.

BACKGROUND: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clini

Introducción: La diabetes mellitus es una enfermedad heterogénea cada vez más prevalente en la sociedad, cuyas complicaciones asociadas afectan a multitud de sistemas a nivel orgánico.Entre estos eventos se encuentra la hipoglucemia, la cual tiene un importante componente nocivo a nivel del sistema nervioso central y periférico, por lo que resulta de gran interés conocer su papel en el desarrollo de deterioro cognitivo. Objetivos: Estudiar la relación entre hipoglucemia y deterioro cognitivo en pacientes con diabetes mellitus a tratamiento con insulina, analizar la influencia de la edad y trazar el perfil de los pacientes. Método: Para la realización de esta revisión bibliográfica, tras una búsqueda en tres bases de datos distintas (Scopus, PubMed, Web of Science), se encontraron 264 artículos potenciales a incluir en el estudio, de los cuales fueron seleccionados 16. Resultados: El 58,3% de los estudios mostraron que la hipoglucemia altera los mecanismos fisiológicos de la insulina a nivel cerebral. Se registra el mismo porcentaje en cuanto al uso de insulina, donde se asocia un peor pronóstico cognitivo para los usuarios de insulina exógena, relacionado con el aumento de la incidencia de hipoglucemias. Con respecto a la influencia de la edad, el 100% de los estudios registraron un peor desempeño cognitivo en los pacientes más envejecidos. Por último, en relación con el perfil de paciente con altas posibilidades de desarrollar deterioro cognitivo, se encuentran distintos factores de riesgo asociados tanto modificables como no modificables. Conclusiones: El aumento de la incidencia de hipoglucemias potenciado por el uso de insulina exógena contribuye a acelerar el deterioro cognitivo en pacientes con diabetes, siendo además la edad avanzada, la duración de la enfermedad, la pluripatología y determinados estilos de vida factores predisponentes al deterioro de la función cognitiva, Introdución: A diabetes mellitus é unha enfermidade heteroxénea cada vez máis prevalecente na sociedade, cuxas complicacións asociadas afectan a multitude de sistemas a nivel orgánico. Entre estes eventos atópase a hipoglicemia, a cal ten un importante compoñente nocivo a nivel do sistema nervioso central e periférico, polo que resulta de gran interese coñecer o seu papel no desenvolvemento da deterioración cognitiva. Obxectivos: Estudar a relación entre hipoglicemia e deterioración cognitiva en pacientes con diabetes mellitus a tratamento con insulina, analizar a influencia da idade e trazar o perfil dos pacientes. Método: Para a realización desta revisión bibliográfica, tras unha procura en tres bases de datos distintas (Scopus, PubMed, Web of Science), atopáronse 264 artigos potenciais a incluír no estudo, dos cales foron seleccionados 16. Resultados: O 58,3% dos estudos mostraron que a hipoglicemia altera os mecanismos fisiolóxicos da insulina a nivel cerebral. Rexístrase o mesmo porcentaxe en canto ao uso de insulina, onde se asocia un peor prognóstico cognitivo para os usuarios de insulina esóxena, relacionado co aumento da incidencia de hipoglicemias. Con respecto á influencia da idade, o 100% dos estudos rexistraron un peor desempeño cognitivo nos pacientes máis envellecidos. Por último, en relación co perfil de paciente con altas posibilidades de desenvolver deterioración cognitiva, atópanse distintos factores de risco asociados tanto modificables como non modificables. Conclusións: O aumento da incidencia de hipoglicemias potenciado polo uso de insulina esóxena contribúe a acelerar a deterioración cognitiva en pacientes con diabetes, sendo ademais a idade avanzada, a duración da enfermidade, a pluripatoloxía e determinados estilos de vida factores predispoñentes á deterioración da función cognitiva, Introduction: Diabetes mellitus is an increasingly prevalent heterogeneous disease in society, whose associated complications affect a multitude of systems at the organ level. Among these events is hypoglycemia, which has an important harmful component at the level of the central and peripheral nervous system, so it is of great interest to know its role in the development of cognitive impairment. Objectives: To study the relationship between hypoglycemia and cognitive impairment in patients with diabetes mellitus treated with insulin, to analyse the influence of age and to profile the patients. Method: To carry out this literature review, after a search in three different databases (Scopus, PubMed, Web of Science), 264 potential articles were found for inclusion in the study, of which 16 were selected. Results: 58.3% of the studies showed that hypoglycemia alters the physiological mechanisms of insulin at the brain level. The same percentage is recorded for insulin use, where a worse cognitive prognosis is associated with a higher incidence of hypoglycemia in exogenous insulin users. Regarding the influence of age, 100% of the studies recorded worse cognitive performance in older patients. Finally, in relation to the patient profile with high chances of developing cognitive impairment, different associated modifiable and non-modifiable risk factors are found. Conclusions: The increased incidence of hypoglycemia enhanced by the use of exogenous insulin contributes to accelerated cognitive decline in patients with diabetes, with advanced age, disease duration, pluripathology and certain lifestyles also being predisposing factors to impaired cognitive function

Context: The outcome of patients requiring intensive care can be influenced by the presence of previously undiagnosed diabetes (undiagDM). Objective: This work aimed to define the clinical characteristics, glucose control metrics, and outcomes of patients admitted to the intensive care unit (ICU) with undiagDM, and compare these to patients with known DM (DM). Methods: This case-control investigation compared undiagDM (glycated hemoglobin A1c [HbA1c] ≥ 6.5%, no history of diabetes) to patients with DM. Glycemic ratio (GR) was calculated as the quotient of mean ICU blood glucose (BG) and estimated preadmission glycemia, based on HbA1c ([28.7 × HbA1c]-46.7mg/dL). GR was analyzed by bands: less than 0.7, 0.7 to less than or equal to 0.9, 0.9 to less than 1.1, and greater than or equal to 1.1. Risk-adjusted mortality was represented by the Observed:Expected mortality ratio (OEMR), calculated as the quotient of observed mortality and mortality predicted by the severity of illness (APACHE IV prediction of mortality). Results: Of 5567 patients 294 (5.3%) were undiagDM. UndiagDM had lower ICU mean BG (P <. 0001) and coefficient of variation (P <. 0001) but similar rates of hypoglycemia (P =. 08). Mortality and risk-adjusted mortality were similar in patients with GR less than 1.1 comparing undiagDM and DM. However, for patients with GR greater than or equal to 1.1, mortality (38.5% vs 10.3% [P =. 0072]) and risk-adjusted mortality (OEMR 1.18 vs 0.52 [P <. 0001]) were higher in undiagDM than in DM. Conclusion: These data suggest that DM patients may develop tolerance to hyperglycemia that occurs during critical illness, a protective mechanism not observed in undiagDM, for whom hyperglycemia remains strongly associated with higher risk of mortality. These results may shed light on the natural history of diabetes., SCOPUS: ar.j, info:eu-repo/semantics/published

Hyper-/hypoglycemic states are rare but well-established causes of hyperkinetic movements, including chorea and ballismus, usually associated with brain lesions in the basal ganglia. We report a case of hemichorea-hemiballismus (HCHB) syndrome that developed after a severe hypoglycemic episode in a 71-year-old man with poorly controlled type 2 diabetes mellitus. Uncommonly, brain MRI showed contralateral cortical-subcortical T2 and T2-FLAIR-hyperintense frontoparietal lesions, with cingulate gyrus involved, while the basal ganglia were unaffected. In patients with hypoglycemic encephalopathy associated with cortical lesions, the long-term prognosis is usually poor. Nevertheless, in our patient, the dyskinesias and the cerebral lesions progressively regressed by achieving good glycemic control. After four and 12 months, the patient's neurological examination was normal. To our knowledge, this is the first evidence of hypoglycemic etiology of cortical HCHB syndrome, supporting recent theories that cortical circuitries may independently contribute to the pathogenesis of chorea and ballismus. This is also the first report of cingulate gyrus involvement in hypoglycemic encephalopathy. Finally, this case may indicate that a subset of patients with cortical lesions due to hypoglycemia could present a good clinical outcome, likely depending on the size of the lesions and the duration and severity of the hypoglycemic episode.

Background: The Hypoglycaemia - MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. Objective: The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. Methods: Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. Results: A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes wer

Type 1 diabetes is characterized by insulin deficiency, and treatment is to supply insulin mimicking the physiological endogenous insulin secretion. Since its discovery, insulin therapy has evolved, and since the 1990s, an increasing number of insulin analogs with various pharmacokinetic and pharmacodynamic profiles have become available. Despite the improvement of insulin therapy, hypoglycemia remains the main side effect and is a daily concern for many people with diabetes and their families. A proportion of people with type 1 diabetes are at increased risk of hypoglycemia and experience recurring episodes. When designing insulin trials, this group of people is most often excluded in order to reduce the risk of adverse study outcomes, even though it may be the group that may benefit the most from treatment with new insulins. The results of the phase III trials, therefore, underestimate the clinical impact and pharmacoeconomic effect of the implementation of new insulins in the broader type 1 diabetes population. This paper reviews the four insulin trials that include people at increased risk of hypoglycemia. In general, the studies confirm the results from phase III trials in terms of similar reduction and maintenance of HbA1c, as well as relative rate reductions of hypoglycemia. However, the absolute treatment differences in the reduction of hypoglycemia are even greater in the trials, including people at high risk of hypoglycemia. This emphasizes the importance of including people at high risk of hypoglycemia to assess the full clinical and pharmacoeconomic benefit of new insulins.

Objective: To investigate the frequency and duration of hypo- and hyperglycemia, assessed by continuous glucose monitoring (CGM) during and after major surgery, in departments with implemented diabetes care protocols. Summary Background Data: Inadequate glycemic control in the perioperative period is associated with serious adverse events, but monitoring currently relies on point blood glucose measurements, which may underreport glucose excursions. Methods: Adult patients without (A) or with diabetes [non-insulin-treated type 2 (B), insulin-treated type 2 (C) or type 1 (D)] undergoing major surgery were monitored using CGM (Dexcom G6), with an electrochemical sensor in the interstitial fluid, during surgery and for up to 10 days postoperatively. Patients and health care staff were blinded to CGM values, and glucose management adhered to the standard diabetes care protocol. Thirty-day postoperative serious adverse events were recorded. The primary outcome was duration of hypoglycemia (glucose <70 mg/dL). Clinicaltrials.gov: NCT04473001. Results: Seventy patients were included, with a median observation time of 4.0 days. CGM was recorded in median 96% of the observation time. The median daily duration of hypoglycemia was 2.5 minutes without significant difference between the 4 groups (A-D). Hypoglycemic events lasting ≥15 minutes occurred in 43% of all patients and 70% of patients with type 1 diabetes. Patients with type 1 diabetes spent a median of 40% of the monitoring time in the normoglycemic range 70 to 180 mg/dL and 27% in the hyperglycemic range >250 mg/dL. Duration of preceding hypo- and hyperglycemia tended to be longer in patients with serious adverse events, compared with patients without events, but these were exploratory analyses. Conclusions: Significant duration of both hypo- and hyperglycemia was detected in high proportions of patients, particularly in patients with diabetes, despite protocolized perioperative diabetes management.

Background: The present study was designed to assess the feasibility and reliability of a Continuous Glucose Monitoring System (CGMS) in a population of asphyxiated neonates during therapeutic hypothermia. Methods: This non-randomized feasibility study was conducted in the Neonatal Intensive Care Unit (NICU) facilities of Fondazione Policlinico A. Gemelli IRCSS. Infants matching the criteria for hypothermic treatment were included in this study and were connected to the CGMS (Medtronic, Northridge, CA, USA) within the first 12 h of life. Hypoglycemia was defined as a glucose value <= 47 mg/dL, and hyperglycemia was defined as a glucose value >= 180 mg/dL. Data obtained via the CGMS were compared with those obtained via a point-of-care blood glucometer (GTX). Results: The two measuring techniques were compared using the Modified Clarke Error Grid (MCEG). Sixteen infants were enrolled. The sensor had an average (standard deviation) duration of 93 (38) h. We collected 119 pairs of glycemia values (CGMVs) from the CGMS vs. GTX measurements. The CGMS detected twenty-five episodes of hypoglycemia and three episodes of hyperglycemia. All the CGMVs indicating hyperglycemia matched with the blood sample taken via the point-of-care glucometer. Conclusions: The use of a CGMS would be useful as it could detect more episodes of disglycemia than standard care. Our data show poor results in terms of the accuracy of the CGMS in this particular setting.

BACKGROUND: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. METHODS: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low-glucose and low-glucose hypoglycemia; very high-glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. RESULTS: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. CONCLUSION: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clini