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Hypoglycaemia In Type 1 Diabetes: Technological Treatments, Their Limitations And The Place Of Psychology

Hypoglycaemia In Type 1 Diabetes: Technological Treatments, Their Limitations And The Place Of Psychology

, Volume 61, Issue4 , pp 761769 | Cite as Hypoglycaemia in type 1 diabetes: technological treatments, their limitations and the place of psychology Advances in technology allowing improved insulin delivery and glucose monitoring can significantly reduce the burden of hypoglycaemia when used appropriately. However, limitations of the current technology, and the skills, commitment and motivation required to use them, mean that it does not work for all people. Education and informed professional support are key to success. In the context of problematic hypoglycaemia, data suggest that newer technology has lower efficacy and uptake in those with most need. Identifying the causes of hypoglycaemia and understanding some of the underlying behavioural drivers may prove useful and psycho-educational strategies may be effective in selected individuals. Ultimately, as in many spheres of medicine, successful management of problematic hypoglycaemia depends upon matching the right treatment to the right individual. Continuous glucose monitoringContinuous subcutaneous insulin infusionDiabetes technologiesHypoglycaemiaInsulin analoguesInsulin pumpsPsychologyReview The online version of this article ( ) contains a slide of the figure for download, which is available to authorised users. Management of type 1 diabetes is complex, with patients juggling the competing risks of hyperglycaemia and hypoglycaemia. To achieve optimal glucose control, people with type 1 diabetes must adjust insulin dosing for predicted requirements, which vary according to food and alcohol intake, exercise, illness and other variables. The slow onset and long duration of action of currently available subcutaneous injections of insulin add to this challenge. Achieving optimal glucose control is an uphill task tha Continue reading >>

(pdf) Diabetes Prevention - Promise And Limitations: A Review

(pdf) Diabetes Prevention - Promise And Limitations: A Review

Kaniklidis, C. Diabetes Prevention Promise, Limitations Review Copyright 2013. Constantine Kaniklidis. All rights reserved. Diabetes Prevention - Promise and Limitations: European Association for Cancer Research (EACR) Director, Medical Research, No Surrender Breast Cancer Foundation (NSBCF) Disclosures: The author indicates no financial relationships. We are experiencing a pandemic in metabolic syndrome and in particular diabetes and obesity, with an expected doubling of prevalence by 2025 2030 to between 366 - 380 million cases worldwide, and with over 8.3% of adults being affected in the United States alone. But even more concerning is the fact that over 79 million American adults have a condition of prediabetes, with either impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) or elevated A1C, putting them at significantly increased 5 - to 15-fold higher risk of progression to frank diabetes compared to people with normal blood glucose. This is an especially grave problem since treatment only prevents some of the dire complications of diabetes, usually failing to restore normal blood glucose levels or to eliminate all of the adverse events associated with diabetes, entailing enormous and accelerating national and global economic and social costs. Most regrettably the burden of diabetes continues to shift toward low and middle-income countries where almost 80% of diabetes deaths occur, precisely where there is limited access to affordable treatment, and often insufficient education / awareness of the magnitude and fundamentals of the problem. We here review and critically appraised the diabetes prevention research to date, restricting attention to predominantly Level I (RCT, systematic review and meta-analyses) data, exposing certain misperceptions in o Continue reading >>

Managing Diabetes With Physical Limitations

Managing Diabetes With Physical Limitations

Do you have difficulty manipulating test strips or inserting them into your blood glucose meter? Can you no longer easily open medicine bottles? Do you sometimes struggle with tying your shoelaces? Many physical problems can interfere with your ability to manage your diabetes and take proper care of yourself more generally. Some of these problems, such as decreased feeling in your hands, may be a product of the diabetes itself, while other challenges such as tremors or poor joint mobility may be unrelated to your diabetes. Managing diabetes successfully requires a broad range of habits and behaviors. According to a model developed by the American Association of Diabetes Educators (AADE) in 2003, there are seven key behaviors that define a healthy lifestyle with diabetes; these are known as the AADE7 Self-Care Behaviors. They are (1) healthy eating, (2) being active, (3) monitoring, (4) taking medications, (5) problem-solving, (6) healthy coping, and (7) reducing risks. Some of these behaviors, such as healthy eating, are pretty self-explanatory, while others may benefit from a bit more explanation. For example, “monitoring” includes not just blood glucose monitoring but also tracking your blood pressure, weight, and foot health, as well as the number of steps you’ve walked throughout the day (to ensure that you’re getting enough physical activity). “Reducing risks” also encompasses a broad group of behaviors, including but not limited to smoking cessation, self-inspection of feet, maintaining up-to-date personal health records, and having regular eye, foot, and dental exams. Reducing risks also includes keeping track of and following instructions from your health-care team. This article focuses on common physical limitations, particularly those that can affe Continue reading >>

Functional Limitations In Patients With Diabetes And Transmetatarsal Amputations

Functional Limitations In Patients With Diabetes And Transmetatarsal Amputations

Background and Purpose. Reports in the surgical and rehabilitation literature suggest that patients with transmetatarsal amputations (TMAs) function well with regular shoes and a toe filler. Functional limitations, however, have not been documented in this population. The purpose of this study was to compare the function of patients with diabetes mellitus (DM) and TMA with that of age- and gender-matched control subjects. Subjects. Thirty subjects (15 subjects with DM and TMAs and 15 control subjects), with a mean age of 62.3 years (SD=9.2, range=4383), were studied. Methods. Function was measured using the Functional Reach Test (FRT), the Physical Performance Test (PPT), walking speed for 15.2 m (50 ft), and the Sickness Impact Profile (SIP). Subjects in the TMA-DM group wore standard shoes with a toe filler. Results. The TMA-DM group scored lower (meanstandard deviation) than did the control group on all tests (FRT: 19.18.6 vs 31.59.1 cm [7.53.4 vs 12.43.6 in]; PPT: 18.74.8 vs 24.12.2 points [28 points possible]; walking speed: 51.513.2 vs 75.69.3 m/min; SIP: 17.012.7 vs 3.74.7). Conclusion and Discussion. Persons with DM and TMAs have considerable functional limitations. Research is needed to determine whether therapeutic footwear or other forms of rehabilitation can improve their function. 1997 by the American Physical Therapy Association Inc. Continue reading >>

Limitations Of Diabetes Pharmacotherapy: Results From The Vermont Diabetes Information System Study.

Limitations Of Diabetes Pharmacotherapy: Results From The Vermont Diabetes Information System Study.

Limitations of diabetes pharmacotherapy: results from the Vermont Diabetes Information System study. Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA. [email protected] There are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years. The goals of this study were to describe the glycemic medication profiles in a cohort of adult patients enrolled in primary care, to compare the regimens with measures of glycemic control, and to describe potential contraindicated regimens. One thousand and six subjects with diabetes cared for in community practices in the Northeast were interviewed at home at the time of enrollment in a trial of a diabetes decision support system. Laboratory data were obtained directly from the clinical laboratory. Current medications were obtained by direct observation of medication containers by a research assistant. The median age of subjects was 63 years; 54% were female. The mean A1C was 7.1%, with 60% of subjects in excellent glycemic control (A1C < 7%). Ninety percent of patients were taking 2 or fewer medications for glycemic control, with a range of 0 to 4 medications. Insulin was used by 18%. As the number of diabetes medications increased from 0 to 4, the A1C increased from 6.5% to 9.2% (p < 0.001). The association between glycemic control and number of glycemic medications was confirmed using logistic regression, controlling for potential confounders. Almost 20% of subjects on metformin or thiazolidenediones had potential contraindications to these medications. Patients with diabetes cared for in primary care are on a wide variety of medication combinations for glycemic co Continue reading >>

Value And Limitations Of The Continuous Glucose Monitoring System In The Management Of Type 1 Diabetes - Sciencedirect

Value And Limitations Of The Continuous Glucose Monitoring System In The Management Of Type 1 Diabetes - Sciencedirect

Volume 32, Issue 2 , April 2006, Pages 123-129 Value and limitations of the Continuous Glucose Monitoring System in the management of type 1 diabetes Get rights and content The CGMS (Continuous Glucose Monitoring System) is a portable device allowing continuous measuring of glucose. It provides recordings of at least 72 h, during which 288 measures/day are performed. Results are visualised in the form of a set of curves, illustrating the variations in blood glucose levels over time. The quality of the records has often been questioned by several authors. Some of the system's physiologically related limitations can be explained by the less than perfect coincidence of variations in glucose levels observed in the interstitial tissue, where CGMS measurings are done, and in the blood, where calibrations are performed. Other limitations, such as defects in accuracy or in reproducibility of tracings or premature curtailments of recordings, are due to technical weaknesses which were considerably improved during the past few years, particularly with regard to the quality of the electrodes providing a more stable signal over time. In clinical practice, CGMS is a tool for investigating the glycaemic patterns of diabetic patients in conjonction with SMBG. It allows the identification of overlooked hyper- or hypoglycaemia. Generally well accepted, it is a usefull tool to analyse the nocturnal period, or any situation where glucose checks are rare. The visual nature of its results provides a facilitating support in the discussion between the patient and the care-provider during consultations or educational sessions. CGMS utilisation was proposed for guiding treatment adjustment. At present, it is still difficult to state with certainty that this tool allows effective improvement in Continue reading >>

The Joy Trip Project | Project 365 ~ Climbing Above The Limitation Of Diabetes The Joy Trip Project

The Joy Trip Project | Project 365 ~ Climbing Above The Limitation Of Diabetes The Joy Trip Project

Project 365 ~ Climbing above the limitation of diabetes The Joy Trip Project Project 365 ~ Climbing above the limitation of diabetes The Joy Trip Project Posted at 15:14h in Adventure Activism , Adventure Media Review , Film Review , People with disabilities by James Edward Mills 0 Comments Life is a fatal condition from which no one will ever recover or even survive. Every day is a constant struggle to manage our symptoms. Whether from illness or injury we all experience aches and pains, especially as we get a bit older. We suffer from chronic fatigue that can only be relieved with eight hours of bed rest every evening. And of course theres our addiction to food, water and oxygen. Twenty-four hours a day, seven days a week, 365 days a year we fight to maintain our existence knowing all the while that we are waging a battle that we will ultimately lose. Our death is inevitable. The question is, through the course of our lives will we truly live? With the added disadvantage of type-1 diabetes climber and filmmaker Steven Richert set out on an adventure to push the boundaries of his illness. His goal was to devote every day of his life for an entire year to climbing while diligently managing the symptoms of a disease that could kill him. In his film Project 365 Richert struggles to carefully balance his blood sugar levels with regular injections of insulin. While traveling across the country to visit the most prestigious climbing spots in North America he sets out on an ambitious road trip meant to rise above the limitations of diabetes as well as gravity in the vertical world. Selling everything they owned Richert and his wife Stefanie embarked upon a year-long journey in 2012. With just climbing, camping and camera equipment they packed their meager possessions into a Continue reading >>

Can You Work If You Have Diabetes?

Can You Work If You Have Diabetes?

This is the question that Aidan sent to The Diabetes Council last week: Can you work if you have diabetes? Of course you can work if you have diabetes, or can you? Seemingly this is a simple question, but there are three answers: Yes No Maybe – you can work if you have diabetes by fighting the system Careers that you cannot have with diabetes There are some careers that preclude you from working as a person with diabetes. These careers are not open to people with diabetes who are taking insulin. For example, if you have Type 1 diabetes, you are not allowed to pilot a plane commercially in the United States, no matter how well controlled your diabetes is. The FAA currently will not allow it. However, if you want to pilot a plane in Canada or the United Kingdom, there are regulations set up that allow persons with Type 1 diabetes who are in good control of their diabetes to pilot a plane commercially. We have looked at a lot of different careers at The Diabetes Council. We have looked at whether or not you can be in the military with diabetes, be a firefighter or a law enforcement officer with diabetes, astronaut, work as an EMT/paramedic, a long-distance truck driver, or be a pilot with diabetes. Soon, we will look at whether or not you can be a flight attendant with diabetes. Please read the articles above to find out what the specifics of working in these careers with diabetes are, and what kind of rules and regulations you must follow. The careers we have looked at so far all have certain rules and regulations that apply to people with diabetes. These rules and regulations are put into place to ensure the safety of the employee with diabetes, and also the safety of the general public. For example, a pilot with poorly controlled diabetes who has a low blood sugar cou Continue reading >>

Exercises To Avoid When You Have Diabetes

Exercises To Avoid When You Have Diabetes

Regular physical activity is an important part of a healthy lifestyle when you have diabetes. It is good for your cardiovascular system and can help control blood glucose levels. However, there are times when you need to be careful about exercising with diabetes. If you have certain diabetes complications, there are exercises that you should avoid. Michael See, MS, RCEP, Clinical Exercise Physiologist at Joslin Diabetes Center, discusses certain situations that may require you to modify your fitness program The following complications may affect your exercise routine:. Proliferative diabetic retinopathy (PDR)—Patients with diabetes and active PDR should avoid activities that involve strenuous lifting; harsh, high-impact activities; or placing the head in an inverted position for extended periods of time. Diabetic peripheral neuropathy— Diabetic peripheral neuropathy may result in loss of sensation and position awareness of your feet. Repetitive exercise on insensitive feet can lead to ulceration and fractures. “Limit your choice of exercise to low impact or non-weight bearing activities,” says See. Advanced kidney disease— Individuals with diabetes and advanced kidney disease can engage in moderate intensity activities, but should avoid strenuous activity. High blood glucose levels— Individuals with type 1 diabetes should avoid exercise if fasting blood glucose is higher than 250 mg/dl and ketones are present. Caution should be used if glucose levels are higher than 300 and no ketones are present. Individuals with type 2 diabetes should avoid exercise if blood glucose is higher than 400 mg/dl. Monitoring blood glucose before, after and possibly during physical activity is necessary to keep blood glucose within an appropriate range. Always consult with an exe Continue reading >>

Potentials And Limitations Of Bile Acids And Probiotics In Diabetes Mellitus

Potentials And Limitations Of Bile Acids And Probiotics In Diabetes Mellitus

Open Access is an initiative that aims to make scientific research freely available to all. To date our community has made over 100 million downloads. Its based on principles of collaboration, unobstructed discovery, and, most importantly, scientific progression. As PhD students, we found it difficult to access the research we needed, so we decided to create a new Open Access publisher that levels the playing field for scientists across the world. How? By making research easy to access, and puts the academic needs of the researchers before the business interests of publishers. We are a community of more than 103,000 authors and editors from 3,291 institutions spanning 160 countries, including Nobel Prize winners and some of the worlds most-cited researchers. Publishing on IntechOpen allows authors to earn citations and find new collaborators, meaning more people see your work not only from your own field of study, but from other related fields too. Momir Mikov, Hani Al-Salami and Svetlana Golocorbin-Kon (November 21st 2011). Potentials and Limitations of Bile Acids and Probiotics in Diabetes Mellitus, Type 1 Diabetes Chih-Pin Liu, IntechOpen, DOI: 10.5772/20553. Available from: Momir Mikov, Hani Al-Salami and Svetlana Golocorbin-Kon (November 21st 2011). Potentials and Limitations of Bile Acids and Probiotics in Diabetes Mellitus, Type 1 Diabetes Chih-Pin Liu, IntechOpen, DOI: 10.5772/20553. Available from: Embed this chapter on your site Copy to clipboard Embed this code snippet in the HTML of your website to show this chapter Over 21,000 IntechOpen readers like this topic Help us write another book on this subject and reach those readers Continue reading >>

Limitations Of Diabetes Pharmacotherapy: Results From The Vermont Diabetes Information System Study

Limitations Of Diabetes Pharmacotherapy: Results From The Vermont Diabetes Information System Study

Limitations of diabetes pharmacotherapy: results from the Vermont Diabetes Information System study 1 Benjamin Littenberg ,1 and Amanda G Kennedy 1 1Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA 1Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA 1Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA 1Division of General Internal Medicine, University of Vermont College of Medicine, 371 Pearl Street, Burlington, VT 05401, USA Received 2006 Feb 6; Accepted 2006 Aug 15. Copyright 2006 MacLean et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. There are a wide variety of medications available for the treatment of hyperglycemia in diabetes, including some categories developed in recent years. The goals of this study were to describe the glycemic medication profiles in a cohort of adult patients enrolled in primary care, to compare the regimens with measures of glycemic control, and to describe potential contraindicated regimens. One thousand and six subjects with diabetes cared for in community practices in the Northeast were interviewed at home at the time of enrollment in a trial of a diabetes decision support system. Laboratory data were obtained directly from the clinical laboratory. Current medications were obtained by direct observation of medication containers by a research assi Continue reading >>

Diabetes: Limitationsof Glycaemic Index Forblood Glucosecontrol

Diabetes: Limitationsof Glycaemic Index Forblood Glucosecontrol

Diabetes: Limitations of Glycaemic Index for Blood Glucose Control Diabetes: Limitationsof Glycaemic Index forBlood GlucoseControl Ms Kala Adaikan, Senior Principal Dietitian, from the Department of Dietetics at Singapore General Hospital, a member of the SingHealth group, shares the limitations of using glycaemic index for blood glucose control. is not a foolproof method of achieving optimal glycaemic control. Limitationsof using glycaemic index (GI) Individual variations in GI response: Rate at which different individuals digest carbohydrates can vary, leading to individual differences in glycaemic response. This means that GI lists may not be reliable. Combining different carbohydrate foods with different individual GIs also alters the overall GI of that meal. A composite meal with protein and added fat for cooking also alters the GI of the meal itself. Not all low GI foods are healthy food choices. Fat lowers the GI of a food. Take chocolate for example. Chocolate has a lower GI because of its fat content, which slows the absorption of glucose into the blood stream but chocolate is very energy-dense and very calorific, also because of its fat content. This will not be to your favour, especially if you are trying to lose weight. So, is it ok to focus on glycaemic indexalone? "Relying and focusing on GI alone is not a foolproof method to achieving optimal glycaemic control. Focusing on GI alone could lead to your diet being high in fat and calories, and being unbalanced," says Ms Kala Adaikan, Senior Principal Dietitian from the Department of Dietetics at Singapore General Hospital , a member of the SingHealth group . This is because GI does not consider total macronutrient intake. It is the total amount of caloric intake that leads to weight gain and increased insul Continue reading >>

What Are The Limitations Of The A1c Test For Diabetes Management? | Diabetes - Sharecare

What Are The Limitations Of The A1c Test For Diabetes Management? | Diabetes - Sharecare

What are the limitations of the A1C test for diabetes management? Marjorie Nolan Cohn on behalf of Academy of Nutrition and Dietetics It's important to note that the effectiveness of A1C tests may be limited in certain cases. For example: If you experience heavy or chronic bleeding, your hemoglobin stores may be depleted. This may make your A1C test results falsely low. If you don't have enough iron in your bloodstream, your A1C test results may be falsely high. Most people have only one type of hemoglobin, called hemoglobin A. If you have an uncommon form of hemoglobin (known as a hemoglobin variant), your A1C test result may be falsely high or falsely low. Hemoglobin variants are most often found in blacks and people of Mediterranean or Southeast Asian heritage. Hemoglobin variants can be confirmed with lab tests. If you're diagnosed with a hemoglobin variant, your A1C tests may need to be done at a specialized lab for the most accurate results. Also keep in mind that the normal range for A1C results may vary somewhat among labs. If you consult a new doctor or use a different lab, it's important to consider this possible variation when interpreting your A1C test results. Although the A1C test is an important tool, it can't replace daily self-testing of blood glucose for those who need it. A1C tests don't measure your day-to-day control. You can't adjust your insulin on the basis of your A1C tests. That's why your blood sugar checks and your log of results are so important to staying in effective control. Diabetes mellitus (MEL-ih-tus), often referred to as diabetes, is characterized by high blood glucose (sugar) levels that result from the bodys inability to produce enough insulin and/or effectively utilize the insulin. Diabetes ... is a serious, life-long condition Continue reading >>

An Error Occurred Setting Your User Cookie

An Error Occurred Setting Your User Cookie

An Error Occurred Setting Your User Cookie This site uses cookies to improve performance. If your browser does not accept cookies, you cannot view this site. There are many reasons why a cookie could not be set correctly. Below are the most common reasons: You have cookies disabled in your browser. You need to reset your browser to accept cookies or to ask you if you want to accept cookies. Your browser asks you whether you want to accept cookies and you declined. To accept cookies from this site, use the Back button and accept the cookie. Your browser does not support cookies. Try a different browser if you suspect this. The date on your computer is in the past. If your computer's clock shows a date before 1 Jan 1970, the browser will automatically forget the cookie. To fix this, set the correct time and date on your computer. You have installed an application that monitors or blocks cookies from being set. You must disable the application while logging in or check with your system administrator. This site uses cookies to improve performance by remembering that you are logged in when you go from page to page. To provide access without cookies would require the site to create a new session for every page you visit, which slows the system down to an unacceptable level. This site stores nothing other than an automatically generated session ID in the cookie; no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a website to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. This w Continue reading >>

Diabetes Public Health Resource

Diabetes Public Health Resource

Methodology We estimated the percentage of American adults aged 18 years and older with diabetes who took insulin or oral medications using data from the National Health Interview Survey (NHIS) of the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). NHIS is a health survey of the civilian, noninstitutionalized, household population of the United States that has been conducted since 1957. The survey provides information on the health of the U.S. population, including information on the prevalence and incidence of disease, the extent of disability, and the use of health care services. The multistage probability design of the survey has been described elsewhere.1 Adult respondents were asked whether a health professional had ever told them they had diabetes. To exclude gestational diabetes, the NHIS asked women participants whether they had been told that they had diabetes other than during pregnancy. Responses to the following questions were used to determine the percentage of adults with diabetes who were taking insulin or oral medication: “Are you now taking insulin?” and “Are you now taking diabetic pills to lower your blood sugar? These pills are sometimes called oral agents or oral hypoglycemic agents.” Responses to these questions were used to determine the percentage of adults with diabetes who took insulin or oral medications. Adults with diabetes were categorized into five groups of medication use—those taking insulin only, those taking oral medications only, those taking both, those taking either insulin or oral medication, and those taking neither insulin nor oral medications. We considered respondents to be taking “any diabetes medication” if they reported taking either insulin, oral medication, or b Continue reading >>

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