Management Of Hospitalized Patients With Type 2 Diabetes Mellitus
Suboptimal glycemic control in hospitalized patients with type 2 (non–insulin-dependent) diabetes mellitus can have adverse consequences, including increased neurologic ischemia, delayed wound healing and an increased infection rate. Poor glycemic control can also affect the outcome of the primary illness. If possible, hospitalized diabetic patients should continue their previous antihyperglycemic treatment regimen. Decreased physical activity and the stress of illness often lead to hyperglycemia in hospitalized patients with type 2 diabetes. When indicated, insulin is given either as a supplement to usual therapy or as a temporary substitute. The overall benefit of the traditional sliding-scale insulin regimen has been questioned. Insulin supplementation given according to an algorithm may be a logical alternative. Any antihyperglycemic regimen should be administered and monitored in a manner coincident with the intake of food or other sources of calories. Factors that can alter glycemic control acutely, including specific medical conditions and medications, should be identified and anticipated. Diabetes mellitus is a common secondary diagnosis in hospitalized patients. In 1988, diabetes was one of the diagnoses recorded for 2.8 million patients discharged from hospitals in the United States. Altogether, these patients spent 24.5 million days in hospitals. Diabetes was the secondary diagnosis in more than 80 percent of these patients, with the most frequently listed primary diagnoses being circulatory and cardiovascular diseases.1 Patients with diabetes are hospitalized twice as often as those who do not have this disease, and they are likely to stay in the hospital 30 percent longer.2 Furthermore, annual insurance claims for inpatient care are four times higher amon Continue reading >>
Hyperglycemia In Diabetes
Print Diagnosis Your doctor sets your target blood sugar range. For many people who have diabetes, Mayo Clinic generally recommends target blood sugar levels that are: Between 80 and 120 mg/dL (4 and 7 mmol/L) for people age 59 and younger who have no other underlying medical conditions Between 100 and 140 mg/dL (6 and 8 mmol/L) for people age 60 and older, those who have other medical conditions, such as heart, lung or kidney disease, or those who have a history of low blood sugar (hypoglycemia) or who have difficulty recognizing the symptoms of hypoglycemia Your target blood sugar range may differ, especially if you're pregnant or you develop diabetes complications. Your target blood sugar range may change as you get older, too. Sometimes, reaching your target blood sugar range is a challenge. Home blood sugar monitoring Routine blood sugar monitoring with a blood glucose meter is the best way to be sure that your treatment plan is keeping your blood sugar within your goal range. Check your blood sugar as often as your doctor recommends. If you have any signs or symptoms of severe hyperglycemia — even if they're subtle — check your blood sugar level. If your blood sugar level is 240 mg/dL (13 mmol/L) or above, use an over-the-counter urine ketones test kit. If the urine test is positive, your body may have started making the changes that can lead to diabetic ketoacidosis. You'll need your doctor's help to lower your blood sugar level safely. Glycated hemoglobin (A1C) test During an appointment, your doctor may conduct an A1C test. This blood test indicates your average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. An A1C level of 7 perc Continue reading >>
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Insulin For Diabetes Treatment (types, Side Effects, And Preparations)
What is the dosage and how is insulin administrated? A meal should be consumed within 30 minutes after administering regular insulin Insulin usually is administered by subcutaneous injection into the abdominal wall, thigh, buttocks (gluteal region), or upper arm. Injection sites should be rotated within the same region. Some insulins (for example, regular insulin) also may be administered intravenously. The dose is individualized for each patient. A combination of short or rapid acting and intermediate or long acting insulin typically are used Some patients may develop resistance to insulin and require increasing doses. Multiple daily insulin injections or continuous subcutaneous infusions via a pump closely mimic pancreatic insulin secretion. Insulin sliding scales (doses of insulin that are based on the glucose level ) may be used for managing critically ill hospitalized patients. What are the contraindications, warnings, and precautions for insulin? Hypersensitivity to insulin or its excipients (inactive co-ingredients) Hypoglycemia may occur and is the most common side effect of insulin treatment. Severe, life-threatening allergic reactions, including anaphylaxis, may occur. Hypokalemia (low blood potassium) may occur because insulin stimulates movement of potassium from blood into cells. Combining insulin with potassium-lowering drugs may increase the risk of hypokalemia. Hepatic (liver) impairment may reduce the insulin requirement. Renal (kidney) dysfunction may reduce the insulin requirement. Illness, emotional disturbance, or other stress may alter the insulin requirement. Intravenous administration increases the risk of hypoglycemia and hypokalemia. Continue reading >>
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Infection In Patients With Diabetes Mellitus
Practice Essentials Diabetes increases susceptibility to various types of infections. The most common sites of infection in diabetic patients are the skin and urinary tract. Ear, Nose, and Throat Infections Malignant otitis externa and rhinocerebral mucormycosis are 2 head-and-neck infections seen almost exclusively in patients with diabetes. Malignant or necrotizing otitis externa principally occurs in diabetic patients older than 35 years and is almost always due to Pseudomonas aeruginosa. [1] Infection starts in the external auditory canal and spreads to adjacent soft tissue, cartilage, and bone. Patients typically present with severe ear pain and otorrhea. Rhinocerebral mucormycosis collectively refers to infections caused by various ubiquitous molds. [2] Invasive disease occurs in patients with poorly controlled diabetes, especially those with diabetic ketoacidosis. Organisms colonize the nose and paranasal sinuses, spreading to adjacent tissues by invading blood vessels and causing soft tissue necrosis and bony erosion. Urinary Tract Infections Patients with diabetes have an increased risk of asymptomatic bacteriuria and pyuria, cystitis, and, more important, serious upper urinary tract infection. [3, 4] Intrarenal bacterial infection should be considered in the differential diagnosis of any patient with diabetes who presents with flank or abdominal pain. Pyelonephritis makes control of diabetes more difficult by causing insulin resistance; in addition, nausea may limit the patient's ability to maintain normal hydration. Treatment of pyelonephritis does not differ for patients with diabetes, but a lower threshold for hospital admission is appropriate. Skin and Soft Tissue Infections Sensory neuropathy, atherosclerotic vascular disease, and hyperglycemia all predis Continue reading >>
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Why Are Some Patients Of Diabetes Treated By Giving Injections Of Insulin
Q. No. 4: Why are some patients of diabetes treated by giving injections of insulin? Ans: Insulin is a hormone secreted by pancreas that regulates the sugar level in the blood. When this hormone is not synthesised in proper amount then the sugar level in the blood rises and the persons suffer from diabetes. This is the reason why diabetic patients are treated by giving injections of insulin. Continue reading >>
- Patients with Diabetes Are Treated Differently in the ER
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Type 1 diabetes patients retain some ability to produce insulin
The Importance Of Hypoglycemia In Diabetic Patients
Go to: Abstract Hypoglycemia is one of the most important complications of diabetes treatment. The risk of severe hypoglycemia is higher in elderly patients, those having comorbidities such as vascular disease or renal failure, pregnant women and in children with type 1diabetes. Moreover, in type 2 diabetes, progressive insulin deficiency, longer duration of diabetes, and tight glycemic control increase the risk of hypoglycemia as much as type 1 diabetes.Episodes hypoglycemia may lead to impairment of counter-regulatory system, with the potential of development of hypoglycemia unawareness. So, hypoglycemia may increase the vascular events even death in addition to other possible detrimental effects. Glycemic control should be individualized based on patient characteristics with some degree of safety. Recognition of hypoglycemia risk factors, blood glucose monitoring, selection of appropriate regimens and educational programs for healthcare professionals and patients with diabetes are the major issues to maintain good glycemic control, minimize the risk of hypoglycemia, and prevent long- term complications. Keywords: Diabetes, Hypoglycemia, Complications Go to: Introduction Diabetes is a chronic disease that requires continuous medical care and patient self-management education to prevent acute complications and reduce the risk of long-term complications [1]. The prevalence of diabetes has reached epidemic proportions in most populations. According to the UN World Health Organization (WHO) more than 220 million people worldwide have diabetes, from which more than 70% live in low- and middle income countries. It is expected that the number of diabetic subjects grows to 366 million by 2030, a figure that is more than twice the number in 2000. Epidemiologic evidences sugges Continue reading >>
Tips For Managing Type 1 And 2 Diabetes At Home
Diabetes home care management facts Diabetes mellitus is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. The main types of diabetes mellitus are type 1 (insulin deficiency; formerly called juvenile diabetes) and type 2 (insulin resistance). Type 1 diabetes requires insulin therapy as well as controlled nutrition and exercise. Type 2 diabetes is best treated with weight reduction, the proper diabetic diet, and exercise. When these measures do not control the blood sugar, oral medications and/or injectable therapies (including insulin) are prescribed. The main goal of diabetes care is to control blood glucose levels in order to prevent the serious complications of diabetes. Glucose levels should be lowered into the normal range, while avoiding low blood sugar whenever possible. It is essential to monitor the effects of treatment on blood glucose levels to avoid overtreatment or undertreatment. Two kinds of home blood glucose monitoring exist. The first type uses a reagent strip. The second type uses a reagent strip and glucose meter. Use of the glucose meter has become more common due to higher reliability than strips alone. Glucose can also be measured in the urine but no longer has a significant role in home testing. Ketoacidosis is a serious but preventable complication from inadequate treatment of diabetes. This dangerous condition is identified by testing for the urine for ketones. People with diabetes should discuss monitoring in detail with their health-care professional, and have clearly defined goals for blood sugar control. Choices for blood glucose meters should be discussed with your physician and any caregivers. The optimal meter accounts for characteristics of the patient which impact usability, such as visual impa Continue reading >>
Patient Education: Diabetes Mellitus Type 2: Treatment (beyond The Basics)
TYPE 2 DIABETES OVERVIEW Type 2 diabetes mellitus occurs when the pancreas (an organ in the abdomen) produces insufficient amounts of the hormone insulin and/or the body becomes resistant to normal or even high levels of insulin. This causes high blood sugar (glucose) levels, which can lead to a number of complications if untreated. People with type 2 diabetes require regular monitoring and ongoing treatment to maintain normal or near-normal blood sugar levels. Treatment includes lifestyle adjustments, self-care measures, and medicines, which can minimize the risk of diabetes and cardiovascular (heart-related) complications. This topic review will discuss the treatment of type 2 diabetes. Topics that discuss other aspects of type 2 diabetes are also available: (See "Patient education: Diabetes mellitus type 2: Overview (Beyond the Basics)".) (See "Patient education: Diabetes mellitus type 2: Alcohol, exercise, and medical care (Beyond the Basics)".) TYPE 2 DIABETES TREATMENT GOALS Blood sugar control — The goal of treatment in type 2 diabetes is to keep blood sugar levels at normal or near-normal levels. Careful control of blood sugars can help prevent the long-term effects of poorly controlled blood sugar (diabetic complications of the eye, kidney, nervous system, and cardiovascular system). Home blood sugar testing — In people with type 2 diabetes, home blood sugar testing might be recommended, especially in those who take certain oral diabetes medicines or insulin. Home blood sugar testing is not usually necessary for people who are diet controlled. (See "Patient education: Self-monitoring of blood glucose in diabetes mellitus (Beyond the Basics)".) A normal fasting blood sugar is less than 100 mg/dL (5.6 mmol/L), although some people will have a different goal. Continue reading >>
Use Of Traditional Medicine For The Treatment Of Diabetes In Eastern Uganda: A Qualitative Exploration Of Reasons For Choice
Use of traditional medicine for the treatment of diabetes in Eastern Uganda: a qualitative exploration of reasons for choice 1Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda 2Iganga-Mayuge Demographic Surveillance Site, Iganga, Uganda 3African Field Epidemiology Network, Kampala, Uganda 1Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda 3African Field Epidemiology Network, Kampala, Uganda 8Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden 1Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda 2Iganga-Mayuge Demographic Surveillance Site, Iganga, Uganda 3African Field Epidemiology Network, Kampala, Uganda 5Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda 7Joint Clinical Research Centre, Kampala, Uganda 8Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Elizeus Rutebemberwa: [email protected] ; Muhamadi Lubega: [email protected] ; Sheila K Katureebe: [email protected] ; Abanga Oundo: [email protected] ; Francis Kiweewa: [email protected]_tamecnirp ; David Mukanga: [email protected] Received 2011 Sep 29; Accepted 2012 Dec 18. Copyright 2013 Rutebemberwa 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. While th Continue reading >>
The Facts About Insulin For Diabetes
Insulin is a hormone that your pancreas makes to allow cells to use glucose. When your body isn't making or using insulin correctly, you can take man-made insulin to help control your blood sugar. Many types can be used to treat diabetes. They're usually described by how they affect your body. Rapid-acting insulin starts to work within a few minutes and lasts for a couple of hours. Regular- or short-acting insulin takes about 30 minutes to work fully and lasts for 3 to 6 hours. Intermediate-acting insulin takes 2 to 4 hours to work fully. Its effects can last for up to 18 hours. Long-acting insulin can work for an entire day. Your doctor may prescribe more than one type. You might need to take insulin more than once daily, to space your doses throughout the day, and possibly to also take other medicines. How Do I Take It? Many people get insulin into their blood using a needle and syringe, a cartridge system, or pre-filled pen systems. The place on the body where you give yourself the shot may matter. You'll absorb insulin the most consistently when you inject it into your belly. The next best places to inject it are your arms, thighs, and buttocks. Make it a habit to inject insulin at the same general area of your body, but change up the exact injection spot. This helps lessen scarring under the skin. Inhaled insulin, insulin pumps, and a quick-acting insulin device are also available. When Do I Take It? It will depend on the type of insulin you use. You want to time your shot so that the glucose from your food gets into your system at about the same time that the insulin starts to work. This will help your body use the glucose and avoid low blood sugar reactions. For example, if you use a rapid-acting insulin, you'd likely take it 10 minutes before or even with your m Continue reading >>
9 Diabetes Treatments To Try Before Insulin
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Why Are Some Patients Of Diabetes Treated By Giving Injections Of Insulin?
Q. Why are some patients of diabetes treated by giving injections of insulin? Answer:- Insulin plays an important role in sugar metabolism. In some patients of diabetes insulin secretion is reduced. Insulin injection is given to such patients to compensate for reduced insulin secretion. Such cases of diabetes are called Insulin Dependent Diabetes Mellitus (IDDM). Continue reading >>
- Patients with Diabetes Are Treated Differently in the ER
- Relative effectiveness of insulin pump treatment over multiple daily injections and structured education during flexible intensive insulin treatment for type 1 diabetes: cluster randomised trial (REPOSE)
- Type 1 diabetes patients retain some ability to produce insulin
Facts About Diabetes And Insulin
Diabetes is a very common disease, which, if not treated, can be very dangerous. There are two types of diabetes. They were once called juvenile-onset diabetes and adult diabetes. However, today we know that all ages can get both types so they are simply called type 1 and type 2 diabetes. Type 1, which occurs in approximately 10 percent of all cases, is an autoimmune disease in which the immune system, by mistake, attacks its own insulin-producing cells so that insufficient amounts of insulin are produced - or no insulin at all. Type 1 affects predominantly young people and usually makes its debut before the age of 30, and most frequently between the ages of 10 and 14. Type 2, which makes up the remaining 90 percent of diabetes cases, commonly affects patients during the second half of their lives. The cells of the body no longer react to insulin as they should. This is called insulin resistance. In the early 1920s, Frederick Banting, John Macleod, George Best and Bertram Collip isolated the hormone insulin and purified it so that it could be administered to humans. This was a major breakthrough in the treatment of diabetes type 1. Insulin Insulin is a hormone. Hormones are chemical substances that regulate the cells of the body and are produced by special glands. The hormone insulin is a main regulator of the glucose (sugar) levels in the blood. Insulin is produced in the pancreas. To be more specific, it's produced by the beta cells in the islets of Langerhans in the pancreas. When we eat, glucose levels rise, and insulin is released into the bloodstream. The insulin acts like a key, opening up cells so they can take in the sugar and use it as an energy source. Sugar is one of the top energy sources for the body. The body gets it in many forms, but mainly as carbohydr Continue reading >>
Diabetes - A Major Risk Factor For Kidney Disease
Diabetes mellitus, usually called diabetes, is a disease in which your body does not make enough insulin or cannot use normal amounts of insulin properly. Insulin is a hormone that regulates the amount of sugar in your blood. A high blood sugar level can cause problems in many parts of your body. The most common ones are Type 1 and Type 2. Type 1 diabetes usually occurs in children. It is also called juvenile onset diabetes mellitus or insulin-dependent diabetes mellitus. In this type, your pancreas does not make enough insulin and you have to take insulin injections for the rest of your life. Type 2 diabetes, which is more common, usually occurs in people over 40 and is called adult onset diabetes mellitus. It is also called non insulin-dependent diabetes mellitus. In Type 2, your pancreas makes insulin, but your body does not use it properly. The high blood sugar level often can be controlled by following a diet and/or taking medication, although some patients must take insulin. Type 2 diabetes is particularly prevalent among African Americans, American Indians, Latin Americans and Asian Americans. With diabetes, the small blood vessels in the body are injured. When the blood vessels in the kidneys are injured, your kidneys cannot clean your blood properly. Your body will retain more water and salt than it should, which can result in weight gain and ankle swelling. You may have protein in your urine. Also, waste materials will build up in your blood. Diabetes also may cause damage to nerves in your body. This can cause difficulty in emptying your bladder. The pressure resulting from your full bladder can back up and injure the kidneys. Also, if urine remains in your bladder for a long time, you can develop an infection from the rapid growth of bacteria in urine that h Continue reading >>
