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Monday, September 17, 2012
  Clinical Accuracy Spoken Here  

DM: Causes of Hypoglycemia

Hypoglycemia caused by oral anti-diabetes medications, such as sulfonylureas, are just as dangerous as those caused by insulin.

Biological mechanisms responsible for most hypoglycemic symptoms are: 1) hormonal counter-regulation (autonomic symptoms caused by hormonal reactions that increase the glucose level to counteract hypoglycemia) and 2) neuroglycopenia [disruption in mental and motor function secondary to depletion of glucose that is available to the central nervous system (CNS)]. Autonomic symptoms are generally adrenergically based, although sweating appears to be cholinergic. They provide early warning signs of hypoglycemia.

[Reference: Diabetes, Module A, Therapies]
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  Excellence in Case Mgmt  

Vomiting Life-threatening in DM

The stress of illness aggravates glycemic control and necessitates more frequent monitoring of blood glucose and ketones.

Marked hyperglycemia requires adjustment of the treatment plan, and if accompanied by ketosis, frequent interaction with the diabetes care team. Patients treated with anti-diabetes agents or MNT alone may temporarily require insulin. Adequate fluid and caloric intake must be assessed. Infection or dehydration often necessitates hospitalization of the diabetic patient. A vomiting illness accompanied with ketosis is a life-threatening condition that requires immediate medical care to prevent complications and death.

[Reference: DM, Module D, Care Standards]
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  Improving Patient Care...  

DM: Is Monitoring PPG Clinically Beneficial?

To date, no randomized clinical trials have been conducted to support PPG monitoring. No clinical trial data address whether PPG plays a unique role in the pathogenesis of diabetes-specific complications.

Interventional studies have not demonstrated a convincing beneficial effect of glucose lowering on cardiovascular disease outcomes or events. The only setting in which PPG monitoring has been shown to improve outcomes is gestational diabetes.

Randomized clinical trials have demonstrated that a reduction in the long-term complications of diabetes is proportional to average glycemia as determined by A1C.

[Reference: DM, Module D, Care Standards]
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Tom RasmussenTom Rasmussen
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