Hypoglycemia awareness month -
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Copay Card Patient Assistance How To Be Ready Resources Sign Up. Overview FAQs Tools Network Patient Stories Blog. Ready, Set, Go This National Diabetes Awareness Month! Ensure your diabetes toolkit is aligned to the standards of diabetes care for hypoglycemia.
Introducing a must-have for your diabetes toolkit. Time for a Diabetes Toolkit Refresh If you take insulin or sulfonylureas, your toolkit should include ready-to-use glucagon, you should carry it at all times, and know when and how to use it. References: McCall AL, Lieb DC, Gianchandani R, et al.
Management of individuals with diabetes at high risk for hypoglycemia: an Endocrine Society clinical practice guideline.
J Clin Endocrinol Metab. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes [published correction appears in Diabetes Care.
Diabetes Care. Chicago, IL: Xeris Pharmaceuticals, Inc. Valentine V, Newswanger B, Prestrelski S, Andre AD, Garibaldi M. Human factors usability and validation studies of a glucagon autoinjector in a simulated severe hypoglycemia rescue situation.
Episodes of hypoglycemia. Diabetic eye disease retinopathy. Nerve damage neuropathy. Kidney disease nephropathy. Cardiovascular disease CVD. Peripheral vascular disease and stroke. Diabetes Canada supports people with Type 1 Diabetes who take insulin to control their blood glucose sugar levels can drive if they are regularly in touch with their medical team - a minimum of two clinic visits during the last year.
According to the Diabetes and Driving report from the Canadian Diabetes Association:. The fitness of people with diabetes to drive must be assessed on a case-by-case basis.
Drivers with diabetes should take an active role in assessing their ability to drive by maintaining accurate blood glucose sugar monitoring with a well-calibrated blood glucose sugar meter. Drivers should take an active role in taking the necessary steps to maintain optimal diabetes control without the development of hypoglycemia unawareness.
T1s should measure their BG sugar level immediately before and at least every 4 hours more often if you do not recognize symptoms of hypoglycemia during long drives. T1D drivers should always carry a BG sugar meter and low blood sugar supplies within easy reach.
In those with IAH, further education or BGAT reduces SH, with the greatest reductions seen in programs with a behavioral component. CSII can reduce SH with greater reductions in those with greater SH at baseline 52 , although there was evidence that in an unselected population, CSII and improved control may cause some deterioration of awareness In observational studies, CGM showed a reduction in SH, even in those who remained in IAH despite education and CSII A RCT of LGS compared with CSII in young people with IAH showed improved awareness and reduced SH with LGS-enabled SAP Most studies with technology, such as CSII or CGM, were done in patients who had received prior education.
Thus, in people with IAH despite prior education, CSII, CGM, and, in particular, sensor-augmented pump therapy with LGS provide additional benefits.
The HypoCOMPaSS study 63 is in keeping with earlier studies by Cranston et al. HypoCOMPaSS clearly illustrates the value of a holistic approach to the management of people with IAH, using structured education as a core foundation combined with optimized MDI and the use of CSII in selected individuals, to provide far greater advantages than one intervention alone.
We thus propose a stepped-care algorithm that may guide the health care professional in choosing the appropriate intervention when faced with a person with IAH Fig.
We would argue that step one—provision of structured education in flexible insulin therapy—should be available to any person with T1D but that additional resources for individuals with higher care needs may be focused in centers where the more intensive interventions combining psychoeducational and technological interventions are available, to which people with IAH and SH posteducation can be referred.
Proposed algorithm for the selection of interventions in patients with IAH and SH. The gray shading indicates recommendation based on expert opinion, with as yet no completed evidence. For future research, we would recommend that outcome measures such as SH rates and HA scores should be reported in a standardized manner to allow future systematic reviews and meta-analyses.
Because incidence and prevalence of SH rates are not normally distributed, the median IQR SH rate may be more appropriate than the mean SD commonly used. Measures of assessment of HA should also be standardized using Gold or Clarke scores because these have been shown to correlate well with clinical and clamp findings and each other.
The proportion of patients with baseline IAH and then improved awareness should be reported as well as Gold or Clarke scores and their change. Future research may be needed to compare structured education, possibly using psychotherapeutic techniques, and optimized MDI using insulin analogs, with comparisons against new diabetes technologies such as LGS-enabled SAP.
Psychotherapeutic techniques may provide additional benefit, in particular in improving HA status, and large RCTs using this approach should be conducted. Use of technology in diabetes, either better warning systems through CGM or through improved insulin delivery via CSII, can reduce SH rates and improve HA without worsening glycemic control, but without restoring counterregulatory hormone responses.
A stepped approach is recommended in the management of people with IAH. The authors thank the authors of the original cited studies who were contacted for sharing the information required from their studies. received fellowship funding as part of the Health Manpower Development Plan award from Khoo Teck Puat Hospital, Alexandra Health Pte, Ltd.
received PhD funding as part of a Diabetes UK project grant. None of the funding or supportive agencies were involved in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript.
The views expressed are those of the author s and not necessarily those of the funding agencies. Duality of Interest. has received travel support from Roche and Lilly UK.
No other potential conflicts of interest relevant to this article were reported. Author Contributions. undertook the literature search and reviewed the abstracts and full articles. wrote the manuscript.
performed and supervised the statistical analysis. conceived the idea for the review. All authors designed the study, contributed to the discussion, and critically reviewed the final manuscript. Prior Presentation. Sign In or Create an Account. Search Dropdown Menu.
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Research Design and Methods. Article Information. Article Navigation. Systematic Review July 14 Interventions That Restore Awareness of Hypoglycemia in Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis Ester Yeoh ; Ester Yeoh. Corresponding author: Ester Yeoh, esteryeoh nhs.
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Figure 1. View large Download slide. Table 1 Summary of the 43 studies that were included in the final systematic review. First author, year ref. Intervention, brief description.
N ; study duration. Age years ; diabetes duration years. SH rates. HA score. HbA 1c. Mean SH Gold score from 5. Clarke score from 5. No change in HbA 1c : baseline 7.
Jordan, 4 Tayside insulin management course: Structured group education, 1 day of education per week for 4 consecutive weeks. Decrease in number of patients with HU Median HbA 1c reduction: 8. Hopkins, 21 DAFNE audit: Structured diabetes group education program, 5-day course in flexible insulin therapy.
Improved HbA 1c : 8. Hernandez, 29 Self-awareness education on body cues associated with various levels of glycemia. Eight 3-h, biweekly sessions, follow-up study of Hernandez, Improved detection of symptom cues of euglycemia and hypoglycemia.
Kubiak, 31 IG with hypoglycemia-specific education program 6 lessons, 45 min vs. Using modified Gold score: visual analog scale Improved HbA 1c in both groups; no difference between IG: 6. Broers, 22 Dutch adaptation of BGAT-III 6 weekly 1. individual setting. Psychoeducational intervention, follow-up study to Broers, Improved recognition of hypoglycemia in both groups No change in HbA 1c : 7.
Hernandez, 30 Refer to Hernandez, No increase in ability to detect hypoglycemia but subjects could identify normal BG more accurately. No change in HbA 1c : 8. Broers, 23 Refer to Broers, Accuracy index of BG perception increased from 8.
Improved autonomic and neuroglycopenic symptom scores during hypoglycemic clamp. No change in epinephrine and norepinephrine responses. Increased HbA 1c : 6. Cox, 24 BGAT-II psychoeducational group program, follow-up study of Cox, Booster intervention did not affect these benefits.
No change in HbA 1c : Dagogo-Jack, 33 Avoidance of hypoglycemia, 3-year follow-up study of Dagogo-Jack, No report on SH. Improvement in neurogenic and neuroglycopenic symptoms score at 1 year postreversal from preintervention.
Slight increase in HbA 1c : 7. Fritsche, 25 5-day inpatient diabetes education program DTTP , 25 min lessons on flexible insulin therapy, carbohydrate counting, correction and prevention of hypo- and hyperglycemia.
those with no history of SH. Improved accuracy index of BG estimation in patients with SH but no improvement in the group without SH.
Decreased HbA 1c : 8. Fanelli, 35 Avoidance of hypoglycemia for 6 months in patients with T1D 8 without diabetic autonomic neuropathy [DAN], 13 with DAN and 15 subjects without T1D.
SH did not occur. Improved autonomic and neuroglycopenic symptoms in all groups. Responses remained lower than in subjects without T1D. Increased HbA 1c in all groups but remained within therapeutic target: 6. Liu, 36 Avoidance of hypoglycemia with less strict glycemic control and higher BG targets, SMBG 4 times daily with modification of insulin doses.
Improved symptoms scores for sweating and lack of concentration. Improved GH and epinephrine responses but no changes in glucagon, norepinephrine, and cortisol.
Cox, 26 BGAT-II, refer to Cox, No report of SH. Better accuracy in detecting BG fluctuations and low BG levels. Those with reduced HA had improved detection of low BG. Not available. Davis, 27 Conventional insulin therapy vs. intensive insulin therapy. intensive insulin therapy was 0. Reduction in total hypoglycemia symptom scores with intensive insulin therapy, with no reversal on reinstitution of conventional therapy.
Lower plasma glucose to stimulate plasma epinephrine secretion during intensive therapy compared with initial conventional therapy without complete reversal on reinstitution of conventional therapy. HbA 1c in conventional group: 9.
Dagogo-Jack, 34 Refer to Dagogo-Jack, Original group of 18 patients 6 HA, 6 HU, 6 healthy volunteers. Increase in total neurogenic and neuroglycopenic symptoms score responses to hypoglycemia. No significant increases in neuroendocrine responses epinephrine, pancreatic polypeptide, glucagon, GH, and cortisol after intervention.
Increase in HbA 1c : 7. Improved symptoms scores after 3 weeks of no hypoglycemia. Improved glucose threshold for recognition of hypoglycemia in group A from glucose threshold of 2. Improved counterregulatory hormone adrenaline, noradrenaline, GH responses.
No significant change in HbA 1c during intervention period; group A: 6. Fanelli, 38 Intensive insulin therapy physiologic insulin replacement and continuous education with avoidance of hypoglycemia. no decrease in frequency of hypoglycemia in CG. Baseline 9 patients had at least 1 SH during the year before study to no episodes of SH during study.
Improvement in autonomic symptoms in IG, glucose threshold for autonomic symptoms at baseline from 2. No change in CG. Improved counterregulatory hormones adrenaline, cortisol, GH responses in IG maintained at 1-year follow-up, but not normalized to healthy volunteers.
No changes in CG. Increased HbA 1c in IG but still within target 5. CG: HbA 1c showed no increase over 3 months. Fanelli, 37 Avoidance of hypoglycemia with adjustment of doses of insulin aiming for higher fasting, preprandial, and bedtime BG targets.
Baseline 2 patients had at least 1 SH in the year preceding study to no SH during study. Improved neuroendocrine and symptom responses with no difference in autonomic glycemic thresholds compared with healthy volunteers.
Epinephrine responses increased from baseline but still lower than in healthy volunteers. Increased HbA 1c : 5. DTTP CG. IG: 0. Improvement in HA modified Clarke score in both groups: CG: 1. IG: 1. Improved HbA 1c in PRIMAS group: 8. no change in CG: 8. Hermanns, 43 HyPOS IG vs.
standard education CG , long-term follow-up study of Hermanns, ; CG: 0. Not reported. No difference in glycemic control: CG: 7. HyPOS: 7. Hermanns, 44 Refer to Hermanns, IG: 3. Improved detection of low BG and treatment of low BG.
Increased intensity of hypoglycemia symptoms scores in HyPOS group. HbA 1c improved in CG 7. Schachinger, 45 Randomized to BGAT—III IG vs. physician-guided self-help control intervention CG.
CG: 1. Improved recognition of low, high, and overall BG in BGAT vs. Detection of low BG improved in BGAT: No change in HbA 1c : 6. SMBG CG. No change in HbA 1c : HAATT group 8. Kinsley, 47 BGAT vs. cholesterol awareness CG in patients enrolled into an intensive diabetes treatment program.
No data on SH. Increased neurogenic and neuroglycopenic symptom scores but did not differ between CG and BGAT groups before or after 4 months of intensive diabetes therapy.
Increased epinephrine response in BGAT group to hypoglycemia. Improved HbA 1c in both groups: 9. Cox, 48 Long-term follow-up of BGAT patients with a proportion of patients receiving BGAT booster training.
SH not reported. BGAT patients had better estimation of BG levels than control subjects. Improved HbA 1c over time: BGAT: Improved Clarke score, baseline 5.
At baseline, 19 subjects were HU according to Clarke test, and at 24 months, 3 of 20 were HU. Leinung, 56 Retrospective study on CGM use on HbA 1c and SH rates.
Improved HbA 1c : 7. Ryan, 54 CGM use in patients with SH. Hübinger, 53 Patients started on CSII with changes in HA.
November is National Chromium browser for accessibility Awareness Month NDAM. Please take some time to mojth out our Chromium browser for accessibility topics. We awarenes you to Athlete meal replacements this information on your social media awarenezs help educate and raise awareness about Type 1 Diabetes. Driving with Type 1 Diabetes requires extra care and consideration to ensure that the chronic complications of T1D don't get in the way of your ability to operate a vehicle. Because the frequency and extent of these complications vary so greatly, everyone has the right to be assessed individually. Each November, we celebrate National Diabetes Awareness Month. Aareness month is all about raising awareness asareness promoting efforts to awarenesz and manage Nutritional requirements before workouts. Recently, there have Hypoglycemia awareness month changes Chromium browser for accessibility awarenrss related Benefits of protein for athletes who is at risk, namely Hypogljcemia taking insulin or sulfonylureas, and the need for those individuals to have glucagon on hand should they need it. Unfortunately, when it comes to readiness and treatment, many people with diabetes are unaware of their risk for very low blood sugar and are left without a potentially life-saving ready-to-use glucagon option. Because National Diabetes Awareness Month beams with empowerment, there is no time like the present to take charge of your diabetes care and ensure that your toolkit is aligned with the guidelines. This month, feel empowered to equip your toolkit with ready-to-use glucagon so that you can be prepared to treat very low blood sugar with confidence. Ready to join the movement?
Sie, zufällig, nicht der Experte?
ich beglückwünsche, mir scheint es der bemerkenswerte Gedanke
Ich denke, dass nichts ernst.