Blood glucose control

Hyperglycemia Poor blood glucose control (in patients with... 

Intensive Blood Glucose Control (for Patients with Diabetes)... 

Patients and clinicians can evaluate blood glucose control through a combination of self-monitoring of blood glucose data and hemoglobin HbAlc testing. 

Insulin pump therapy may be used to lower blood glucose levels in any type of DM however, patients with type 1 DM are the most likely candidates for this form of treatment. Use of an insulin pump may improve blood glucose control, reduce wide fluctuations in blood glucose levels, and allow individuals to... 

Is the patient taking any medications that may affect blood glucose control ... 

UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998 352 837-853. 

Sugars can react with proteins to form, among others, hemoglobin Aic, a measure of blood glucose control over time. 

Q56 Avandia treatment should be started in combination with insulin. Blood-glucose control may deteriorate temporarily when Avandia is substituted for an oral antidiabetic drug. 

Avandia (rosiglitazone) as with other thiazolidinediones is used either as monotherapy or in combination with either metformin or a sulphonylurea. A disadvantage of rosiglitazone is the risk of heart failure as a side-effect. This risk is increased when rosiglitazone is used in patients with cardiovascular disease and when used in combination with insulin. Blood-glucose control may deteriorate temporarily when a thiazolidinedione is substituted for an oral antidiabetic agent. 

An important qualification must be made. While a biomarker may be of proven value in establishing whether a drug has the desired effect in patients or healthy volunteers (see Section 4.6.3) and for evaluation of the dose-response relationship, a biomarker may not be a surrogate for the clinical endpoint. Thus, suppression of testosterone after an initial rise will give an almost immediate endpoint for the effect of GnRH analogues in prostate cancer but the relationship breaks down later in the disease. Measures of blood glucose control are vital... 

Blood glucose control When diabetic patients are exposed to stress such as fever, trauma, infection or surgery, a temporary loss of control of blood glucose may occur. At such times, temporary insulin therapy may be necessary. 

Certain drugs tend to produce hyperglycemia and may lead to loss of blood glucose control. These drugs include the thiazides and other diuretics, corticosteroids, phenothiazines, thyroid products, estrogens, oral contraceptives, phenytoin, nicotinic acid, sympathomimetics, calcium channel blocking drugs, and isoniazid. 

Loss of blood glucose control When a patient stabilized on any diabetic regimen is exposed to stress such as fever, trauma, infection, or surgery, a loss of control may occur. At such times, it may be necessary to discontinue the drug and give insulin. Disulfiram-like syncframe. A sulfonylurea-induced facial flushing or breathlessness reaction may occur when some sulfonylureas are administered with alcohol. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) Water retention and dilutional hyponatremia have occurred after administration of sulfonylureas to type 2 diabetes patients, especially those with CHF or hepatic cirrhosis. 

ADVANCE Collaborative Group Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 2008 358 2560. Baggio LA et al Biology of incretins GLP-1 and GIP. Gastroenterology 2007 132 2131. [PMID 17498508]... 

A 42-year-old man who had had type 1 diabetes for 24 years had deteriorating blood glucose control despite increasing insulin doses (HBAic increased from 11% to 17%). He was injecting into two areas that contained 4 cm hard woody nodules. Biopsy showed collagen with fibroblasts and necrosis. When he avoided the areas his blood glucose improved with reduced insulin doses. 

Koivisto VA, Felig P. Alterations in insulin absorption and in blood glucose control associated with varying insulin injection sites in diabetic patients. Ann Intern Med 1980 92(1) 59-61. 

Rivellese A A, Patti L, Romano G, Innelh F, Di Marino L, Annuzzi G, Iavicoli M, Coronel GA, Riccardi G. Effect of insulin and sulfonylurea therapy, at the same level of blood glucose control, on low density hpoprotein subfractions in type 2 diabetic patients. J Clin Endocrinol Metab 2000 85(11) 4188-92. 

Home PD, Lindholm A, Riis AEuropean Insulin Aspart Study Group. Insulin aspart vs. human insulin in the management of long-term blood glucose control in type 1... 

Colombel A, Murat A, Krempf M, Kuchly-Anton B, Charbonnel B. Improvement of blood glucose control in Type 1 diabetic patients treated with lispro and multiple NPH injections. Diabet Med 1999 16(4) 319-24. 

Van Gaal LF, Van Acker KL, De Leeuw IH. Repaglinide improves blood glucose control in sulphonylurea-naive type 2 diabetes. Diabetes Res Clin Pract 2001 53(3) 141-8. 

Turner RC, Holman RR, Cull CA, Stratton IM, Matthews DR, Frighi V, Manley E, Neil A, McElroy H, Wright D, Kohner E, Fox C, Hadden D. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998 352(9131) 837-53. 

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