Hyperglycemia may occur in patients with known or previously undiagnosed diabetes mellitus. Hyperglycemia during the acute phase of the disease can also occur in patients with previously normal glucose tolerance, a condition called stress hyperglycemia.
- How common is hyperglycemia in critically ill patients?
Hyperglycemia is common in critically ill patients. It is estimated that 90% of all patients have a blood glucose concentration of more than 110 mg/dL during critical illness. Stress-induced hyperglycemia is associated with adverse clinical outcomes in patients with trauma, acute myocardial infarction, and subarachnoid hemorrhage.
- What causes hyperglycemia in seriously ill patients?
In healthy people, blood glucose concentrations are tightly regulated within a narrow range. The cause of hyperglycemia in seriously ill patients is multifactorial. Activation of inflammatory cytokines, as well as counter-insular hormones such as cortisol and epinephrine, causes increased peripheral insulin resistance and increased glucose production in the liver. The use of glucocorticoids, parenteral and enteral nutrition are important factors in hyperglycemia.
- What is the relationship between hyperglycemia and critical illness?
The relationship between hyperglycemia and critical illness is complex. Severe hyperglycemia (more than 250 mg/dl) has a negative effect on the vascular, immune systems, and hemodynamics. Hyperglycemia can also lead to electrolyte imbalance, mitochondrial damage, and neutrophil and endothelial dysfunction. Critical illness increases the risk of developing hyperglycemia due to the release of counterinsular hormones, increased insulin resistance and immobilization.
- Should oral glucose-lowering medications be continued in the intensive care unit?
Given the high incidence of renal and hepatic impairment, oral medications for diabetes should not be continued in the intensive care unit (ICU). Metformin is contraindicated in patients with renal and/or hepatic dysfunction and congestive heart failure. Long-acting sulfonylureas have been associated with episodes of prolonged severe hypoglycemia in patients. Oral medications are difficult to dose for glycemic control and cannot be used to rapidly lower blood glucose levels.
- Is it possible to use non-insulin injectable drugs in intensive care?
Non-insulin injectable drugs, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), stimulate insulin release through a glucose-like mechanism. These drugs have been shown to cause nausea and vomiting and slow gastric emptying. GLP-1 RAs have similar limitations for oral medications and should not be used in the ICU setting.
- How to most effectively treat hyperglycemia in the intensive care unit?
Intravenous infusion of short-acting insulin is the safest and most effective treatment for hyperglycemia in critically ill patients. Because of its short half-life, providing plasma insulin concentrations (minutes), the infusion rate can be frequently adjusted to meet the frequently changing insulin needs of critically ill patients. Intravenous insulin therapy should follow validated written or computerized protocols that establish predetermined infusion rate parameters based on frequent blood glucose measurements.
- When should I start intravenous insulin infusion?
Intravenous insulin infusion should be started to treat persistent hyperglycemia, starting at a blood glucose concentration of 180 mg/dL.
- What is the target blood glucose concentration for critically ill patients??
Recognizing the importance of managing hyperglycemia in critically ill patients, a number of professional societies have developed guidelines and/or consensus statements that contain evidence-based glycemic goals. Although glycemic goals are not identical, all groups advocate tight glycemic control while avoiding hypoglycemia.
Target blood glucose concentration(from medical literature)
- American Diabetes Association – 140–180 mg/dL
- American Association of Clinical Endocrinologists – 140–180 mg/dL
- Surviving Sepsis Campaign – 150–180 mg/dL
- American College of Physicians – 140–200 mg/dL
- American Thoracic Society - less than 180 mg/dL (in patients with heart surgery)
- What evidence supports recommended blood glucose targets?
The first randomized controlled trial (RCT) comparing tight glycemic control (target blood glucose 80–110 mg/dL) with conventional insulin therapy (target blood glucose 180–200 mg/dL) was conducted by Van den Berghe and his colleagues (2001). This single-center study included more than 1,500 surgical patients in the intensive care unit and showed a 34% reduction in mortality associated with tight glycemic control. However, subsequent studies did not show a significant reduction in mortality with strict glycemic control. A meta-analysis of an RCT including 8432 critically ill adults found no significant difference in mortality between the strict glycemic control and control groups.
- What is the NICE-SUGAR study?
NICE-SUGAR (Normoglycemia in Intensive Care Evaluation – Survival Using Glucose Algorithm Regulation) was a multicentre, multinational RCT that assessed the effects of tight glycemic control (target glucose 81–108 mg/dL) and standard glucose control (180 mg/dL) on a number of clinical outcomes in 6104 critically ill adult patients, more than 95% of whom required mechanical ventilation. 90-day mortality was significantly higher in the strict glycemic control group.
Cardiovascular mortality and severe hypoglycemic events were also more common in the strict glycemic control group. The results of the NICE-SUGAR trial have led to a shift from tight glycemic control to standard control in critically ill patients, with therapy now targeting glucose levels between 140 and 180 mg/dL.
- How should the transition from intravenous insulin infusion to subcutaneous injections be made?
Patients should be switched from insulin infusion to subcutaneous injections when clinically stable. It has been shown that in patients eating meals, once or twice a day administration of basal insulin, administration of short-acting insulin in combination with a planned meal and an additional (corrective) component provides adequate glycemic control without clinically significant hypoglycemia.
Subcutaneous insulin therapy should be started at least 2 hours before stopping the insulin infusion to reduce the risk of hyperglycemia. The use of a sliding scale insulin regimen as the sole treatment for hyperglycemia is ineffective and should be avoided.
- How is hypoglycemia diagnosed?
Hypoglycemia is defined as a blood glucose level of less than 70 mg/dL. This level correlates with the initial release of contrainsular hormones. Cognitive impairment occurs when the blood glucose concentration is about 50 mg/dL, and severe hypoglycemia occurs when the blood glucose concentration is less than 40 mg/dL.
- What is the clinical impact of hypoglycemia?
Hypoglycemia is associated with increased mortality, although whether it serves as a disease marker or a causative factor remains to be established. Patients with diabetes who experience episodes of hypoglycemia during hospitalization have longer hospital stays and higher treatment costs than similar patients without hypoglycemia.
Insulin-mediated hypoglycemia and subsequent endothelial damage, hypercoagulability, and the release of counterinsular hormones are all associated with an increased risk of cardiovascular events and sudden death. The true incidence of inpatient hypoglycemia is underestimated due to the lack of standardized definitions and varying data collection and reporting models between hospitals.
- How to prevent severe hypoglycemic conditions in the intensive care unit?
Severely ill patients often fail to report symptoms of hypoglycemia; therefore, it is important that patients are closely monitored. Early recognition and treatment of mild hypoglycemia may prevent adverse outcomes associated with severe hypoglycemia. Establishing a system for documenting the frequency and severity of hypoglycemic conditions and implementing protocols that standardize the treatment of hypoglycemia are critical components of an effective glycemic management program.
- What are the economics of glycemic control?
Intensive treatment of hyperglycemia not only reduces morbidity and mortality, but is also cost-effective. Cost savings were due to reduced laboratory and radiology costs, reduced time on mechanical ventilation, and reduced length of stay in the intensive care unit and hospital.
Key points
- Hyperglycemia is common in critically ill patients and is an independent predictor of increased mortality in the ICU.
- Oral and non-insulin injectable medications should not be used to control hyperglycemia in critically ill patients.
- Intravenous insulin infusion is the safest and most effective treatment for hyperglycemia in critically ill patients.
- For critically ill patients, a glycemic target of 140 to 180 mg/dL is recommended.
- Early recognition and management of mild hypoglycemia may prevent adverse outcomes associated with severe hypoglycemia.
Matthew P. Gilbert and Amanda Fernandes
Polly E. Parsons
CRITICALCARESECRETS
Glycemia is an indicator that determines the amount of sugar in the blood. It is very important to control this parameter, since the activity of the brain and the body itself depends on its operation. Doctors distinguish between low, high and normal glycemic levels.
The consequences of its change can be very different, up to the patient falling into a coma. It must be remembered that only a qualified doctor can help make a diagnosis and prescribe effective treatment.
Classification of the disease
Medicine distinguishes 2 main types of disease, taking into account pathological disorders:
- Hyperglycemia.
Each of these types is determined by a certain level of sugar in the blood. In addition, each has characteristic features.
Hypoglycemia occurs in patients who follow strict diets or undergo intense physical activity. Glycemia in diabetes mellitus in most patients develops because the dose of insulin for the patient was incorrectly selected.
Characteristic signs of this form of the disease are:
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- hunger;
- vomit;
- weakness of the whole body;
- arrhythmia worries;
- increased arousal state;
- dizziness;
- impaired coordination of movement.
Qualified help should not be neglected. Only a doctor knows what it is and how to fight the disease. There is a risk of causing serious problems in the patient’s health. He may not only lose consciousness, but also fall into a coma..
Hyperglycemia is more common among those with diabetes. Hyperglycemia is accompanied by pronounced symptoms. This:
- strong thirst;
- polyuria;
- fatigue;
- itching on the skin.
Symptoms
There are no signs of glycemia if the amount of glucose does not exceed the established norm. At the same time, the body works well and copes well with any stress. If the parameters recognized as normal are violated, characteristic symptoms of glycemia occur:
- the patient is constantly thirsty;
- itching appears on the skin;
- the patient is bothered by frequent urination;
- the person becomes irritable;
- gets tired quickly;
- sometimes loses consciousness.
More serious situations may result in coma. Most often, fasting glycemia worries people who have diabetes mellitus.
As a rule, after eating, blood sugar levels rise because there is not enough insulin in the body. The same applies to the situation when this substance is more than enough. Medicine calls this phenomenon “postprandial glycemia.”
If your blood sugar is low, it is a sign of hypoglycemia. Pathology can develop in a completely healthy person, for example, after serious physical activity or against the background of a strict diet. Hypoglycemia is also a concern for people with diabetes, and also if the insulin dose is chosen incorrectly.
When an overdose is observed, the accompanying symptoms will indicate this:
- the patient feels severe hunger and nausea;
- feeling dizzy, feeling general weakness of the body;
- coordination is impaired;
- in the most difficult situations, coma or loss of consciousness can be provoked.
How to determine the disease
Modern medicine provides 2 main methods to determine the level of glycemia. Can:
- Take a blood test.
- Perform a glucose tolerance test.
In the first case, a disorder is detected on an empty stomach. But this method is not reliable enough to give an accurate answer. But quite common.
It is used to determine the level of glucose in the blood; it is taken for analysis 8 hours after the start of fasting. As a rule, the procedure is carried out in the morning. Experts take blood from a finger.
Impaired glycemia is accompanied by elevated blood sugar levels, but the parameters are at acceptable levels. To get an accurate test result, the patient should not take medications; they can affect hormonal levels.
Important! To obtain the most accurate information, the patient should undergo at least two procedures on different days to avoid the slightest inaccuracy.
The second method provides a specific algorithm:
- Donate blood on an empty stomach.
- Take 75 g of glucose.
- Do a repeat blood test after 2 hours.
Treatment
Only a specialist can make an accurate diagnosis, prescribe treatment and other therapeutic measures. As a rule, if the case is not too advanced, it is enough to adjust your lifestyle. In more serious situations, the doctor prescribes medication.
Diet is one of the main components of complex therapy. Patients suffering from diabetes are required to carefully monitor the glycemic index and eat only those foods that have a low glycemic index. For any form of the disease, strict recommendations must be followed:
- Give preference to fractional meals. Eat often, but in small portions.
- The menu should include carbohydrates of a complex group. They will be absorbed for a long time, providing the body with the necessary energy.
- You should avoid foods such as sugar and white flour products.
- Limit fat intake.
- Eat enough protein.
During the course of treatment, do not forget about physical activity, especially if it accompanies weight loss. Foreign researchers have proven that moderate weight loss, as well as walking every day, help to significantly reduce the risk of glycemic disease.
An attack can also be triggered by other diseases, so the disease can be discovered completely by accident. In this case, even if the patient feels great, you should not refuse effective treatment.
Often the pathology can be transmitted hereditarily. Therefore, people who are at risk need to periodically test their blood for glycemia. This applies to all patients who are at risk of developing endocrine diseases.
Possible consequences of the disease
The connection between glycemia and diabetes is quite close; many people do not know why this disease is dangerous. They do not ask this question, especially when the pathology is just beginning to develop. The person is not sick yet, but there are already changes in his blood.
As a rule, the latent form of diabetes is accompanied by a slight increase in blood sugar levels. And this is a fairly important sign that indicates that the disease is beginning to develop.
Medical professionals do not consider glycemia a disease. Rather, it is a consequence of any other pathology, which can lead to more complex disorders in the body.
Diabetes mellitus is a disease that develops as a result of improper functioning of the pancreas. It can also be caused by the hormone insulin, which is not enough in the body.
If the blood glucose level is exceeded, carbohydrate metabolic processes are disrupted. First, the pathology affects the cells, and then the entire body as a whole. Once carbohydrate metabolism changes, protein, lipid and water balance is disrupted.
The danger is that blood is a transport system in the human body; an excess or deficiency of any of its components will immediately make itself felt.
Thus, the nutritional process of the cells will be disrupted, they will perform their functions worse, and subsequently die. For the skin, this means dryness, lifelessness, flaking, as cells die. Vision will deteriorate and hair will begin to fall out. Poor wound healing will lead to the appearance of boils and carbuncles.
For the circulatory system, the consequence will be dangerous and unwanted atherosclerosis. Most often, disorders affect the arteries in the legs. Poor nutrition and lack of oxygen will cause the death of not only cells, but also tissues. The result will be lameness or gangrene.
Complications for pregnant women
The disease can harm not only a pregnant woman, but also her unborn child. Glycemia in pregnant women is in most cases accompanied by disorders associated with blood circulation. The expectant mother has problems with memory and thinking. And after giving birth, there is a risk that she will develop diabetes.
Glycemia can have negative consequences not only for the woman, but also for the unborn baby:
- incomplete development, which will disrupt the functioning of the nervous system;
- an increase in fetal weight, then the patient is prescribed a cesarean section;
- the functions of the placenta are disrupted;
- there is a threat of miscarriage.
Important! It is better to identify pathology before pregnancy. This way you can prevent your child from developing diabetes.
Glycemia is accompanied by various symptoms, so it is easy to confuse it with other diseases. A violated norm causes the same symptoms as neuroses or depression. That is why doctors recommend conducting research whenever possible.
In this way, you can not only prevent the disease, but also take action if the pathology is at an early stage of development. The doctor will tell you what it is, diagnose it and prescribe effective treatment.
Marina Pozdeeva on the selection of hypoglycemic therapy
Marina Pozdeeva
General information: what is glycemia in diabetes mellitus
Type 2 diabetes is characterized by a constant deterioration in beta cell function, so treatment should be dynamic, involving a gradual increase in drug intervention as the disease progresses. Ideally, blood glucose levels should be maintained within limits close to normal: before meals, blood glucose is 5–7 mmol/l and glycated hemoglobin (HbA1c) less than 7 %. However, hypoglycemic therapy alone does not provide adequate treatment for patients with type 2 diabetes. Monitoring lipid levels and blood pressure is necessary.
Aggressive glucose lowering is not the best strategy for a wide range of patients. Thus, in patients at high risk of cardiovascular disease, reducing HbA1c levels to 6 % or lower may increase the risk of cardiovascular disaster.
Treatment of type 2 diabetes should be based on individual risk stratification. A study by a team led by Frieda Morrison, published in the Archives of Internal Medicine, 2011, showed that in patients who visited an endocrinologist every two weeks, blood glucose, HbAc1 and LDL levels fell faster and were better controlled than in patients who Visit your doctor once a month or less. The patient himself makes a significant contribution to the success of treatment by following a diet and following lifestyle recommendations.
Pharmacotherapy for type 2 diabetes
Early initiation of pharmacotherapy for type 2 diabetes helps improve glycemic control and reduces the likelihood of long-term complications. As for the question of how to treat type 2 diabetes and what specific drugs to use, everything will depend on the chosen treatment regimen.
Diabetes mellitus type 2 (DM 2) is characterized by hyperglycemia, which develops as a result of a combination of disorders, including:
- tissue insulin resistance;
- insufficient secretion of insulin;
- excessive or inadequate secretion of glucagon.
Metformin
Metformin is the drug of choice for monotherapy, as well as the leading drug in combination treatment for type 2 diabetes mellitus. Its advantages include:
- efficiency;
- no weight gain;
- low likelihood of hypoglycemia;
- low level of side effects;
- good tolerance;
- low cost.
Scheme 1. List of hypoglycemic drugs used for type 2 diabetes mellitus
The dose of metformin is titrated over 1–2 months, determining the most effective method of selection. The therapeutically active dosage is at least 2000 mg metformin per day. To reduce the risk of side effects from the gastrointestinal tract, the drug is taken during or after meals several times a day.
Metformin reduces the risk of developing dementia associated with type 2 diabetes. This was proven in a large 2013 study involving 14,891 patients, divided into four groups depending on which drug they took. Throughout the experiment, patients received monotherapy with metformin, sulfonylureas, thiazolidinediones and insulins. Within five years of starting metformin treatment, dementia was diagnosed in 1487 (9 %) patients. This is 20% lower than the sulfonylurea group and 23% lower than the thiazolidinediones group (data from Colayco DC, et al., Diabetes Care, 2011).
Two-component treatment regimen
If within 2–3 months of monotherapy with metformin it was not possible to achieve a stable reduction in blood glucose levels, another drug should be added. The choice should be based on the individual characteristics of the patient. According to the recommendations of the American Association of Clinical Endocrinologists, published in the journal Endocrine Practice in 2009, it is better to give preference to:
- DPP-4 inhibitors - when glucose levels rise both on an empty stomach and after meals;
- GLP-1 receptor agonists - with a significant increase in blood glucose after meals;
- thiazolidinediones — in the treatment of patients with metabolic syndrome and/or non-alcoholic fatty hepatosis.
Discontinuation of oral medications and insulin monotherapy in type 2 diabetes is associated with weight gain and hypoglycemia, while combination treatment reduces these risks.
Table 1. Groups of medications used for type 2 diabetes mellitus
Table 2. List of medications (tablets, solutions) used for type 2 diabetes mellitus
Triple therapy for type 2 diabetes
If two-component therapy is ineffective, another, third hypoglycemic drug is added within 2-3 months. It could be:
- an oral drug belonging to a different class of hypoglycemic agents than the first two components of the treatment regimen;
- insulin;
- injectable exenatide. Drugs from the thiazolidinedione group are not recommended as a third drug in the regimen. Thus, data from the American Endocrinology Association indicate an increased risk of myocardial infarction in patients taking roxiglitazone. Therefore, it is recommended to be prescribed only to those patients who cannot control their glucose levels with other drugs.
In patients at high risk for cardiovascular disease, reducing HbA1c levels to 6 % or lower may increase the risk of cardiovascular disaster. Thus, an observation of a group of 44,628 patients conducted by American scientists led by Danielle C. Colayco showed that patients with an HbA1c level of less than 6 % had cardiovascular problems 20 % more often than patients with an average HbA1c level 6–8 %.
Published in Diabetes Care, 2011An experiment conducted by the ACCORD (Action to Control Cardiovascular Risk in Diabetes) research group showed that a drop in HbAc1 levels below 6% in patients at risk led to an increase in five-year mortality from myocardial infarction.
Data from researchers led by Gerstein HC, published in The new England journal of medicine, 2011
Regarding another well-known thiazolidinedione, pioglitazone, there has also been alarming information about an increased risk of developing bladder cancer with its use. The American Drug Regulatory Association (FDA) does not recommend prescribing pioglitazone to patients with a history of bladder cancer.
GLP1 receptor agonists have a different mechanism of action from other hypoglycemic drugs. They mimic endogenous incretin GLP-1 and thus stimulate glucose-dependent insulin release. In addition, GLP1 receptor agonists help reduce glucagon levels.
The combination of exenatide—the best-known drug in this group—with one or two oral medications (for example, metformin and/or sulfonylureas) is attractive for its simplicity and high effectiveness.
Insulin as a supplement
Many patients with type 2 diabetes whose disease cannot be controlled with oral hypoglycemic drugs require insulin therapy. For type 2 diabetes, the combination of oral blood sugar-lowering medications and insulin is effective in lowering blood glucose levels.
It is advisable to add a single morning injection of medium- or long-term insulin to oral hypoglycemic agents. This approach may provide better glycemic control with lower doses of insulin.
A group of British scientists led by Nicholas A. Wright, in a six-year randomized trial, proved that discontinuation of oral medications and insulin monotherapy in type 2 diabetes is associated with the likelihood of weight gain and hypoglycemia, while combination treatment reduces these risks. The experimental data were published in Internal Medicine in 1998.
Insulin can be used in individuals with severe hyperglycemia, and can also be prescribed temporarily during periods of general illness, pregnancy, stress, a medical procedure or surgery. As type 2 diabetes progresses, the need for insulin increases and additional doses of basal insulin (medium- and long-acting) as well as bolus insulin (short- or rapid-acting) may be needed.
When deciding which oral hypoglycemic agents are best to combine insulin with, one should be guided by the general principles of constructing a multicomponent treatment regimen for type 2 diabetes. It is known, for example, that adding insulin before bed during treatment with metformin leads to weight gain half as often as combined treatment with insulin and sulfonylureas or double insulin monotherapy (data from H. Yki-Järvinen L. Ryysy K. Nikkilä, Internal Medicine, 1999).
During treatment with bolus insulin, it is necessary to discontinue oral medications that enhance insulin secretion (sulfonylureas and meglitinides). In this case, metformin therapy should be continued.
obstetrics and gynecology Articles
Glycemic control during pregnancy in women with diabetes
2013-07-23Monitoring glycemia (blood glucose levels) for people with diabetes mellitus (DM) is now a daily routine, like washing or eating. However, it is structured self-monitoring of blood glucose levels that gives the patient and doctor an understanding of the individual impact of different foods, insulin doses and physical activity on blood glucose levels and the ability to intelligently change treatment tactics to improve control of the disease and prevent its complications.
Why is it important to control your glucose levels?
During pregnancy, structured self-control is more important than ever. Even well-chosen and proven treatment regimens for diabetes mellitus before pregnancy have to be constantly adjusted due to sudden hormonal changes while expecting a baby. In addition, depending on the time of day and stage of pregnancy, the need for insulin, which is necessary for the absorption of glucose from different foods, and sensitivity to this hormone constantly changes. However, in a pregnant woman without diabetes, fluctuations in blood glucose levels during the day are within very narrow limits, from 3.3 to 6.6 mmol/l.
In the presence of diabetes, the main source of complications during pregnancy is elevated blood glucose levels. Research convincingly proves that stable compensation of diabetes 2-4 months before conception and while expecting a child not only sharply reduces the risk of any consequences, but often allows them to be completely avoided. Typically, pregnancy lasts about 40 weeks, counting from the first day of the last menstrual period. If a woman did not plan a pregnancy, then most often she finds out about it 2-3 weeks after the next menstruation is missed. With decompensated diabetes, the menstrual cycle may be irregular, and the woman finds out about pregnancy much later, already in the 2nd or 3rd month. By this time (before the 7th week), all the vital internal organs of the fetus have already formed, and organ systems begin to form. Therefore, all possible complications in the child associated with decompensation of diabetes in the mother may develop by the time the fact of pregnancy is actually established. That is why it is so important to have normal blood glucose levels before it occurs. Therefore, planning pregnancy with diabetes first of all means excluding the possibility of its occurrence until stable compensation of carbohydrate metabolism is achieved and maintained for at least 2-4 months before conception.
Self-control
To achieve stability in the course of diabetes, it is necessary to self-monitor blood glucose levels at least 7-8 times a day: on an empty stomach, before and after main meals, before bedtime and at 3 am. What determines the need for such frequency of analysis? The fact is that for normal fetal development, a woman with diabetes must have almost the same blood glucose levels as a pregnant woman without diabetes. Therefore, the latest recommendations from leading diabetes organizations have set glycemic targets for expectant mothers with diabetes.
|
Index/ Glycemia (control time) |
Standards for plasma-calibrated blood glucose meters (mmol/L) |
Control frequency |
|
daily |
|
|
daily |
|
|
daily |
|
|
daily |
|
|
daily |
|
|
daily |
|
|
Ketone bodies |
daily |
|
|
every 6 weeks |
||
|
Episodes of hypoglycemia |
absence |
|
*Algorithms for specialized medical care for patients with diabetes, 2013.
Such values can be achieved only with constant self-monitoring using individual devices - glucometers. The use of other means of control that give an “approximate” blood glucose level during pregnancy is unacceptable. Even a slight but chronic increase in blood glucose levels is the main cause of the development of diabetic fetopathy - a complex of severe complications and diseases of the child associated with decompensated diabetes of the mother during pregnancy. In addition, poor compensation of diabetes provokes the occurrence of acute complications of diabetes in the mother, for example, ketoacidosis or severe hypoglycemia. Only after receiving an accurate result of the blood glucose level using a glucometer can you respond to its increase in time: give an additional injection of insulin, select the correct dose of the drug, change your diet and the intensity of physical activity.
Compensation for diabetes largely depends on the accuracy of the glucometer readings, since the measurement results obtained serve as a guideline for changing the treatment plan. During pregnancy, it is most optimal to use blood glucose meters calibrated using blood plasma. The indicators of such devices correspond to the reference methods of high-quality laboratory equipment, which allows you to determine blood glucose levels with maximum accuracy in each individual case.
Does the above mean that an expectant mother with diabetes should quit her job, her hobbies and devote herself entirely to blood sugar control during planning and pregnancy? Of course not! The use of modern glucometers, such as Accu-Chek Mobile, allows you not only to quickly and almost painlessly obtain a reliable and accurate result of your blood glucose level, but also to do this with maximum comfort and unnoticed by others. The uniqueness of the glucometer lies in the complete refusal to use single test strips and their further disposal. Technology without test strips makes it possible to simplify the process of measuring blood glucose as much as possible and make it possible to carry it out almost anywhere and at any time (at work, in a cafe, on public transport), without attracting the attention of others. Accu-Chek Mobile contains a test cassette with 50 tests on a continuous tape, as well as a lancing device with lancets in the drum, that is, all the components necessary for measuring glycemia are integrated in one device. Therefore, the process of measuring glycemia requires fewer simple steps to obtain an accurate result: no need to take out the strip, change the lancet, and also dispose of them each time (dropping, picking up, etc.). The test cassette and lancet drum remain in the meter until all 50 tests and 6 lancets have been used.
In the Accu Chek Mobile glucometer, you can program a reminder to measure your glucose level 1 hour, 1.5 hours or 2-3 hours after a meal, which is especially important during pregnancy when eating foods with different glycemic indexes. In addition, the device program can note when each blood glucose value was measured - before or after a meal, setting a target glycemic range so that the meter reports results above or below the target values. Included with the glucometer, the user has a USB cable for connecting the device to a computer. Now, at any convenient time, you can see reports on your blood glucose levels, displayed in the form of detailed and intuitive graphs, without the need to meticulously record the results of measurements in a self-monitoring diary. Analysis of data together with your doctor will help you quickly identify problem areas and make the right decisions on changing treatment. Large memory capacity, calculation of average glycemic values over the past few days, weeks and months, graphical display of glycemia before and after meals, the ability to transfer data to a personal computer - these features of the new generation glucometer allow young women with diabetes to feel comfortable and safe in the modern world during the exciting 9 months of pregnancy.
You can hear the opinion that a healthy child with maternal diabetes is an accident, luck, an isolated incident. In fact, this is a lot of work and patience of the expectant mother, and with the help of modern technologies, this is a really achievable result.
The material was prepared by N. Yu. Arbatskaya, Ph.D., Associate Professor of the Department of Endocrinology and Diabetology of the Federal Institution of Internal Affairs of the Russian National Research Medical University named after. N.I. Pirogova, endocrinologist, Perinatal Medical Center, Moscow.
Synonyms: Diabetes mellitus
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- Description
- Compound
- Decoding
- Why Lab4U?
Period of execution
The analysis will be ready within 1 day, excluding Saturday and Sunday (except for the day of taking the biomaterial). You will receive the results by email. mail immediately when ready.
Completion time: 2 days, excluding Saturday and Sunday (except for the day of taking biomaterial)Preparing for analysis
In advanceDo not take a blood test immediately after radiography, fluorography, ultrasound, or physical procedures.
IMPORTANT: The level of the indicator in the blood can change significantly during the day, so for taking the test, select the interval from 8.00 to 11.00.
To check the dynamics of the indicator, select the same analysis intervals each time.
Discuss with your doctor the intake of medications the day before and on the day of the blood test, as well as other additional preparation conditions.
The day before24 hours before blood collection:
Limit fatty and fried foods, do not drink alcohol.
Avoid heavy physical activity.
From 8 to 14 hours before donating blood, do not eat food, drink only clean, still water.
On the day of deliveryDo not smoke 60 minutes before blood sampling.
Be in a calm state for 15-30 minutes before taking blood.
Analysis information
Material for research - Venous blood with EDTA, EDTA plasma + glucose stabilizer
Composition and results
- Composition of a comprehensive study
Diabetes mellitus (glycemic control)
It is very important when managing patients with diabetes to achieve optimal blood glucose levels. The patient can monitor blood glucose levels independently (using portable glucometers) or in the laboratory. The result of a single determination of glucose in the blood shows the concentration of glucose at the time of collection, so it is not possible to make any assumptions about the state of the patient’s carbohydrate metabolism between measurements. It is possible to assess a patient’s carbohydrate metabolism over a long period of time only by determining the concentration of glycosylated hemoglobin (HbA1c) in the blood. This comprehensive study is recommended for patients with diabetes to monitor the state of carbohydrate metabolism and blood glucose levels.
The American Diabetes Association (1999) recommends that patients whose therapy has been successful (stable levels of carbohydrate metabolism) undergo an HbA1c test at least 2 times a year, while in the case of a change in diet or treatment, the frequency of testing should be increased to 4 times a year. x times a year. In the Russian Federation, according to the Targeted Federal Program “Diabetes Mellitus,” HbA1c testing is recommended for patients with diabetes mellitus at least 4 times a year for any type of diabetes.
Interpretation of the results of the study "Diabetes mellitus (glycemic control)"
Interpretation of test results is for informational purposes only, is not a diagnosis and does not replace medical advice. Reference values may differ from those indicated depending on the equipment used, the actual values will be indicated on the results form.
The goal of glucose-lowering therapy for diabetes is to normalize blood glucose levels. DCCT studies (DCCT Research Group, 1993) have shown that intensive treatment protects the patient from the development of long-term complications such as retinopathy, nephropathy and neuropathy or significantly delays their clinical manifestation. If patients strictly adhere to a regimen aimed at normalizing carbohydrate metabolism, the incidence of retinopathy is reduced by 75%, nephropathy by 35-36%, and the risk of polyneuropathy is reduced by 60%.
Below are the therapeutic goals for the treatment of diabetes mellitus according to the Targeted Federal Program “Diabetes Mellitus”.
|
Name of the study |
Reference values |
Adequate level |
Inadequate |
|
|
4,0 - 5,0
|
5,1 - 6,5
| |||
|
2 hours after eating |
4,0 - 7,5
|
7,6 - 9,0
| ||
|
before bedtime |
4,0 - 5,0
|
6,0 - 7,5
| ||
Table 1. Therapeutic goals in the treatment of type 1 diabetes mellitus.
|
Name of the study |
Low risk |
Risk |
Risk |
|
|
Self-monitoring of blood glucose, mmol/l (mg%) | ||||
|
2 hours after eating | ||||
Table 2. Therapeutic goals in the treatment of type 2 diabetes mellitus.
Lab4U is an online medical laboratory whose goal is to make tests convenient and accessible so that you can take care of your health. To do this, we eliminated all costs for cashiers, administrators, rent, etc., directing the money to the use of modern equipment and reagents from the world's best manufacturers. The laboratory has implemented the TrakCare LAB system, which automates laboratory tests and minimizes the influence of the human factor
So, why without a doubt Lab4U?
- It is convenient for you to select assigned analyzes from the catalog or in the end-to-end search line; you always have at hand an accurate and understandable description of preparation for analysis and interpretation of results
- Lab4U instantly generates a list of suitable medical centers for you, all you have to do is choose the day and time, near your home, office, kindergarten or along the way
- You can order tests for any family member in a few clicks, entering them once into your personal account, quickly and conveniently receiving the results by email
- Analyzes are up to 50% more profitable than the average market price, so you can use the saved budget for additional regular studies or other important expenses
- Lab4U always works online with every client 7 days a week, this means that your every question and request is seen by managers, it is due to this that Lab4U is constantly improving its service
- An archive of previously obtained results is conveniently stored in your personal account, you can easily compare the dynamics
- For advanced users, we have created and are constantly improving a mobile application
We have been working since 2012 in 24 cities of Russia and have already completed more than 400,000 analyzes (data as of August 2017)
The Lab4U team is doing everything to make this unpleasant procedure simple, convenient, accessible and understandable. Make Lab4U your permanent laboratory