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Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
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Insulin: Dosing Regimen and Adverse Effects01:16

Insulin: Dosing Regimen and Adverse Effects

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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
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SBAR II: Application of SBAR01:14

SBAR II: Application of SBAR

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SBAR is an effective communication tool used by healthcare professionals to communicate patient information accurately. SBAR stands for Situation, Background, Assessment, and Recommendation. For a better understanding, an example is given below.
SBAR Report from a Nurse to a Health Care Provider
S: "Hello, Dr. Smith. This is Jane, RN, from the Med Surg unit. I am calling to tell you about Ms. White in Room 210, who is experiencing increased pain and redness at her incision site. Her recent...
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Dosage Regimen: Individualization01:24

Dosage Regimen: Individualization

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Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
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Diabetes Mellitus: Type 2 and Gestational01:22

Diabetes Mellitus: Type 2 and Gestational

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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Related Experiment Video

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Improving IV Insulin Administration in a Community Hospital
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Individualizing Glycemic Control in the Critically Ill.

Claire V Murphy1, Lina Saliba, Jennifer MacDermott

  • 1Department of Pharmacy, The Ohio State University Wexner Medical Center (Dr Murphy), Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University (Dr Dungan), and Riverside Methodist Hospital (Ms MacDermott), Columbus, Ohio; Department of Pharmacy, Yale New Haven Hospital, New Haven, Connecticut (Dr Saliba); and Department of Internal Medicine, Division of Endocrinology, The University of Texas Southwestern Medical Center (Dr Soe) and VA North Texas Healthcare System (Dr Soe), Dallas, Texas.

Critical Care Nursing Quarterly
|December 3, 2019
PubMed
Summary
This summary is machine-generated.

Managing blood glucose in critically ill patients is complex. Individualized targets and advanced monitoring may be needed for optimal outcomes, balancing hyperglycemia and hypoglycemia risks.

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Area of Science:

  • Critical care medicine
  • Endocrinology
  • Metabolic disorders

Background:

  • Hyperglycemia is prevalent in critically ill patients, impacting outcomes.
  • Landmark studies initially supported tight glucose control (80-110 mg/dL).
  • Both hyperglycemia and hypoglycemia are linked to increased morbidity and mortality.

Purpose of the Study:

  • To review evidence on glycemic control in critically ill patients.
  • To discuss the need for individualized glucose targets.
  • To explore advanced glucose management strategies.

Main Methods:

  • Review of landmark studies and recent literature on glycemic control.
  • Analysis of factors influencing glycemic control outcomes (e.g., diabetic status, variability).
  • Discussion of limitations of traditional glucose monitoring and insulin titration.

Main Results:

  • Tight glycemic control (80-110 mg/dL) benefits are debated due to hypoglycemia risks.
  • Euglycemia (≤180 mg/dL) shows improved outcomes but hypoglycemia risk persists.
  • Individual patient characteristics and glycemic variability impact outcomes.

Conclusions:

  • Optimal glycemic targets in critically ill patients remain unclear.
  • Individualized glucose targets are increasingly supported by emerging data.
  • Continuous glucose monitoring and computerized algorithms may be necessary for complex glycemic control.