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Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

294
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...
294
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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Oral Hypoglycemic Agents: α-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are...
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Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

183
Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
183
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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Oral Hypoglycemic Agents: Biguanides and Glitazones01:26

Oral Hypoglycemic Agents: Biguanides and Glitazones

230
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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Improving IV Insulin Administration in a Community Hospital
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Pharmacy stewardship to reduce recurrent hypoglycemia.

Madison Wood, Jessica Moses, Diana C Andrade

    Journal of the American Pharmacists Association : Japha
    |September 11, 2023
    PubMed
    Summary

    Pharmacist-led reviews of inpatient hypoglycemia alerts significantly reduced recurrent hypoglycemic events by 5.1%. This initiative improves patient safety by identifying causes and modifying therapy, demonstrating the value of pharmacist intervention in glycemic control.

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    Area of Science:

    • Inpatient glycemic management
    • Clinical pharmacy services
    • Patient safety initiatives

    Background:

    • Inpatient hypoglycemia increases morbidity and mortality, with a higher likelihood of subsequent episodes after an initial event.
    • The Joint Commission mandates root-cause analysis for all hypoglycemia episodes.
    • Pharmacist involvement in glycemic control protocols is proven to prevent hypoglycemia.

    Purpose of the Study:

    • To assess the impact of pharmacist real-time assessment of hypoglycemia using electronic alerts on reducing recurrent hypoglycemic events during hospitalization.

    Main Methods:

    • A single-center retrospective observational study compared pre- and post-implementation phases (2020 vs. 2021).
    • Electronic health record (EHR) alerts triggered by blood glucose < 70 mg/dL and recent hypoglycemic agent administration were reviewed by pharmacists.
    • Statistical analysis included t-tests and chi-square tests to compare outcomes.

    Main Results:

    • A 5.1% absolute reduction in recurrent hypoglycemic events was observed post-implementation (P < 0.001).
    • There was a 0.6% reduction in severe hypoglycemic days (P = 0.269).
    • Pharmacist intervention occurred within 4 hours, with a 92% acceptance rate of recommendations.

    Conclusions:

    • Pharmacist-led reviews of hypoglycemia are effective in reducing recurrent hypoglycemic events in hospitalized patients.
    • This initiative highlights the critical role of pharmacists in enhancing inpatient glycemic control and patient safety.