Insulin pump therapy: A guide for non-specialist staff (2019)

Type of publication:
Journal article

Author(s):
*Richardson, Erica A.

Citation:
Journal of Diabetes Nursing; Jan 2019; vol. 23 (no. 1); p. 1-7

Abstract:
With the growing use of insulin pump therapy worldwide, healthcare professionals from all sectors will see more and more people with diabetes who are currently using this therapy. Although NICE guidance stipulates that this cohort should be cared for by a “specialist team”, healthcare professionals from all sectors are increasingly likely to care for these individuals. Therefore, training in the basic functions and principles of this kind of therapy can help us to support them, signpost them to services and involve relevant healthcare teams, to ensure they receive the best quality care and support to effectively manage their diabetes. This article provides basic information for nonspecialist staff to help them identify patients who may be suitable for this therapy,
identify emergency situations and signpost to appropriate services.

Steroid-induced diabetes and hyperglycaemia. Part 1: mechanisms and risks (2018)

Type of publication:
Journal article

Author(s):
*Morris, David

Citation:
Diabetes & Primary Care; Aug 2018; vol. 20 (no. 4); p. 151-153

Abstract:
Glucocorticoids are prescribed widely in primary care for the treatment of a range of conditions. Courses of treatment are usually short, but around 22% of use continues for over 6 months. As well as their therapeutic actions, glucocorticoids have a powerful impact on glucose metabolism, contributing to hyperglycaemia and a predisposition to diabetes. In the first of two articles on steroid-induced hyperglycaemia and diabetes, the author outlines the scale of the problem and explains the mechanisms by which glucocorticoids induce hyperglycaemia. High-risk situations are identified, and the short- and long-term dangers summarised. The second article will appear in the next issue of this journal.

How accurate is glycated haemoglobin in patients with liver cirrhosis? A case series (2018)

Type of publication:
Conference abstract

Author(s):
*Basavaraju N.; *Rangan S.; *Singh P.; *Moulik P

Citation:
Diabetic Medicine; Mar 2018; vol. 35 ; S1

Abstract:
Introduction: Glycated haemoglobin (HbA1c) is the gold standard for monitoring glycaemic control in patients with diabetes. We present three cases of chronic liver disease where HbA1c may be misleading. Case 1: A 71-year-old Caucasian woman with liver cirrhosis due to hepatitis C, Type 2 diabetes, previous bladder tuberculosis and chronic kidney disease stage 3 was evaluated in clinic. Her capillary glucose (CG) was 6 to 9 mmol/l, no hypoglycaemia. She was anaemic; HbA1c was low at 34mmol/mol. Fructosamine was elevated at 296umol/l (205 to 285). Case 2: A 38-year-old Caucasian man with alcoholic liver cirrhosis, portal hypertension, and Type 2 diabetes was admitted with haematemesis. His CG was 10 to 14 mmol/l and HbA1c 26mmol/mol. He had iron deficiency anaemia, deranged liver enzymes and renal function. Fructosamine was normal at 246umol/l. Case 3: A 65-year-old Caucasian woman with non-alcoholic steatohepatosis/cirrhosis, portal hypertension, Type 2 diabetes, iron deficiency anaemia was admitted with melena. Her CG was 12 to 14mmol/l and HbA1c 44mmol/mol. Results showed acute kidney injury, deranged liver enzymes, normal albumin but low haemoglobin. Fructosamine is awaited. All patients required insulin for management of their diabetes. Discussion: The degree of glycation (glucose binding to N-terminal valine of HbA) is dependent on glycation rate, glucose availability and lifespan of red blood cells. Reference range of HbA1c is based on normal lifespan of RBC. There are very limited studies in evaluating the accuracy of HbA1c in chronic liver disease (CLD). Multiple factors can shorten RBC survival in CLD, including anaemia, portal hypertension, hypersplenism, variceal bleeding, resulting in falsely low HbA1c. Fructosamine, glycated albumin can also be inaccurate. Capillary glucose monitoring should guide glycaemic management.

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