Dextrose 50% versus Dextrose 10% or Dextrose Titration for the Treatment of Out-of-Hospital Hypoglycemia: A Systematic Review

2021 ◽  
pp. 1-9
Author(s):  
Marissa Hurtubise ◽  
Jeffery Stirling ◽  
Jennifer Greene ◽  
Alix JE Carter ◽  
Janel Swain ◽  
...  
Keyword(s):  
Adverse Events ◽  
Post Treatment ◽  
Diabetic Patients ◽  
Significant Finding ◽  
Symptom Resolution ◽  
Glucose Levels ◽  
Pooled Data ◽  
Blood Glucose Levels ◽  
Glycemic Profile ◽  
Mean Time

Abstract Introduction: Paramedics commonly administer intravenous (IV) dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may cause harm and lead to difficulties regulating blood glucose levels (BGLs) post-treatment. It is hypothesized that a lower concentration, such as 10% dextrose (D10), may improve symptoms while minimizing harm. Methods: PubMed, Embase, CINAHL, and Cochrane Central were systematically searched on September 15, 2020. The PRISMA guidelines were followed. GRADE and risk of bias were applied to determine the certainty of the evidence. Primary literature investigating the use of IV dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department was included. Outcomes of interest included safety, efficacy (symptom resolution), and BGL. Results: Of 680 abstracts screened, 51 full-text articles were reviewed, with eleven studies included. Data from three randomized controlled trials (RCTs) and eight observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies, there was greater symptom resolution in the D10 group (95.9%) compared to the D50 group (88.8%). However, the mean time to resolution was approximately four minutes longer in the D10 group (4.1 minutes [D50] versus 8.0 minutes [D10]). There was a greater need for subsequent doses with the use of D10 (19.5%) compared to D50 (8.1%). The post-treatment glycemic profile was lower in the D10 group at 6.2mmol/L versus 8.5mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia: 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/1057) compared to 13/310 adverse events in the D50 group. Conclusion: Studies show D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer, there appear to be fewer adverse events. The post-D10-treatment BGL may result in fewer untoward hyperglycemic episodes.

scholarly journals P088: Dextrose 50% versus dextrose 10% or dextrose titration for the treatment of out-of-hospital hypoglycemia; a systematic review and meta-analysis

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S96-S96
Author(s):  
M. Hurtubise ◽  
J. Greene ◽  
A. Stirling ◽  
A. Carter ◽  
J. Swain ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Adverse Events ◽  
Meta Analysis ◽  
Post Treatment ◽  
Diabetic Patients ◽  
Significant Finding ◽  
Glucose Levels ◽  
Glycemic Profile ◽  
Glucose Management ◽  
Intravenous Dextrose

Introduction: Paramedics commonly administer intravenous dextrose to severely hypoglycemic patients. Typically, the treatment provided is a 25g ampule of 50% dextrose (D50). This dose of D50 is meant to ensure a return to consciousness. However, this dose may be unnecessary and lead to harm or difficulties regulating blood glucose post treatment. We hypothesize that a lower dose such as dextrose 10% (D10) or titrating the D50 to desired level of consciousness may be optimal and avoid adverse events. Methods: We systematically searched Medline, Embase, CINAHL and Cochrane Central on June 5th 2019. PRISMA guidelines were followed. The GRADE methods and risk of bias assessments were applied to determine the certainty of the evidence. We included primary literature investigating the use of intravenous dextrose in hypoglycemic diabetic patients presenting to paramedics or the emergency department. Outcomes of interest were related to the safe and effective reversal of symptoms and blood glucose levels (BGL). Results: 660 abstracts were screened, 40 full text articles, with eight studies included. Data from three randomized controlled trials and five observational studies were analyzed. A single RCT comparing D10 to D50 was identified. The primary significant finding of the study was an increased post-treatment glycemic profile by 3.2 mmol/L in the D50 group; no other outcomes had significant differences between groups. When comparing pooled data from all the included studies we find higher symptom resolution in the D10 group compared to the D50 group; at 99.8% and 94.9% respectively. However, the mean time to resolution was approximately 4 minutes longer in the D10 group (4.1 minutes (D50) and 8 minutes (D10)). There was more need for subsequent doses in the D10 group at 23.0% versus 16.5% in the D50 group. The post treatment glycemic profile was lower in the D10 group at 5.9 mmol/L versus 8.5 mmol/L in the D50 group. Both treatments had nearly complete resolution of hypoglycemia; 98.7% (D50) and 99.2% (D10). No adverse events were observed in the D10 group (0/871) compared to 12/133 adverse events in the D50 group. Conclusion: D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia. Although the desired effect can take several minutes longer there appear to be fewer adverse events. The post treatment glycemic profile may facilitate less challenging ongoing glucose management by the patients.

Nutritional Interventions and Considerations for the Development of Low Calorie or Sugar Free Foods

2020 ◽  
Vol 16 (4) ◽  
pp. 301-312 ◽  
Author(s):  
Jyoti Singh ◽  
Prasad Rasane ◽  
Sawinder Kaur ◽  
Vikas Kumar ◽  
Kajal Dhawan ◽  
...  
Keyword(s):  
Metabolic Disease ◽  
Blood Glucose ◽  
Human Population ◽  
Artificial Sweeteners ◽  
Diabetic Patients ◽  
Nutritional Interventions ◽  
Low Calorie ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Diet Plan

Diabetes is a globally prevalent chronic metabolic disease characterized by blood glucose levels higher than the normal levels. Sugar, a common constituent of diet, is also a major factor often responsible for elevating the glucose level in diabetic patients. However, diabetic patients are more prone to eat sweets amongst the human population. Therefore, we find a popular consumption of zero or low-calorie sweeteners, both natural and artificial. But, the uses of these sweeteners have proved to be controversial. Thus, the purpose of this review was to critically analyze and highlight the considerations needed for the development of sugar-free or low-calorie products for diabetic patients. For this purpose, various measures are taken such as avoiding sugary foods, using natural nectar, artificial sweeteners, etc. It cannot be ignored that many health hazards are associated with the overconsumption of artificial sweeteners only. These sweeteners are high-risk compounds and a properly balanced consideration needs to be given while making a diet plan for diabetic patients.

PERBEDAAN PENGETAHUAN DAN SIKAP PASIEN DIABETES MELLITUS RAWAT INAP RUMAH SAKIT ISLAM SAMARINDA SEBELUM DAN SESUDAH KONSELING GIZI DENGAN MENGGUNAKAN MEDIA AUDIOVISUAL

2017 ◽  
Vol 2 (1) ◽  
pp. 8
Author(s):  
Siswanto Siswanto ◽  
Ismail Kamba ◽  
Siti Aminah
Keyword(s):  
Diabetes Mellitus ◽  
Public Health Problem ◽  
Visual Media ◽  
P Value ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Disease Mortality ◽  
Before And After ◽  
Patients With Diabetes

Diabetes mellitus is one of the communicable diseases that have become a public health problem, not only in Indonesia but also the world. Currently morbidity of diabetes mellitus is increasing every year, where in 2006 there were 14 million people in 2011 and ranks fourth with 773 cases. DM is also a cause of disease mortality by 5.8%. And Samarinda own particular Islamic Hospital years 2009, there were 449 patients with DM, and 2011 an increase in the 1931 patients with diabetes mellitus. To increase patients’ knowledge about diabetes and diabetic patients be directing attitudes that support or positive attitude towards keeping blood glucose levels to remain normal. Methode to use pra eksperiment with one group pretest posttest. individual conseling withAudiovisual media. There is increased knowledge about diabetes diabetic patients before and after intervention with increasing value of 3.77 (p value = 0.000) and increase in attitudes regarding diabetes mellitus diabetic patients with an increase in the value of 5,35 (p value = 0.003). There was an increase in knowledge and attitudes of patients hospitalized with diabetes mellitus hospital after islam samarinda given nutritional counseling using audio-visual media

Effect of Corticosteroid Injections on Blood Glucose Levels in Diabetic Patients

2018 ◽  
pp. 1
Author(s):  
Sylvain Mathieu ◽  
Marion Couderc ◽  
Sandrine Malochet-Guinamand ◽  
Jean-Jacques Dubost ◽  
Anne Tournadre ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Corticosteroid Injections

Investigating the Efficacy of Using Hand Tremors for Early Detection of Hypoglycemic Events: A Scoping Literature Review

2018 ◽  
Vol 62 (1) ◽  
pp. 1211-1215 ◽  
Author(s):  
Karim Zahed ◽  
Farzan Sasangohar ◽  
Ranjana Mehta ◽  
Madhav Erraguntla ◽  
Mark Lawley ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Early Detection ◽  
Diabetic Patients ◽  
Medium Frequency ◽  
Hand Tremor ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Scoping Literature Review ◽  
Continuous Glucose Monitors ◽  
The Relationship

Diabetes is a prevalent condition affecting millions of patients globally. Some diabetic patients suffer from a deadly condition called Hypoglycemia (sudden drop in blood glucose levels). Continuous Glucose Monitors (CGMs) have been the most pervasive tool used to track blood glucose levels but these tools are invasive and costly. While early detection of hypoglycemia has been studied, current approaches do not leverage tremors; which are a primary symptom of hypoglycemia. A scoping review was conducted to understand the relationship between tremors and hypoglycemia, and to document any efforts that utilized tremor signatures non-invasively to detect hypoglycemic events. Findings suggest that hypoglycemic tremors are a medium frequency tremor, more resistant to hypoglycemic impairment than other symptoms, and have not been fully explored yet. This paper also documents the work in progress to utilize a novel wearable device that predicts the onsets of hypoglycemia using hand tremor sensing.

scholarly journals Influence of Nutrition Education with Calendar Method in Diabetic Patients' Blood Glucose

2018 ◽  
Vol 3 (2) ◽  
pp. 72
Author(s):  
Setyoadi Setyoadi ◽  
Heri Kristianto ◽  
Siti Nur Afifah
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Nutrition Education ◽  
Community Health Center ◽  
Control Group ◽  
P Value ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Before And After

Diabetes mellitus is a disease that required good self-management. Noncompliance in diet and meal plans cause the instability of blood glucose levels. Nutrition education calendar method can improve knowledge and ability to consume food that matches the number, hours and types with dietary adjustments listed in the calendar diet. This study aimed to determine the effect of nutrition education calendar method on blood glucose levels of patients with type 2 diabetes mellitus in Community Health Center Pakis Malang. Pre-experimental design one group pretest-posttest with purposive sampling was conducted in this study and sample obtained as many as 21 people. Blood glucose levels were measured before and after the nutrition education calendar methods. Compliance in using calendar method with the observation sheet. Statistical analysis values obtained by Wilcoxon, the p-value of 0.007 (p <0.05). The results of the analysis, 16 respondents showed a decrease in blood glucose levels and 5 respondents experienced an increase in blood glucose levels after the given intervention. It can be concluded that there are differences between blood glucose levels before and after nutrition education calendar method. Differences in blood glucose levels can be influenced by controlling diet respondent in accordance with the calendar method in education, but also antidiabetic drugs, and sports. Should be added to the control group to determine objectively the effect of nutrition education on the calendar method.

scholarly journals Study on the prevalence of dyslipidemia in type 2 diabetes mellitus

2019 ◽  
Vol 6 (3) ◽  
pp. 786
Author(s):  
Eda Dayakar ◽  
C. Sathya Sree ◽  
E. Sanjay
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Diabetic Patients ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Type 2 Diabetic

Background: Diabetes mellitus is a common health problem globally. Dyslipidaemia is a major risk factor to develop cardiovascular disease in diabetics. They present study was undertaken to find out the prevalence of dyslipidaemia in type 2 diabetic patients.Methods: The present study was a cross sectional study consisting of 46 (23 male and 23 female) known type 2 diabetes mellitus patients. Age, gender, duration of diabetes, body mass index (BMI) was recorder in all the diabetic patients.  Fasting blood glucose levels, total cholesterol, triglycerides, HDL, LDL, VLDL levels were measured using standard methods and recorded.Results: The average total cholesterol, triglycerides, LDL, HDL and VLDL were 200±42mg/dl, 169.62±89.79mg/dl, 132.45±36.38mg/dl,39.1±16.6mg/dl and 35.85±17.09mg/dl respectively. The incidence of occurrence of hypercholesterolemia was 58.6% and hypertriglyceridemia 36.9%. Increased levels of LDL were observed in 30 (65.2%) patients and reduced HDL was observed in 43 (93.4%) patients. The incidence rate of dyslipidaemia was higher in female diabetic patients when compared to male diabetic patients.Conclusions: Awareness on the dyslipidaemia and its risk factors should be provided to the type 2 diabetic patients as they are more prone to get cardiovascular disease and lipid profile also should be monitored regularly along with blood glucose levels.

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