Malignant insulinoma hypoglycaemia: complex palliative management

2021 ◽  
pp. bmjspcare-2021-003188
Author(s):  
Lauri Simkiss ◽  
Frances Hakkak ◽  
Rajeev Raghavan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Medical Management ◽  
Glucose Monitoring ◽  
Case Presentation ◽  
Flash Glucose Monitoring ◽  
Malignant Insulinoma ◽  
Frequent Episodes

This case presentation describes a 65-year-old woman with metastatic malignant insulinoma who experienced frequent episodes of hypoglycaemia causing significant distress and burden to her quality of life. The report describes how medical management was altered and how the patient was supported in order to alleviate these burdens. In particular, the report highlights the first documented use of flash glucose monitoring in insulinoma, which was beneficial in reducing the discomfort of lancet use and anxiety associated with hypoglycaemic episodes. This case demonstrates the benefits of an individualised approach, collaboration with other specialisms and recommends further evaluation of the use of flash glucose monitoring in palliative care.

scholarly journals Flash Glucose Monitoring: A Review of the Literature with a Special Focus on Type 1 Diabetes

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 992 ◽  
Author(s):  
Giulia Mancini ◽  
Maria Berioli ◽  
Elisa Santi ◽  
Francesco Rogari ◽  
Giada Toni ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Health Care ◽  
Glycemic Control ◽  
Health Care Professionals ◽  
Glucose Monitoring ◽  
Special Focus ◽  
Flash Glucose Monitoring

In people with type 1 diabetes mellitus (T1DM), obtaining good glycemic control is essential to reduce the risk of acute and chronic complications. Frequent glucose monitoring allows the adjustment of insulin therapy to improve metabolic control with near-normal blood glucose concentrations. The recent development of innovative technological devices for the management of T1DM provides new opportunities for patients and health care professionals to improve glycemic control and quality of life. Currently, in addition to traditional self-monitoring of blood glucose (SMBG) through a glucometer, there are new strategies to measure glucose levels, including the detection of interstitial glucose through Continuous Glucose Monitoring (iCGM) or Flash Glucose Monitoring (FGM). In this review, we analyze current evidence on the efficacy and safety of FGM, with a special focus on T1DM. FGM is an effective tool with great potential for the management of T1DM both in the pediatric and adult population that can help patients to improve metabolic control and quality of life. Although FGM might not be included in the development of an artificial pancreas and some models of iCGM are more accurate than FGM and preferable in some specific situations, FGM represents a cheaper and valid alternative for selected patients. In fact, FGM provides significantly more data than the intermittent results obtained by SMBG, which may not capture intervals of extreme variability or nocturnal events. With the help of a log related to insulin doses, meal intake, physical activity and stress factors, people can achieve the full benefits of FGM and work together with health care professionals to act upon the information provided by the sensor. The graphs and trends available with FGM better allow an understanding of how different factors (e.g., physical activity, diet) impact glycemic control, consequently motivating patients to take charge of their health.

scholarly journals Effect of Using Additional Readers for Flash Glucose Monitoring System on Metabolic Control, Safety, and the Incidence of Complications in Patients With Diabetes Mellitus

2020 ◽  
pp. 193229681990025 ◽  
Author(s):  
Oskar Kublin ◽  
Mariusz Stępień
Keyword(s):  
Quality Of Life ◽  
Metabolic Control ◽  
Online Survey ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Glucose Levels ◽  
Freestyle Libre ◽  
Patients With Diabetes ◽  
Do It Yourself

Background: The FreeStyle Libre is a flash glucose monitoring (FGM) system, and glucose levels are measured when the reader is brought to the sensor. Additional readers allow for the conversion into a continuous glucose monitoring (CGM) system. These transmitters read data from the sensor and send them to a bluetooth-enabled device thanks to which the user acquires glucose measurements automatically. This modification allows the patient to receive alerts when blood glucose values are abnormal. Methods: The study relied on the results of an anonymous online survey conducted among patients with diabetes or their caregivers who use Facebook groups. A total of 132 respondents who met certain criteria (diabetic who use FGM system longer than 3 months, at least 14 days per month) were enrolled in the study. Results: A significant decrease in self-reported glycated hemoglobin levels was found in adults and children using readers (variable: age P = .008; time P < .001), regardless of the age. The use of additional readers was associated with a significant decrease in the number of self-reported episodes of hypoglycemia ( P < .001) and an improvement in the quality of life (based on self-reported limitations in everyday activities, social contacts, work/school, or doing sports). Conclusion: The use of additional readers for FGM system improves the metabolic control of diabetes and the quality of life, and has a positive effect on the safety of treatment. Flash glucose monitoring used together with additional readers operates as a CGM system and seems to be helpful for patients for the monitoring of interstitial levels of glucose; however, they should be careful when they use do it yourself solution.

scholarly journals Two-year use of flash glucose monitoring is associated with sustained improvement of glycemic control and quality of life (FLARE-NL-6)

2021 ◽  
Vol 9 (1) ◽  
pp. e002124
Author(s):  
Annel Lameijer ◽  
Marion J Fokkert ◽  
Mireille A Edens ◽  
Reinold O B Gans ◽  
Henk J G Bilo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Glycemic Control ◽  
Glucose Monitoring ◽  
Flash Glucose Monitoring ◽  
Sustained Improvement ◽  
Positive Effects ◽  
Freestyle Libre ◽  
Continued Use

IntroductionThe FreeStyle Libre (FSL) is a flash glucose monitoring (FGM) system. The Flash Monitor Register in the Netherlands (FLARE-NL-4) study previously demonstrated the positive effects of FSL-FGM use during 1 year on glycemic control, quality of life and disease burden among persons with diabetes mellitus (DM). The present follow-up study assesses the effects of FSL-FGM after 2 years.Research design and methodsPatients included in the FLARE-NL-4 study who continued FSL-FGM during the 1-year study period were invited to participate (n=687). Data were collected using questionnaires (the 12-Item Short Form Health Survey version 2 (SF-12v2) and the EuroQol 5-Dimension 3-Level (EQ-5D-3L) for quality of life), including self-reported hemoglobin A1c (HbA1c).ResultsA total of 342 patients agreed to participate: mean age 48.0 (±15.6) years, 52% men and 79.5% with type 1 DM. HbA1c decreased from 60.7 (95% CI 59.1 to 62.3) mmol/mol before use of FSL-FGM to 57.3 (95% CI 55.8 to 58.8) mmol/mol after 1 year and 57.8 (95% CI 56.0 to 59.5) mmol/mol after 2 years. At the end of the 2-year follow-up period, 260 (76%) persons were still using the FSL-FGM and 82 (24%) had stopped. The main reason for stopping FSL-FGM was financial constraints (55%). Concerning the whole 2-year period, there was a significant decrease in HbA1c among persons who continued use of FSL-FGM (−3.5 mmol/mol, 95% CI −6.4 to –0.7), while HbA1c was unaltered compared with baseline among persons who stopped FSL-FGM (−2.4 mmol/mol, 95% CI −7.5 to 2.7): difference between groups 2.2 (95% CI −1.3 to 5.8) mmol/mol. After 2 years, persons who continued use of FSL-FGM had higher SF-12 mental component score and higher EQ-5D Dutch tariff score and felt less often anxious or depressed compared with persons who discontinued FSL-FGM.ConclusionsAlthough the considerable number of non-responders limits generalizability, this study suggests that persons who continue to use FSL-FGM for 2 years may experience sustained improvement in glycemic control and quality of life.

scholarly journals Clinical Approach to Flash Glucose Monitoring: An Expert Recommendation

2019 ◽  
Vol 14 (1) ◽  
pp. 155-164 ◽  
Author(s):  
Ana Chico ◽  
Eva Aguilera ◽  
Francisco Javier Ampudia-Blasco ◽  
Virgina Bellido ◽  
Roque Cardona-Hernández ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Scientific Evidence ◽  
Glucose Monitoring ◽  
Clinical Approach ◽  
Flash Glucose Monitoring ◽  
Maximum Benefit ◽  
Freestyle Libre ◽  
System Use ◽  
Interstitial Glucose

The flash glucose monitoring (FGM) system FreeStyle Libre® is a device that measures interstitial glucose in a very simple way and indicates direction and speed of glucose change. This allows persons with diabetes to prevent hypoglycemic and hyperglycemic events. Scientific evidence indicates that the system can improve glycemic control and quality of life. To obtain the maximum benefit, it is necessary to properly handle glucose values and trends. Due to the generalization of the system use, the purpose of the document is to provide recommendations for the optimal use of the device, not only in the management of glucose values and trends but also in the prevention of hypoglycemia, actuation in exercise, special situations, and retrospective analysis of the glucose data, among others.

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