scholarly journals Strategies to Increase Time in Range in Children Wearing Continuous Glucose Monitors

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Will Bridgeman ◽  
Linda DiMeglio
Keyword(s):  
Blood Glucose ◽  
Young Children ◽  
Severe Hypoglycemia ◽  
Educational Interventions ◽  
Third Party ◽  
Activity Levels ◽  
Peace Of Mind ◽  
Fear Of Hypoglycemia ◽  
Time In Range ◽  
Continuous Glucose Monitors

Background and Hypothesis: Optimal management of Type 1 Diabetes (T1D) requires careful orchestration of insulin dosing with blood glucose values, food intake, activity levels, and concurrent illness. This is particularly burdensome for caretakers of very young children. Continuous glucose monitors (CGMs) provide useful real-time blood glucose information. Yet, data suggest that their use in young children can reduce severe hypoglycemia but does not consistently improve the time that blood glucose values are in an optimal range. Project Methods: We first analyzed survey data from a study of CGM use in 143 children 2-8 years of age). We then developed a semi-structured qualitative interview, and queried parents of children using CGM under 9 years of age (mean age 5.2±1.6 years, A1c 7.8±0.9%). Results: Recurrent themes identified included: CGMs and remote monitoring brought parents peace of mind and permitted more flexibility in care. Trend arrows indicating rapid glucose decreases induced “anxiety” and “panic” in caretakers, due to fear of hypoglycemia and immediate safety. Rising trend arrows induced frustration, but were less likely to change management decisions, due to lack of immediacy of risk of long-term complications. CGM data can be “overwhelming”, but third party apps and “experience” increase helpfulness. Conclusion/Potential Impact: Our initial data suggest that behavioral/educational interventions to improve time in range must incorporate implementable strategies, potentially using apps, to encourage parents to respond to and reduce time spent in higher blood glucose ranges.

Examining Sensor Agreement in Neural Network Blood Glucose Prediction

2021 ◽  
pp. 193229682110182
Author(s):  
Aaron P. Tucker ◽  
Arthur G. Erdman ◽  
Pamela J. Schreiner ◽  
Sisi Ma ◽  
Lisa S. Chow
Keyword(s):  
Neural Network ◽  
Blood Glucose ◽  
Patient Specific ◽  
Sensor Location ◽  
Effective Care ◽  
Freestyle Libre ◽  
Patients With Diabetes ◽  
Interstitial Glucose ◽  
Continuous Glucose Monitors ◽  
Glucose Prediction

Successful measurements of interstitial glucose are a key component in providing effective care for patients with diabetes. Recently, there has been significant interest in using neural networks to forecast future glucose values from interstitial measurements collected by continuous glucose monitors (CGMs). While prediction accuracy continues to improve, in this work we investigated the effect of physiological sensor location on neural network blood glucose forecasting. We used clinical data from patients with Type 2 Diabetes who wore blinded FreeStyle Libre Pro CGMs (Abbott) on both their right and left arms continuously for 12 weeks. We trained patient-specific prediction algorithms to test the effect of sensor location on neural network forecasting ( N = 13, Female = 6, Male = 7). In 10 of our 13 patients, we found at least one significant ( P < .05) increase in forecasting error in algorithms which were tested with data taken from a different location than data which was used for training. These reported results were independent from other noticeable physiological differences between subjects (eg, height, age, weight, blood pressure) and independent from overall variance in the data. From these results we observe that CGM location can play a consequential role in neural network glucose prediction.

Adverse Event Data for Years 2018 to 2020 for Diabetes Devices

2021 ◽  
pp. 193229682110116
Author(s):  
Jan S. Krouwer
Keyword(s):  
Adverse Event ◽  
Blood Glucose ◽  
Adverse Events ◽  
Performance Evaluations ◽  
Routine Analysis ◽  
Event Data ◽  
Adverse Event Data ◽  
Continuous Glucose Monitors ◽  
Device Use ◽  
Test Result

Unlike performance evaluations, which are often conducted under ideal conditions, adverse events occur during actual device use for people with diabetes. This report summarizes the number of adverse events for the years 2018 to 2020 for the 3 diabetes devices: blood glucose meters (BG), continuous glucose monitors (CGM), and insulin pumps. A text example of a CGM injury is provided. Possible reasons are suggested for trends. Whereas the rate per test result (events/usage) is exceedingly small, the rate per patient (events/people with diabetes that use insulin) is of concern. Hence, it is important to determine event causes and provide corrective actions. The first step is to put in place routine analysis of adverse event data for diabetes devices.

Effects of Blood Glucose Changes and Physostigmine on Anesthetic Requirements of Halothane in Rats 

1997 ◽  
Vol 87 (2) ◽  
pp. 354-360 ◽  
Author(s):  
Yumiko Ishizawa ◽  
Shuichiro Ohta ◽  
Hiroyuki Shimonaka ◽  
Shuji Dohi
Keyword(s):  
Blood Glucose ◽  
Blood Glucose Level ◽  
Glucose Level ◽  
Minimum Alveolar Concentration ◽  
Severe Hypoglycemia ◽  
Dependent Manner ◽  
Sprague Dawley ◽  
Control Value ◽  
Sprague Dawley Rats ◽  
Brain Acetylcholine

Background Although hyper- and hypoglycemia induce neurophysiologic changes, there have been no reports on the effects of blood glucose changes on anesthetic requirements. This study examined the effects of hyper- and hypoglycemia on the minimum alveolar concentration (MAC) of halothane in rats. In addition, based on a previous finding that the level of brain acetylcholine was reduced during mild hypoglycemia, the authors examined the influence of physostigmine on MAC during hypoglycemia. Methods In Sprague-Dawley rats, anesthesia was induced and maintained with halothane in oxygen and air. The MAC was determined by observing the response to tail clamping and tested during mild hypoglycemia (blood glucose level, 60 mg/dl) and hyperglycemia (blood glucose level, 300 and 500 mg/dl) induced by insulin and glucose infusion, respectively (experiment 1). The effects of 0.3 and 1.0 mg/kg physostigmine given intraperitoneally on MAC were examined in rats with mild and severe hypoglycemia (blood glucose level, 60 and 30 mg/dl; experiment 2). Results In experiment 1, mild hypoglycemia significantly reduced the MAC of halothane (0.76 +/- 0.03%) compared with the control value (0.92 +/- 0.04%), but hyperglycemia did not change MAC. In experiment 2, mild and severe hypoglycemia reduced MAC of halothane in a degree-dependent manner. Physostigmine (1 mg/kg) had no effect on MAC regardless of blood glucose level, but 0.3 mg/kg reduced MAC. Conclusions Hypoglycemia reduced anesthetic requirements in a degree-dependent manner, whereas hyperglycemia had no effects. Although the mechanism of hypoglycemic MAC reduction needs further investigations, physostigmine studies suggest that this may not be related to inhibition of cholinergic transmission.

ALCOHOL-INDUCED HYPOGLYCEMIA AND COMA CAUSED BY ALCOHOL SPONGING

PEDIATRICS ◽  
1970 ◽  
Vol 46 (3) ◽  
pp. 445-447
Author(s):  
Malcolm H. Moss
Keyword(s):  
Blood Glucose ◽  
Elevated Temperature ◽  
Ethyl Alcohol ◽  
Alcohol Intoxication ◽  
Severe Hypoglycemia ◽  
Male Infant ◽  
Blood Alcohol ◽  
Acute Alcohol Intoxication ◽  
Tepid Water

The inhalation of ethyl or isopropylalcohol vapor during sponge bathing may result in alcohol intoxication and coma. Ingestion of these alcohols may cause hypoglycemia in children or adults. The present case is the first reported in which alcohol-induced hypoglycemia developed following inhalation of alcohol. A six month-old male infant became comatose following sponge bathing with ethyl alcohol. He was found to have acute alcohol intoxication (blood alcohol 220 mg per 100 ml) and severe hypoglycemia (blood glucose 22 mg per 100 ml). The administration of 50% glucose in water intravenously resulted in prompt recovery. Alcohol sponging to lower elevated temperature is rarely necessary. Cooling with tepid water is effective and considerably less hazardous; the addition of alcohol is not necessary.

scholarly journals Intraperitoneal, subcutaneous and intravenous glucagon delivery and subsequent glucose response in rats: a randomized controlled crossover trial

2018 ◽  
Vol 6 (1) ◽  
pp. e000560 ◽  
Author(s):  
Ilze Dirnena-Fusini ◽  
Marte Kierulf Åm ◽  
Anders Lyngvi Fougner ◽  
Sven Magnus Carlsen ◽  
Sverre Christian Christiansen
Keyword(s):  
Blood Glucose ◽  
Crossover Trial ◽  
Artificial Pancreas ◽  
Isotonic Saline ◽  
Severe Hypoglycemia ◽  
Diabetes Mellitus Type 1 ◽  
Open Label ◽  
Glucose Response ◽  
Routes Of Administration ◽  
Randomized Controlled

ObjectiveHypoglycemia is a frequent and potentially dangerous event among patients with diabetes mellitus type 1. Subcutaneous glucagon is an emergency treatment to counteract severe hypoglycemia. The effect of intraperitoneal glucagon delivery is sparsely studied. We performed a direct comparison of the blood glucose response following intraperitoneally, subcutaneously and intravenously administered glucagon.Research design and methodsThis is a prospective, randomized, controlled, open-label, crossover trial in 20 octreotide-treated rats. Three interventions, 1  week apart, in a randomized order, were done in each rat. All 20 rats were given intraperitoneal and subcutaneous glucagon injections, from which 5 rats were given intravenous glucagon injections and 15 rats received placebo (intraperitoneal isotonic saline) injection. The dose of glucagon was 5 µg/kg body weight for all routes of administration. Blood glucose levels were measured before and until 60 min after the glucagon/placebo injections.ResultsCompared with placebo-treated rats, a significant increase in blood glucose was observed 4 min after intraperitoneal glucagon administration (p=0.009), whereas after subcutaneous and intravenous glucagon administration significant increases were seen after 8 min (p=0.002  and p<0.001, respectively). In intraperitoneally treated compared with subcutaneously treated rats, the increase in blood glucose was higher after 4 min (p=0.019) and lower after 40 min (p=0.005) and 50 min (p=0.011). The maximum glucose response occurred earlier after intraperitoneal compared with subcutaneous glucagon injection (25 min vs 35 min; p=0.003).ConclusionsGlucagon administered intraperitoneally gives a faster glucose response compared with subcutaneously administered glucagon in rats. If repeatable in humans, the more rapid glucose response may be of importance in a dual-hormone artificial pancreas using the intraperitoneal route for administration of insulin and glucagon.

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 Children’s restorative justice in an intergroup context

2021 ◽  
Author(s):  
Xin Yang ◽  
Zhen Wu ◽  
Yarrow Dunham
Keyword(s):  
Young Children ◽  
Restorative Justice ◽  
Group Membership ◽  
Color Preference ◽  
Third Party ◽  
Total N ◽  
Research Challenges ◽  
Standard Response

The present study investigated 3- to 6-year-old (total n = 158) children’s restoration behaviors both when they were second-party victims (Experiment 1) and when they were third-party bystanders (Experiment 2) of transgressions. We also explored how group membership (based on color preference) affects these behaviors. We found that children preferred restoration to punishment, and that they emphasized restorative justice not only for themselves but also for others. Furthermore, when they were victims of transgressions, the tendency to choose restoration over punishment was stronger in older than younger children. Second-party restoration behavior was influenced by group concerns in that children treated ingroup transgressors more leniently than outgroup and unaffiliated transgressors, but third-party restoration behavior was not. Our research challenges the view that punishment is the standard response to transgressions and suggests that alternative options like restoration are sometimes preferred over punishment by young children.

scholarly journals Objectively-measured sedentary time and physical activity in a bi-ethnic sample of young children: variation by socio-demographic, temporal and perinatal factors

2020 ◽  
Author(s):  
Paul Collings ◽  
Sufyan A Dogra ◽  
Silvia Costa ◽  
Daniel D Bingham ◽  
Sally E. Barber
Keyword(s):  
Physical Activity ◽  
Young Children ◽  
South Asian ◽  
Sedentary Time ◽  
Activity Levels ◽  
Light Physical Activity ◽  
Asian Children ◽  
Physical Activity Levels ◽  
Vector Magnitude ◽  
British Children

Abstract Background: Evidence suggests that South Asian school-aged children and adults are less active compared to the white British population. It is unknown if this generalises to young children. We aimed to describe variability in levels of physical activity and sedentary time in a bi-ethnic sample of young children from a deprived location. Methods: This observational study included 202 South Asian and 140 white British children aged 1.5 to 5y, who provided 3,181 valid days of triaxial accelerometry (Actigraph GT3X+). Variability in sedentary time and physical activity levels were analysed by linear multilevel modelling. Logistic multilevel regression was used to identify factors associated with physical inactivity (failing to perform ≥180 minutes of total physical activity including ≥60 minutes moderate-to-vigorous physical activity (MVPA) per day). Results: There were no significant ethnic differences in the overall levels of behaviours; South Asian and white British children spent half of daily time sedentary, just over 40% in light physical activity, and the remaining 7.5 to 8% of time in MVPA. Sedentary time was lower and physical activity levels were higher in older children, and levels of MVPA and vector magnitude counts per minute (CPM) were higher on weekends compared to weekdays. In South Asian children, sedentary time was lower on weekends. Sedentary time was lower and physical activity levels were higher in spring compared to winter in white British children, and in all seasons compared to winter in South Asian children. South Asian children born at high birth weight performed more MVPA, and in both ethnicities there was some evidence that children with older mothers were more sedentary and less active. Sedentary time was higher and light physical activity was lower in South Asian children in the highest compared to the lowest income families. South Asian girls performed less MVPA, registered fewer vector magnitude CPM, and were 3.5 times more likely to be physically inactive than South Asian boys. Conclusions: Sedentary time and physical activity levels vary by socio-demographic, temporal and perinatal characteristics in young children from a deprived location. South Asian girls have the most to gain from efforts to increase physical activity levels.

Body fatness and physical activity levels of young children

2007 ◽  
Vol 34 (1) ◽  
pp. 1-12 ◽  
Author(s):  
Yahya Al-Nakeeb ◽  
Michael J. Duncan ◽  
Mark Lyons ◽  
Lorayne Woodfield
Keyword(s):  
Physical Activity ◽  
Young Children ◽  
Activity Levels ◽  
Body Fatness ◽  
Physical Activity Levels
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