Precipitating factors of hypoglycemia in diabetic patients undergoing treatment in Taksin hospital

2021 ◽  
Author(s):  
Jintanan Jangsiripornpakorn
Keyword(s):  
Diabetic Patients ◽  
Precipitating Factors

Hypoglycemia in Elderly Diabetic Patients with Good Glycemic Control attending Cardiology Out Patient Department of a Superspeciality Hospital

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Deepika Mittal ◽  
Purushottam Mittal
Keyword(s):  
Glycemic Control ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Diabetic Patients ◽  
Precipitating Factors ◽  
Good Glycemic Control ◽  
Glucose Levels ◽  
Fasting Plasma ◽  
Significant Difference ◽  
Hba1c Levels

Objective-Clinical trials and observational studies have provided good evidence that early glycemic control leads to a reduction in complications and improved survival in diabetics. However, elevated risk of mortality has been reported at both the lower and upper ends of long-term glucose levels. Fear of hypoglycemia has been a significant factor in suboptimal glycemic control. In this retrospective analysis we aimed to identify the incidence of hypoglycemia and their precipitating factors in elderly diabetics on good glycemic control. Material and methods- Ninety seven elderly diabetic patients attending the cardiology Out-Patients Department of a super speciality private sector hospital from 1 December 2017 to 30 November 2018 were studied retrospectively. Their demographic profile, co-morbidities and pharmacological profile were recorded. Incidence of hypoglycemic episodes and their precipitating factor were then analyzed. Result-Mean age was 71.7± 6.3 years, and 64 (66%) were male. Mean duration of diabetes was 7.3± 1.3 years. All patients had type II diabetes mellitus. Mean fasting and random capillary blood glucose levels were 116.5 ±8.7 mg/dl and 169.5±13.5mg/dl, respectively. Mean HbA1c levels of the study population was 6.8±1.14. Over the study period, 23 (23.7%) patients experienced 39 episodes of any level of hypoglycemia. HbA1c Levels in the hypoglycemia group were not significantly different from those in no-hyperglycemia group (6.85±1.13 vs. 6.63±1.04). Mean random plasma glucose values were slightly higher in no-hypoglycemia group (170.9±14.5 vs 164.9±14.9), but the difference did not reach the statistical significance. There was a markedly significant difference in mean fasting plasma glucose values between hypoglycemia and no-hypoglycemia group (101.8±8.9 vs 116.5±12.7). Sulphonylurea and insulin use was more frequent in patients experiencing hypoglycemia (9.6% and 52.2% respectively) as compared with no-hypoglycemia group (33.8% and 39.1% respectively). The most common preceding event was either skipping a meal in 12(30.8%) patients or an unplanned change in diet in 23% patients. Conclusion- Patients with longstanding diabetes and loss of warning symptoms have increased risk of severe hypoglycaemic episodes. Risk of the hypoglycemic episode is better correlated with fasting plasma glucose levels and glycemic variability rather than with HbA1c Level. Sulphonylurea drug use was the only group associated with a statistically significant risk of hypoglycemia. Skipping of a meal or a sudden change in the diet and alteration in antidiabetic drug regimen are the most important precipitating factors for hypoglycemia.

scholarly journals Clinical Characteristics and Outcome of Diabetic Ketoacidosis: Experience at BIRDEM, Dhaka, Bangladesh

2015 ◽  
Vol 3 (2) ◽  
pp. 53-56 ◽  
Author(s):  
Muhammad Abdur Rahim ◽  
Rozana Rouf ◽  
Ashraf Uddin Ahmed ◽  
Palash Mitra ◽  
Shahana Zaman ◽  
...  
Keyword(s):  
Diabetic Ketoacidosis ◽  
Low Income ◽  
Treatment Compliance ◽  
Income Group ◽  
Medical Emergency ◽  
Diabetic Patients ◽  
Precipitating Factors ◽  
Blurred Vision ◽  
Cross Sectional ◽  
Study Population

Background: Diabetic ketoacidosis (DKA) is a medical emergency. It may be the presenting feature of diabetes mellitus, but more commonly DKA complicates diabetic patients during inter-current acute illness or if they become non-compliant to anti-diabetic medications. Early detection and treatment of DKA including underlying cause is important in determining outcome.Objectives: To describe the demographic characteristics, presentations, precipitating factors and outcome of DKA.Methods: This cross-sectional study was conducted at BIRDEM General Hospital from January 2008 to December 2011.Results: Total patients were 200 with female predominance (56%). Mean age of the study population was 37.6 years. Incidence of DKA was more in known diabetic patients (71%) than in new cases (29%), more among rural population (53%) and low income group (76.5%). Common presentations included nausea (63%), vomiting (61%), polyuria (43%), polydypsia (42.5%), fever (29%), abdominal pain (28%), shortness of breath (28%), drowsiness (20%), blurred vision (13%), leg cramps (6.5%) and coma (7%). Infection (45.5%) was the commonest precipitating cause of DKA followed by non-adherence to insulin therapy (31%). Acute pancreatitis (5%), myocardial infarction (2%), stroke (1%) and surgery (1.5%) were less common precipitating factors. Aetiology of DKA could not be identified in 14% cases. Mean random blood glucose during admission was 27.1mmol/L and mean HbA1c was 11.3%. Severe acidosis (pH<7) was less common (8.5%). Neutrophil leukocytosis was present in 87% cases, irrespective of infection. In-hospital mortality was 6.5%.Conclusion: DKA occurred in diabetic patients in over two-third of the cases. In over two-third of the study population, DKA was precipitated by infection and non-adherence to insulin treatment. So, patient education regarding treatment compliance and sick days’ management are important and may prevent many cases of DKABangladesh Crit Care J September 2015; 3 (2): 53-56

Seasonal Variations of Hyperglycemic Crises in Diabetic Patients at a National Hospital Center, Benin: a Cross Sectional Study

2021 ◽  
Vol 5 (6) ◽  
pp. 01-06
Author(s):  
Comlan Jules GNINKOUN ◽  
Finagnon Armand WANVOEGBE ◽  
Joseph Soglo FANOU ◽  
Calice Sèdodé TOFFOHOSSOU ◽  
François DJROLO
Keyword(s):  
Rainy Season ◽  
Meteorological Data ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Adherence To Treatment ◽  
Precipitating Factors ◽  
Cross Sectional ◽  
Seasonal Characteristics ◽  
Significant Difference ◽  
Hyperglycemic Hyperosmolar Syndrome

Aim : To study the seasonal characteristics of hyperglycemic decompensations in the endocrinology department of the CNHU-HKM of Cotonou. Materials and methods :It was a cross-sectional, descriptive, and study of diabetic patients hospitalized from January 1, 2010 to December 31, 2019. Diabetic patients hospitalized for ketosis decompensation and/or hyperglycemic hyperosmolar syndrome were included in this study. The meteorological data used were obtained from the climate observation network of the Direction de la Météorologie Nationale (DMN) du Bénin. We have considered the means of rainfall and temperature per month and per year. Results : A total of 613 patients were included during the study period. The mean age of the patients was 46.77±15.84 years. The frequency of hyperglycemic hyperosmolar syndrome and ketoacidosis was 14.7% and 69.5% respectively. Hyperglycemic crises were more frequent during the rainy season and periods of low temperature. The main precipitating factors were infections and non-adherence to treatment. The main infectious sites involved in hyperglycemic crises were pulmonary (19%), urogenital (21.3%) and malaria (26.8%). The frequency of these different infections was higher during the rainy season with a statistically significant difference (p=0.02) for malaria. Conclusion : The frequency of hyperglycemic crises was high and had a seasonal distribution. The most frequent precipitating factors were infections and non-adherence to treatment. Those factors were more frequent in the rainy season.

scholarly journals Diabetic Ketoacidosis in Children - An Experience in a Tertiary Hospital

1970 ◽  
Vol 2 (1) ◽  
pp. 17-20 ◽  
Author(s):  
Bedowra Zabeen ◽  
Jebun Nahar ◽  
Fauzia Mohsin ◽  
Kishwar Azad ◽  
Nazmun Nahar
Keyword(s):  
Diabetic Ketoacidosis ◽  
Tertiary Hospital ◽  
Diabetic Patients ◽  
Type I ◽  
Newly Diagnosed ◽  
Precipitating Factors ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Age Range

A retrospective study was done in the in-patient department of paediatrics, BIRDEM from January 2002 to November 2006 to determine the clinico-laboratory features, precipitating factors and outcome of diabetic ketoacidosis. Over the five year period, 344 diabetic patients were hospitalized. Among them, 54 (15.6%) had diabetic ketoacidosis (DKA). Among those, 50 were Type I, one was Fibrocalculous Pancreatic Diabetes (FCPD) and 3 were of other specific types. More than half (51.9%) of the patients were newly diagnosed. Amongst the precipitating factors, 28% had missed insulin and 48% had overt infection. Infections, particularly those of the respiratory tract, were the main precipitating cause for the DKA. There was h/o both infection and missed insulin injections in 11.5% patients. The mean age of patients with DKA was 11.2 ± 4.4 years. Those in the age range 10-14 yrs suffered most frequently (p<0.0001) from ketoacidosis (n= 38, 70.4%) compared with those aged 0-4 yrs (9%) and 5-9 yrs. (20%). There was a significant difference between those newly diagnosed (group I) and known diabetics (group II) (p<.029). The frequency of DKA was higher in girls than in boys (66.7% vs. 33.3%; p =.0001). The median duration of polyuria and/or polydipsia was variable between newly diagnosed and known diabetics (3.2 - 25d) (p<.001). All patients presented with altered levels of consciousness and 35 (67.3%) were unconscious of different grades. Mean random blood glucose (RBG) and HbA1c were 27.6mmol/L and 13.4%. Complications noted were acute renal failure (n=2, 3.7%) and cerebral edema (n = 4, 7.5%). The outcome of treatment in the whole group was good, 46 (86.7%) patients recovered without complications, but 7 (13.4%) patients died. Ibrahim Med. Coll. J. 2008; 2(1): 17-20 Key words: Ketosis, children, diabetes, BIRDEM doi: 10.3329/imcj.v2i1.2926

scholarly journals Clinical characterstics, precipitating factors and glycemic control among diabetic ketoacidosis patients admitted to university hopsital in Northwest Ethiopia: A hospital based observational study.

2019 ◽  
Author(s):  
Gizework Mekonnen Alemnew ◽  
Tadesse Melaku Abegaz
Keyword(s):  
Glycemic Control ◽  
Diabetic Ketoacidosis ◽  
General Hospital ◽  
Complete Information ◽  
Northwest Ethiopia ◽  
Diabetic Patients ◽  
Precipitating Factors ◽  
Good Glycemic Control ◽  
Cross Sectional ◽  
Precipitating Factor

Abstract Aims: The aim of the study was to determine the clinical characteristics, precipitating factors and the level of glycemic control of diabetic ketoacidosis patients admitted to Debretabor General Hospital, northwest Ethiopia.Methods: A retrospective, cross-sectional study was conducted at Debretabor General Hospital and data was collected from June 1 to 30, 2018.Participants included in the study were all diabetic patients with diabetic ketoacidosis admitted to the General Hospital during the study period. The primary outcome was to determine precipitating factors for DKA and the level of glycemic control of diabetic ketoacidosis patients. All the statistical data was carried out using Statistical Package for Social Sciences (SPSS).Result: A total of 387 patients’ medical records contained pertinent complete information included in this study. The mean age of the patients was 33.30± 14.96 years. The majority of patients were females 244 (63.0%). The most common clinical presentation was polyuria and polydipsia in (n=379, 97.9%) of patients. The most common precipitating factor was newly diagnosed diabetics mellitus 150(38.8%). Binary logistic regression showed that for every increase in the duration of the disease(DM) by 1 year, the likelihood of controlling hyperglycemia would increases nearly 1.5 times AOR:1.497 [1.203-1.814].Conclusions: In this study, newly onset type 1 diabetes mellitus was the major precipitating factor for DKA. Polyuria and polydipsia were the most common presenting clinical characteristic of diabetic ketoacidosis. Long standing DM was found to be associated with good glycemic control among DKA patients.

Intramuscular Nerve and Neuromuscular Junction Alteration In Extraocular Muscles of Diabetic Mice

1985 ◽  
Vol 43 ◽  
pp. 682-683
Author(s):  
Bruce R. Pachter
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Nerves ◽  
Sudden Onset ◽  
Extraocular Muscles ◽  
Diabetic Patients ◽  
Oculomotor Palsy ◽  
Third Nerve Palsy ◽  
Patients With Diabetes ◽  
Intramuscular Nerve ◽  
Oculomotor Nerves

Diabetes mellitus is one of the commonest causes of neuropathy. Diabetic neuropathy is a heterogeneous group of neuropathic disorders to which patients with diabetes mellitus are susceptible; more than one kind of neuropathy can frequently occur in the same individual. Abnormalities are also known to occur in nearly every anatomic subdivision of the eye in diabetic patients. Oculomotor palsy appears to be common in diabetes mellitus for their occurrence in isolation to suggest diabetes. Nerves to the external ocular muscles are most commonly affected, particularly the oculomotor or third cranial nerve. The third nerve palsy of diabetes is characteristic, being of sudden onset, accompanied by orbital and retro-orbital pain, often associated with complete involvement of the external ocular muscles innervated by the nerve. While the human and experimental animal literature is replete with studies on the peripheral nerves in diabetes mellitus, there is but a paucity of reported studies dealing with the oculomotor nerves and their associated extraocular muscles (EOMs).

A Comparison Between Sterological Point Counting and Digitizing Tablets

1985 ◽  
Vol 43 ◽  
pp. 666-667
Author(s):  
John M. Basgen ◽  
Eileen N. Ellis ◽  
S. Michael Mauer ◽  
Michael W. Steffes
Keyword(s):  
Electron Microscopy ◽  
Kidney Tissue ◽  
Volume Density ◽  
Diabetic Patients ◽  
Normal Kidney ◽  
Point Counting ◽  
Normal Kidney Tissue ◽  
Biopsy Specimens ◽  
Mitochondrial Volume ◽  
Kidney Lesions

To determine the efficiency of methods of quantitation of the volume density of components within kidney biopsies, techniques involving a semi-automatic digitizing tablet and stereological point counting were compared.Volume density (Vv) is a parameter reflecting the volume of a component to the volume that contains the component, e.g., the fraction of cell volume that is made up of mitochondrial volume. The units of Vv are μm3 /μm3.Kidney biopsies from 15 patients were used. Five were donor biopsies performed at the time of kidney transplantation (patients 1-5, TABLE 1) and were considered normal kidney tissue. The remaining biopsies were obtained from diabetic patients with a spectrum of diabetic kidney lesions. The biopsy specimens were fixed and embedded according to routine electron microscogy protocols. Three glomeruli from each patient were selected randomly for electron microscopy. An average of 12 unbiased and systematic micrographs were obtained from each glomerulus and printed at a final magnification of x18,000.

Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

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