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19

Falsely elevated capillary glucose and ketone levels and use of skin lightening creams

Hyperglycaemia associated with ketosis reflects severe insulin deficiency that mandates immediate insulin therapy. Point-of-care devices to measure capillary glucose have become essential in diabetes management.1 Management of hyperglycaemic crisis has also been improved by the measurement of β-hydroxybutyrate in a fingerprick blood specimen. The method is quick, accurate, and reliable,2 3 4 and recommended to medical care providers and patients.2 5 6 Here we report two cases of misleadingly high capillary glucose and ketone measurements that could have been prevented by careful hand washing. We also identify the chemical compound, hydroquinone, that interferes with capillary results.  
feeds.bmj.com
almost 6 years ago
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15

Critical Care

A substantial number of patients admitted to the ICU because of an acute illness, complicated surgery, severe trauma, or burn injury will develop a de novo form of muscle weakness during the ICU stay that is referred to as “intensive care unit acquired weakness” (ICUAW). This ICUAW evoked by critical illness can be due to axonal neuropathy, primary myopathy, or both. Underlying pathophysiological mechanisms comprise microvascular, electrical, metabolic, and bioenergetic alterations, interacting in a complex way and culminating in loss of muscle strength and/or muscle atrophy. ICUAW is typically symmetrical and affects predominantly proximal limb muscles and respiratory muscles, whereas facial and ocular muscles are often spared. The main risk factors for ICUAW include high severity of illness upon admission, sepsis, multiple organ failure, prolonged immobilization, and hyperglycemia, and also older patients have a higher risk. The role of corticosteroids and neuromuscular blocking agents remains unclear. ICUAW is diagnosed in awake and cooperative patients by bedside manual testing of muscle strength and the severity is scored by the Medical Research Council sum score. In cases of atypical clinical presentation or evolution, additional electrophysiological testing may be required for differential diagnosis. The cornerstones of prevention are aggressive treatment of sepsis, early mobilization, preventing hyperglycemia with insulin, and avoiding the use parenteral nutrition during the first week of critical illness. Weak patients clearly have worse acute outcomes and consume more healthcare resources. Recovery usually occurs within weeks or months, although it may be incomplete with weakness persisting up to 2 years after ICU discharge. Prognosis appears compromised when the cause of ICUAW involves critical illness polyneuropathy, whereas isolated critical illness myopathy may have a better prognosis. In addition, ICUAW has shown to contribute to the risk of 1-year mortality. Future research should focus on new preventive and/or therapeutic strategies for this detrimental complication of critical illness and on clarifying how ICUAW contributes to poor longer-term prognosis.  
ccforum.com
almost 6 years ago
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10

Type 1 Diabetes Mellitus Differential Diagnoses

Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Onset most often occurs in childhood, but the disease can also develop in adults in their late 30s and early 40s.  
emedicine.medscape.com
almost 6 years ago
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45

Anna Gloyn: Genetics and Diabetes - Nuffield Department of Medicine

The research undertaken by Professor Anna Gloyn focuses on using naturally genetic variants identified in humans as tools to identify critical regulatory pathways for insulin secretion and action. Current research projects are focused on the translation of genetic association signals for type 2 diabetes and glycaemic traits into molecular mechanisms for diabetes and clinically useful tools.  
ndm.ox.ac.uk
over 5 years ago
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25

Fibromyalgia Linked to Deficiencies in RBC Magnesium, IGF-1

A small study shows deficiencies in red blood cell magnesium and insulin-like growth factor 1 in patients with fibromyalgia and reflects growing interest in the role of hormones and endocrine factors in chronic pain.  
medscape.com
over 5 years ago
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FDA Approves Long-Lasting Insulin Drugs Tresiba and Ryzodeg

Both drugs for patients with diabetes contain insulin degludec, which possesses a half-life of 25 hours and acts for at least 42 hours.  
medscape.com
over 5 years ago