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Hyperglycemia
Hyperglycemia, or high blood glucose levels, is a common, albeit manageable occurrence in patients with diabetes. For clinicians treating patients with diabetes, emphasizing proper diet, exercise and regular monitoring of blood glucose is key to preventing adverse complications from hyperglycemia. See below for related articles on hyperglycemia.
Diabetes Management: The Hidden Challenge of Managing Hyperglycemia in Long-Term Care Settings
Diabetes is common in older adults living in long-term care facilities, and has a significant impact on quality of life. Residents in long-term care facilities may not be particularly concerned about the micro- and macrovascular disease associated with diabetes, and they may not be interested in rigidly controlling blood sugars to prevent further vascular complications. Rather, it is the day-to-day impact of diabetes management on functional activities, mood, cognition, and quality of life that is relevant to these individuals. It is therefore particularly important to consider the daily impact of diabetes on these residents and the more commonly ignored and neglected problem of hyperglycemia. This article reviews the way in which optimal care can be provided for long-term care residents with diabetes by combining behavioral interventions with appropriate medication management. (Annals of Long-Term Care: Clinical Care and Aging 2005;13[8]:26-32)
Featured Content from Annals of Long-Term Care
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Impaired Gastrointestinal Motility and Glycemic Control in Patients with Type 2 Diabetes
Although there are very limited clinical data for delayed gastric emptying in elderly individuals, two early studies demonstrated delayed gastric emptying of radiolabeled liquids in elderly patients (mean age, 77 years) relative to younger patients.25,26 IMPACT OF DELAYED GASTRIC EMPTYING ON NUTRIENT AND DRUG ABSORPTION Slowed gastric emptying delays the delivery of nutrients for absorption in the small intestine. Achieving and maintaining glycemic control may also reverse abnormal gastric ...
Featured Content from Clinical Geriatrics
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Risk Factors Associated with Healing Chronic Diabetic Foot Ulcers: The Importance of Hyperglycemia
Diabetic foot ulcer management presents a significant challenge for wound care clinicians; numerous approaches to encourage healing in these difficult wounds have been explored. To determine risk factors related to diabetic foot ulcer time to healing and closure, a secondary analysis of data from a prospective randomized study involving 245 patients treated with a bioengineered human dermal substitute (n = 130) or control treatment (n = 115) was conducted. Analyzed variables included age, race, gender, ulcer duration, initial ulcer size, initial hemoglobin (HgbA1c), average HgbA1c, change in HgbA1c, diabetes type, average hours of weight-bearing, study ulcer infection, history of smoking or alcohol use, and laboratory values. Time to healing was significantly affected by initial ulcer size (risk ratio 0.75, confidence interval 0.59?0.96), gender (risk ratio 2.01, confidence interval 1.20?3.40), and wound infection during the study (risk ratio 2.9, confidence interval 1.45?4.22). Initial ulcer size (>2 cm2), male gender, and an episode of infection during the study were associated with an increased risk of nonclosure after 12 weeks of care (P <0.05). In patients whose HgbA1C increased during the study (n = 101), 20.7% of all wounds and 21% of dermal substitute-managed wounds (n = 105) healed; whereas, in patients whose HgbA1C levels remained stable or decreased, 26.3% of all wounds and 47% of dermal substitute-managed wounds healed (P <0.05). Female gender, small ulcer size, and the absence of infection were found to have a positive effect on healing all diabetic foot ulcers; improved glucose control had a significant effect on healing wounds managed with the dermal substitute only. This is the first diabetic foot ulcer study to find a relationship between hyperglycemia and wound healing. Further research into factors that improve healing of wounds, including diabetic foot ulcers, is warranted. KEYWORDS: diabetes mellitus, foot ulcers, healing, risk factors, hyperglycemia
Featured Content from Ostomy Wound Management
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Cardiovascular Manifestations of Type 2 Diabetes in the Elderly
The Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe Study6 found that, not only are one-third of older persons with diabetes undiagnosed based on the fasting glucose level alone, but the risk of mortality in subjects with IPH is similar to that of those with diabetes. Conclusion Older patients with type 2 diabetes are at increased risk for chronic vascular complications due to the long duration of diabetes and poor control of glycemia, dyslipidemia, and ...
Featured Content from Clinical Geriatrics
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How To Achieve Optimal Perioperative Glycemic Control In Patients With Diabetes
A complex metabolic process ensues in response to surgery and anesthesia. For both groups, an insulin sliding scale supplements glucose control. Dr. Steinberg (pictured at left) is an Associate Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. For related ...
Featured Content from Podiatry Today
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Postoperative Management of Diabetes Mellitus
Postoperative Postoperative considerations for oral glucose- lowering drugs and insulin are summarized in Table I. Patients with type 1 DM cannot have insulin withheld. The population with type 2 diabetes often requires insulin for adequate glycemic control in the postoperative state. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: A randomized prospective 6-year study.
Featured Content from Annals of Long-Term Care
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Atherosclerotic Vascular Disease and Diabetes in the Older Adult; Part I: Understanding Pathogenic Mechanisms and Identifying Risk Factors
Atherosclerotic Vascular Disease and Diabetes in the Older Adult; Part I: Understanding Pathogenic Mechanisms and Identifying Risk Factors Aspects of Diabetes Mellitus: Atherosclerotic Vascular Disease and Diabetes in the Older Adult; Part I: Understanding Pathogenic Mechanisms and Identifying Risk Factors- Jennifer Wheaton, DO, and Sally M. Pinkstaff, MD, PhD Click here to download full article in PDF format RS is a 75-year-old Caucasian man with essential hypertension and type 2 diabetes ...
Featured Content from Clinical Geriatrics
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Painful Sensory Neuropathy in Patients with Impaired Glucose Tolerance: Part 1-- Diagnosis and Pathophysiology
Painful Sensory Neuropathy in Patients with Impaired Glucose Tolerance: Part 1-- Diagnosis and Pathophysiology Painful Sensory Neuropathy in Patients with Impaired Glucose Tolerance: Part 1-- Diagnosis and Pathophysiology By J Robinson Singleton, MD, and A. Gordon Smith, MD Click here to download full article in PDF Type 2 diabetes will afflict one in five persons over 65 years of age and is the most common identifiable cause of peripheral polyneuropathy in North American patients of any ...
Featured Content from Clinical Geriatrics
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An Algorithim for Managing Type 2 Diabetes: A Focus on the Disease Process, Not Just the Sugar
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Featured Content from Annals of Long-Term Care
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August 2004An Algorithm for Managing Type 2 Diabetes: A Focus on the Disease Process, Not Just the Sugar
This supplement reviews the pathophysiology of type 2 diabetes, the oral pharmacologic treatment of type 2 diabetes, and proposed treatment algorithms, which are stratified based on fasting plasma glucose levels. Two recently stopped studies, the Diabetes Prevention Trial Type 1 (DPT-1) and the European Nicotinamide Diabetes Intervention Trial (ENDIT), showed no benefit of insulin (oral or low-dose injected) or nicotinamide, respectively.26,27 Trials that have been traditionally thought of ...
Featured Content from Annals of Long-Term Care
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