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Poison Ivy wrote:Did your mom sue for the botched surgery? I do agree with becoming too obsessed with the numbers sometimes. That in itself can become a full time job.
Poison Ivy wrote:Had the surgeon not screwed up, your mom would not be diabetic, right?
Kaye wrote:Very interesting discussion openmind. My Mum is a diabetic - never sure whether she is classed as Type 1 or Type 2 as she was surgically induced when most of her pancreas (except the tail) was removed by accident during surgery for something else. She takes Repaglinide 3 times daily plus injects with Lantus once daily plus occasionally uses a fast acting insulin if her sugars are too high. She is totally obsessed with checking her blood sugars and has made her fingers so sore. She has just started seeing a new endocrinologist who has told her to stop checking them so much and only to do so before meals - she was checking them after eating as well and then getting in a panic when they were raised.
I'm not sure I totally understand regarding the known complications of diabetes - is Dr McDougall saying they are less likely to occur by eating correctly (this way) than by eating SAD but forcing the sugars down with medications?
3kidlets wrote:An insulin pump gives insulin, it doesn't monitor your blood sugar. A continuous blood glucose meter (CGM) monitors your blood sugar. Speaking as the parent of a child with type 1 diabetes, the CGM is a god send. For her not to have to prick her finger up to 10 times day (and yes, it is absolutely necessary for a type 1 diabetic to do that) is a blessing and a luxury. To not have to worry about her blood sugar dropping dangerously low while she is asleep is a huge relief. To be able to catch a high blood sugar before it goes too high is invaluable. For her to be able to keep her blood sugar in a very tight range so that her a1c is that of a non-type 1 diabetic means everything.
Poison Ivy wrote:3kidlets, how old is your child with the type 1? How long can this thing be left in before you have to repeat by sticking yourself again? Children can be pretty rambunctious sometimes. How do they keep from pulling this thing out during playtime? I googled and watched a guy doing a demo. How long has CGM been available?
Poison Ivy wrote:Thanks, how costly is the monitoring?
John McDougall wrote:Be careful of what you ask for (patient goals).
Tight control of blood sugars even in critically ill children are of more harm than good.
Feb 23, 2017 NEJM:
Tight Glycemic Control in Critically Ill Children
Michael S.D. Agus, M.D., David Wypij, Ph.D., Eliotte L. Hirshberg, M.D., Vijay Srinivasan, M.D., E. Vincent Faustino, M.D., Peter M. Luckett, M.D., Jamin L. Alexander, B.A., Lisa A. Asaro, M.S., Martha A.Q. Curley, R.N., Ph.D., Garry M. Steil, Ph.D., and Vinay M. Nadkarni, M.D., for the HALF-PINT Study Investigators and the PALISI Network*
N Engl J Med 2017; 376:729-741February 23, 2017DOI: 10.1056/NEJMoa1612348
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BACKGROUND
In multicenter studies, tight glycemic control targeting a normal blood glucose level has not been shown to improve outcomes in critically ill adults or children after cardiac surgery. Studies involving critically ill children who have not undergone cardiac surgery are lacking.
METHODS
In a 35-center trial, we randomly assigned critically ill children with confirmed hyperglycemia (excluding patients who had undergone cardiac surgery) to one of two ranges of glycemic control: 80 to 110 mg per deciliter (4.4 to 6.1 mmol per liter; lower-target group) or 150 to 180 mg per deciliter (8.3 to 10.0 mmol per liter; higher-target group). Clinicians were guided by continuous glucose monitoring and explicit methods for insulin adjustment. The primary outcome was the number of intensive care unit (ICU)–free days to day 28.
RESULTS
The trial was stopped early, on the recommendation of the data and safety monitoring board, owing to a low likelihood of benefit and evidence of the possibility of harm. Of 713 patients, 360 were randomly assigned to the lower-target group and 353 to the higher-target group. In the intention-to-treat analysis, the median number of ICU-free days did not differ significantly between the lower-target group and the higher-target group (19.4 days [interquartile range {IQR}, 0 to 24.2] and 19.4 days [IQR, 6.7 to 23.9], respectively; P=0.58). In per-protocol analyses, the median time-weighted average glucose level was significantly lower in the lower-target group (109 mg per deciliter [IQR, 102 to 118]; 6.1 mmol per liter [IQR, 5.7 to 6.6]) than in the higher-target group (123 mg per deciliter [IQR, 108 to 142]; 6.8 mmol per liter [IQR, 6.0 to 7.9]; P<0.001). Patients in the lower-target group also had higher rates of health care–associated infections than those in the higher-target group (12 of 349 patients [3.4%] vs. 4 of 349 [1.1%], P=0.04), as well as higher rates of severe hypoglycemia, defined as a blood glucose level below 40 mg per deciliter (2.2 mmol per liter) (18 patients [5.2%] vs. 7 [2.0%], P=0.03). No significant differences were observed in mortality, severity of organ dysfunction, or the number of ventilator-free days.
CONCLUSIONS
Critically ill children with hyperglycemia did not benefit from tight glycemic control targeted to a blood glucose level of 80 to 110 mg per deciliter, as compared with a level of 150 to 180 mg per deciliter. (Funded by the National Heart, Lung, and Blood Institute and others; HALF-PINT ClinicalTrials.gov number, NCT01565941.)
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