Hypoglycemia

The semi-automated insulin pump performs well

The semi-automated insulin pump performs well

The study reveals that the hybrid closed loop device, MiniMed 670g, helps in reducing A1c by 0.75% compared to standard insulin pumps. For those transitioning to it, carbohydrate to insulin ratio needs to be adjusted immediately. This semi-automated system, differently called semi-artificial pancreas, is a significant advancement in the field of type 1 diabetes. The device was approved by FDA in September 2016.

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Continuous glucose monitoring (CGM) improves hypoglycemia in type 1 diabetes

Continuous glucose monitoring (CGM) improves hypoglycemia in type 1 diabetes

Although of small sample size, the study confirms prior results that continuous glucose monitoring helps avoid hypoglycemia in type 1 diabetes. Authors propose that improved endogenous glucose production during hypoglycemia is a partial molecular mechanism for a such benefit. 

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β-blockers in diabetes: not a good idea

β-blockers in diabetes: not a good idea

Analyses from ACCORD trial show that β-blockade increases cardiovascular events, deaths, all-cause mortality and severe hypoglycemia in adults with diabetes. Similar trends were seen in patients with established coronary heart disease and heart failure.

A possible mechanism is the reduced sympathetic tone from β-blockade, which in turn lowers the body's ability to sense and negate hypoglycemia. Evidence is mounting that prolonged hypoglycemia can lead to arrhythmias and cardiovascular events. 

Findings imply that strong indications are needed to prescribe b-blockers in patients with diabetes.

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EKG helps predict CVD in type 1 diabetes

EKG helps predict CVD in type 1 diabetes

A group of 1300 patients, from DCCT/EDIC study, with type 1 diabetes were followed for 19 years. Authors found that presence of major EKG anomalies worsened cardiovascular outcomes by 200%. Future ADA guidelines could include EKG criteria to identify DM1 individuals at high risk for CVD.

Examples of major EKG derangement are left ventricular hypertrophy with strain pattern, atrial fibrillation/flutter, complete left or right BBB, bifascicular block, ventricular tachycardia, Wolf-Parkinson-White syndrome/pre-excitation, and major QT prolongation.

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Low sugars (hypoglycemia) can cause heart conduction anomaly

Low sugars (hypoglycemia) can cause heart conduction anomaly

This original study gives us a possible new mechanism of how hypoglycemia can lead to cardiac conduction anomalies. Increased QT dynamicity and QTc prolongation was seen in 50% of patients with glucose levels < 70 mg/dL. QT dynamicity is well known to carry poor cardiac prognosis.

Of a concern, sulfonyluria caused hypoglycemia in one third of individuals with "well controlled" diabetes, most of whom were asymptomatic. Although further research is needed, these findings suggest avoidance of insulin injections or secretagogues, if feasible, to minimize hypoglycemic events.

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