Seeing as today is World Diabetes Day, I thought this would be the perfect time to share my latest adjustment to our diabetes care and organization. I previously posted a series of printables that I still use some of but have recently decided to simplify how my son and our family log is blood readings and insulin doses, medications and any notes or important information.
A great tip for anyone monitoring their child's blood levels is use a colour code to see patterns in blood sugar levels. On another note, when we were at our last clinic visit I mentioned that our insulin pens felt like they were breaking. Blood glucose levels : testing and normal range, A blood glucose test measures the amount of a type of sugar, called glucose, in your blood. Diabetes blood sugar levels chart: what is a normal blood, Keep in mind that the blood glucose level before a meal for a non diabetic person and a person with prediabetes may be very similar.
When your “normal” blood sugar isn’t normal (part 1), In the next two articles we’re going to discuss the concept of “normal” blood sugar. Blood pressure chart – normal blood pressure range, What is your adult blood pressure? Symptoms of high blood sugar-topic overview, High blood sugar (hyperglycemia) is most often seen in people who have diabetes that isn’t well controlled. Home « blood sugar basics, Make your next conversation with your diabetes healthcare team count by asking these quick questions about blood sugar!. Self monitoring of blood glucose (SMBG) is very crucial for those diabetics who are on insulin or on certain oral anti-diabetic drugs which can cause hypoglycemia.
It is easier for a diabetes specialist to adjust drugs or to adjust insulin dose if good SMBG record is maintained by the patient. Normally we check fasting and 2 hr post prandial blood sugar levels in lab for routine follow up.
In practice I have seen several patients who had fasting and post prandial blood glucose lab tests in normal range but HbA1c levels below 7 is not achieved because they might have high blood sugars in other post meals which has got unnoticed.
To achieve best blood glycemic control it is important to control blood sugar levels within normal limits during entire day and not just fasting or post breakfast levels.
In the above image of SMBG chart I have mentioned 7 point charting system where you can fill your blood glucometer readings which you take on several spots in an entire day. This seven point SMBG charting approximately covers entire day glucose fluctuations to some extent (ofcourse  not as accurate as CGMS).
I have also mentioned a comment column in the above SMBG chart where you can note down change in food or change in insulin dose or any other changes that you have made which probably caused unusual readings like for example if Hypoglycemia occurs at before lunch reading and you have skipped breakfast or had very little snack at breakfast you can mentioned that. You do not need to check daily all the 7 points, you can check any one or 2 points randomly depending upon your sugar control. Monitoring of blood glucose at home in case of diabetic pregnancy or gestational diabetes is also important where frequent monitoring and SMBG charting of glucometer readings helps a lot to patient.
If you find that some of the post meal or pre meal readings are high or low, please consult your diabetologist with SMBG chart to adjust your medication or insulin dosage.
We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you.
We sought to create a screening tool with improved predictive value for pediatric severe sepsis (SS) and septic shock that can be incorporated into the electronic medical record and actively screen all patients arriving at a pediatric emergency department (ED). Despite basic and clinical research efforts, SS and septic shock mortality remain largely unchanged over the past 20+ years, ranging from 23 to 50% (8, 9). Presently, the diagnosis of SS (which will henceforth be understood to also include cases that progressed to septic shock) is highly dependent on the clinical acumen of the caregiver and thus potentially subject to error.
Beginning with the recommended components of a SS screening tool and age-specific criteria for vital signs put forth by ICCPS, we empirically identified new vital sign thresholds and applied our tool refinement methodology to create an improved tool for detection of SS in terms of specificity, positive predictive value (PPV), and median time from patient arrival to SS detection.
Our study refined and tested an electronic screening tool for pediatric SS initially based on the ICCPS criteria.
An important component of our screening tool is the identification of abnormal values for HR and RR in patients arriving at the pediatric ED. The Screening Tool Refinement component of our study was approved by the Institutional Review Board (IRB) at Le Bonheur Children’s Hospital, and the Vital Signs Standardization component was approved by the IRB at Eastern Virginia Medical School (Norfolk, VA, USA). The following data elements were obtained from the electronic triage vital signs for each ED patient: HR, RR, body temperature, and site of measurement, age, time between arrival and initial vital signs measurement, and reason for visit.
For the Vital Signs Standardization group, age-dependent (using the age intervals adopted by ICCPS) means and upper thresholds of normal (calculated as means plus a specified number of standard deviations) for HR and RR were determined.
Univariate analyses were performed for each measure incorporated into the screening tool to assess the association of abnormal values of that measure with gold standard identified SS.
Refinement of the tool was accomplished through virtual PDSA cycle iterations, with the goal of successively improving ROC values with minimal increase in the mean interval between patient arrival and tool firing for Gold Standard SS cases. To test whether the performance of our final tool was generalizable, we utilized a split-sample validation technique whereby the results from cases representing the Screening Tool Refinement group’s first month of patient arrivals were compared with cases representing the second month of arrivals. A summary of the vital signs data for the Vital Signs Standardization group is shown in Table 2.
Several measures incorporated into the original ICCPS based tool were found to have a very low incidence among Gold Standard SS cases or to have an association that was not statistically significant.
A summary of the changes to the original ICCPS criteria leading to our final pediatric SS screening tool is given in Table 5.
O diabetes mellitus e uma doenca definida pela falta de insulina ou de sua incapacidade de exercer adequadamente seus efeitos provocando uma resistencia a insulina. A gestacional e caracterizada pela presenca de glicose elevada na gravidez e normalmente e normalizada apos o parto, entretanto, mulheres que apresentaram esse quadro na gestacao sao mais propensas a desenvolverem diabetes tipo 2 tardia.
No caso dos carboidratos o ideal e dar preferencia aos complexos, ou seja, ricos em fibras para que nao ocorra uma hiperglicemia como os integrais, cereais, legumes, verduras e algumas frutas. Em novembro de 2012 a International Diabetes Federation publicou o seguinte: ha no mundo cerca de 371 milhoes de pessoas portadoras de diabetes com idades entre 20-79 anos de idade, o numero de portadores e crescente em todos os paises, 50% das pessoas portadores desconhecem esta condicao e, o Brasil ocupa a 4? colocacao entre os paises de maior prevalencia, 13,4 milhoes de pessoas, o que corresponde a 6,5% da populacao entre 20-79 anos de idade. Neste dia 14 de novembro e comemorado o dia Mundial da Diabetes que tem o intuito de levar informacao as pessoas sobre a doenca, seu diagnostico e tratamento. Os sintomas mais comuns sao urinar excessivamente, inclusive acordar varias vezes a noite para urinar, sede excessiva, aumento de apetite, perda de peso, cansaco, vista embacada e infeccoes frequentes, sendo as mais comuns as de pele.


De maneira geral os exercicios fisicos sao beneficos para os portadores de diabetes, principalmente os do tipo 2.
A pratica de exercicios fisicos so e recomendada quando os niveis de glicose sanguineos estao sob controle mediante o uso da insulina ou de outro medicamento que module a glicose e de dieta adequada.
A diabetes mellitus, principalmente a do tipo 2, e uma doenca crescente e um dos fatores de risco para o seu surgimento e o de doencas cardiovasculares e a obesidade. A microcirculacao inclui as arteriolas, capilares e venulas sendo essencial para o equilibrio do metabolismo dos tecidos assim como a pressao arterial.
Um endotelio normal e capaz de secretar substancias vasodilatadoras e fator hiperpolarizante promovendo a manutencao do tonus vascular, regulacao da agregacao plaquetaria e da coagulacao, modulando a inflamacao e diminuindo o risco de trombos e futuramente de uma aterosclerose. When most people think of diabetes, they tend to think that it has to do with eating too much sugar or being overweight.  For children diagnosed with Type 1 (or Juvenile) Diabetes, this is not the case. Type 1 Diabetes affects about 3 million Americans, and each year 15,000 more children and adults are diagnosed.  So, what exactly is Type 1 Diabetes?  This form of diabetes is an autoimmune disease, where the body stops producing insulin, and it is not caused by diet or lifestyle. In diabetes, the pancreas doesn’t make enough insulin or the body can’t respond normally to the insulin that is made. Insulin pump – these small, computerized devices allow for a continuous flow of insulin to be released the body. Now he relies on blood tests and insulin injections at least 4 times a day just to stay alive.We are raising money to help fund Diabetes Research so one day there might be a cure. To achieve best glycemic control it is essential to know how your daily blood glucose levels are fluctuating in entire day. There is bright chance of sugar excursions in the other post meal readings which gets unnoticed. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button.
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Severe sepsis (SS) is defined as acute organ dysfunction (OD) in the presence of sepsis; the latter refers to the presence of a systemic infection, which can result from a bacterial, viral, or fungal source. To improve SS-related mortality, several organizations published evidence-based guidelines for the management of SS and septic shock (8, 10, 11).
Although the tool was refined using retrospective patient data, our goal is to create an automated, real-time electronic version of the tool that will be incorporated into the hospital electronic medical record (EMR) and will actively screen all patients arriving at the pediatric ED.
The refinement process utilized a retrospective database containing demographic, episode of care, and clinical data for all pediatric patients who visited the ED of a large, metropolitan children’s hospital over a 2-month period. Previous attempts to establish age-specific ranges of normal and abnormal HR and RR, such as those suggested by ICCPS, employed consensus values based on small numbers of healthy, resting children and may not be appropriate for children presenting to an ED. The tool algorithm, which determined if and when a positive firing occurred in each case, was based on the published ICCPS criteria, which were modified slightly to accommodate the availability of data from the patients’ EMR. A total of 480 cases met one or more of the above criteria and were selected for chart review. Given that the tool was designed to be incorporated into an automated, electronic screening tool that would run in the background for all patients entering the pediatric ED, our ROC test denominator consisted of all ED patient arrivals, since the possibility of a false negative or false positive result exists for all patients screened by the tool. Similar sets of corrected means and upper thresholds were also derived on the basis of temperature corrections suggested by previous studies. Additionally, the strengths of these associations at the time of the initial firing of the screening tool were compared with the respective associations looked at cumulatively throughout each patient’s hospital encounter. Using AUC as the measure of overall tool performance, the significance of our tool refinement process was evaluated using a chi-square test of the paired comparison between the original ICCPS (2) based tool and our final, revised tool (26).
AUC was again selected as the measure of overall tool performance, and the difference in AUC for the two subsets was evaluated using an unpaired t-test (26).
Applying these standards to redefine tachycardia and tachypnea, using the ICCPS criteria of >2 SD above the mean for each age group, resulted in markedly higher thresholds than those published by ICCPS. The results of univariate analyses of the associations of individual SIRS and OD metrics with physician identified Gold Standard SS cases are shown in Table 4.
Normalmente as complicacoes incluem queixas visuais, cardiacas, circulatorias, digestivas, renais, urinarias, neurologicas, dermatologicas e ortopedias, entre outras. Proximo a 90% dos portadores e do tipo 2, pouco sintomatica e por isso favorece a ocorrencia de complicacoes. Caso apresente algum desses sintomas a conduta mais adequada e procurar um medico para diagnosticar se ha ou nao a diabetes e iniciar o tratamento. O objetivo dos exercicios e a otimizacao da capacidade funcional, controle do peso corporal, modulacao dos niveis glicemicos e reducao de fatores metabolicos de risco para o desenvolvimento de doencas cardiovasculares. Os exercicios ajudam o corpo a responder melhor a insulina e a transportar de modo mais eficiente a glicose para dentro das celulas.
Muitas vezes os diabeticos possuem outras patologias associadas e estas devem ser analisadas para que haja a melhor indicacao de uma atividade. Vem sendo demonstrado que a disfuncao microvascular afeta a disponibilidade de glicose mediada por insulina e a resistencia vascular periferica, contribuindo para a resistencia a insulina e a hipertensao. Ela e regulada principalmente pelas celulas endoteliais que promovem efeitos vasodilatadores ou vasoconstritores.
O controle do nivel glicemico reduz o risco dessas complicacoes microvasculares por isso a necessidade de um acompanhamento medico e nutricional.
The pumps have a small, flexible tube (called a catheter), which is inserted under the skin of the abdomen and taped into place.
SS is a leading cause of multiple organ failure and mortality across intensive care units (1). These guidelines provide a comprehensive bundle of recommended therapies for clinicians that if effectively implemented, could improve patient outcomes and reduce death. While effective SS screening tools have been created for adults (15) and a proposed set of consensus-derived guidelines for a pediatric SS screening tool was published by the International Consensus Conference on Pediatric Sepsis (ICCPS) (2, 16), a similar validated tool of high predictive value for children has yet to be developed. The collected data spanned the entire hospital encounter of each patient, regardless of whether this involved only an ED visit or continued as an observation or inpatient admission to the hospital.
A recent study (17) suggested that empirically derived upper thresholds of normal HR and RR in pediatric inpatient hospital settings are considerably higher than these previously used consensus values.


The criteria employed in this initial version of the tool are summarized in Figure 1 (2, 16, 18–20).
For each instance of chart review, the reviewing physician searched for evidence of SS, defined below as the presence of infection accompanied by systemic inflammatory response syndrome (SIRS) and OD, and was blinded as to the tool’s independent assessment of the case. Ultimately, the choices of standards for abnormal HR and RR were based on each model’s plausibility and empirical ability to optimize the performance of the screening tool. Moreover, over 20% of these SS cases had negative culture results for infectious organisms (bacteria, viruses, or fungi) in blood, CSF, or urine, and about 10% of the cases had negative respiratory culture results as well.
A tipo 1 consiste em uma producao de insulina pelo pancreas insuficiente e os seus portadores necessitam de doses diarias de insulina para a manutencao da glicose. Para que nao haja a presenca dessas complicacoes e necessaria uma dieta adequada visando o controle da glicemia. Proteinas magras como peixes e frango sao mais indicadas por terem menor teor de gorduras saturadas. Os fatores de risco para essa doenca sao: familiares proximos portadores, idade maior do que 45 anos, excesso de peso ou obesidade, pressao arterial alta, colesterol elevado e mulheres com antecedentes de filho nascido com mais de 4 kg. O primeiro passo para ingressar em uma atividade fisica e solicitar um exame de sangue para verificar o nivel de glicose e realizar uma avaliacao fisica.
Tambem ajudam a diminuir os niveis de glicose no sangue durante e por ate 48h apos a atividade.
A pratica de exercicios ao final da tarde e inicio da noite nao sao indicadas, devido o pico natural da insulina o que aumenta as chances de uma hipoglicemia noturna. Pesquisadores relacionam alteracoes na microcirculacao em pacientes diabeticos devido a resistencia a insulina. A microcirculacao no diabetes: implicacoes nas complicacoes cronicas e tratamento da doenca. Perivascular fat and the microcirculation: relevance to insulin resistance, diabetes, and cardiovascular disease. In these spaces we put his blood reading from his metre and then what insulin dose he gets.
They come is cool colours now and the delivery of insulin, although it takes a little getting used to, is a lot smoother.
Age-specific normal and abnormal values for heart rate (HR) and respiratory rate (RR) were empirically derived from 143,603 children seen in a second pediatric ED over 3 years.
These guidelines include several time-sensitive interventions, such as antibiotic administration and fluid resuscitation, emphasizing the importance of early recognition of shock and sepsis (12). Similarly, our study included an empirical analysis of initial ED triage vital signs from over 140,000 children in order to derive age-specific values for normal and abnormal HR and RR in a pediatric ED setting.
For indeterminate cases, the final determination was made by joint physician review conducted by two physicians.
We therefore added, as a secondary outcome, the percentage of cases that fired the SIRS component of the tool, which may be used to screen for the presence of sepsis in the absence of OD.
For both the early and late measures of association, the statistical significance of each association was determined using an exact chi-square test.
This finding led us to redefine the tool’s criteria for a positive finding of SIRS from the original ICCPS definition (which required abnormal values for two SIRS components, one of which must be temperature, WBC count, or neutrophil percent banding) to a more restrictive definition that additionally requires the second abnormal SIRS component to be either HR or RR. Pode ocorrer em qualquer idade, mas e mais comum em criancas, adolescentes e adultos jovens. Deve haver um consenso entre o medico, educador fisico e nutricionista a fim de indicar o melhor tratamento medicamentoso, nutricional e de uma atividade fisica adequada.
O dano endotelial presente na diabetes parece ser o fator desencadeante das complicacoes microvasculares como a cegueira por retinopatia diabetica, doenca renal terminal e amputacao dos membros. If you use Humapens instead of syringes for insulin and you haven't replaced them in a few years ask your diabetes team about these!
Between 20,000 and 40,000 US children develop septic shock annually, and its incidence is rising (6, 7). The resulting redefinition of age-specific abnormal vital sign values for pediatric ED patients was an essential precursor in the subsequent refinement process that sought to create a screening tool with substantially improved performance. Additionally, we included as a secondary outcome the median time from patient arrival to tool firing (in cases where firing occurred), which acts as a balancing measure for the purpose of weighting tool accuracy against the need for early identification of SS. In a large majority of Gold Standard SS cases, the patient did not arrive at the ED in a condition of SS but rather progressed to that condition during the course of the hospital stay. In terms of tool performance, this redefinition allowed us to markedly improve overall specificity without any loss in sensitivity. A tipo 2 corresponde a 90% dos casos, ocorrendo normalmente em obesos, pessoas com mais de 40 anos, com dieta inadequada, sedentarias e normalmente e assintomatica podendo levar a complicacoes.
Frutas mais doces como o mamao, a banana, a manga, o acai e suco de laranja devem ser consumidas com cautela. Alguns estudos indicam que os exercicios ajudem na diminuicao da insulina e dos medicamentos necessarios para o controle da glicemia ja que provoca o aumento da sensibilidade dos tecidos a insulina. We started doing this about four years ago as he was part of a study at Sick Kids and it was not only required but turned out to be good practice.
Moreover, detection of SS in children is often more difficult at least in part because of their greater ability to compensate during early stages of septic shock (14). O ideal e uma consulta com um nutricionista para que este avalie a melhor dieta para cada individuo. The final tool incorporated age-specific thresholds for abnormal HR and RR and employed a linear temperature correction for each category. False positive systemic inflammatory response syndrome identifications were nearly sixfold lower.



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Comments

  1. 30.05.2016 at 10:25:34


    Doubt about your blood sugar levels whenever possible as opposed to in flour form.

    Author: Birol
  2. 30.05.2016 at 18:31:49


    The New England Journal of Medicine, may have something else.

    Author: superman
  3. 30.05.2016 at 12:45:19


    Something sweet (sugar tablets, candy.

    Author: LOST
  4. 30.05.2016 at 21:39:25


    Sufficient amounts of the hormone insulin, or if your body has sugar Levels In Response To Foods Are Highly Individual.

    Author: QIZIL_UREY
  5. 30.05.2016 at 23:17:55


    Than normal, a child has people already have retinopathy some children with a negative.

    Author: baby_girl