Detection of ketonemia and its relationship with hyperglycemia in type 1 diabetic patients.

The aims of this study were to assess the prevalence of ketosis in type 1 diabetic patients with casual hyperglycemia (>250 mg/dl), to establish the relationship between glycemia and ketonemia during daily life, and to determine the utility of ketonemia. Capillary glycemia levels from 562 type 1 diabetic patients were recorded. Prevalence of casual hyperglycemia was 27.58%, and prevalence of asymptomatic ketonemia was 8.39%. Regarding blood ketone levels, 110 out of 155 patients (70.96%) had blood ketone levels of between 0 and 0.1 mmol/l and 32 out of 155 patients (20.63%) had blood ketone levels of between 0.2 and 0.4 mmol/l. Surprisingly, the mean glycemia levels in these subgroups did not differ and was consistently high (around 300 mg/dl), leading to the observation that even ketone levels considered as non-pathologic should probably be taken into account for a proper diabetes control. Some discrepancies between quantitative determination of ketonuria and qualitative determination of ketonemia were observed. That is in 20 patients with positive ketonuria, ketonemia was not detected, probably because ketosis was already resolved. Asymptomatic ketosis was observed in the hyperglycemic type 1 diabetic population, and metabolic control of these patients with a point of care device is recommended, together with a subsequent revision of insulin treatment. Furthermore, this study supports the opinion that the presence of ketosis, detected by beta-OHB levels, even below levels considered as pathologic, together with hyperglycemia, must be taken into account for proper monitoring and therapeutic control of diabetic patients.

Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals.

INTRODUCTION: In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). OBJECTIVE: To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. METHOD: A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n=306) hospitalized for ≥48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. RESULTS: 288 patients were included for analysis (62.5% males; 70.3±10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95%CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P<.05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32±0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for<40 IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P<.05). CONCLUSIONS: Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged.

Behavior of some solid food simulants in contact with several plastics used in microwave ovens.

The behavior of two synthetic adsorbents, Tenax and Porapak, as food simulants in contact with some plastic containers commercially available, recommended to be used for heating food in microwave ovens, has been studied. Containers of polycarbonate (PC), polypropylene (PP), polypropylene random (PP-random), polypropylene-20% talcum (PP%T), and the copolymer styrene-acrylonytrile (SAN) have been studied at 150 degrees C (PC) and 120 degrees C (the others). The volatile compounds released from the plastics and trapped into Tenax and Porapak have been analyzed by thermal desorption-gas chromatography-mass spectrometry (TD-GC-MS). The results obtained from these migration studies at high temperature are shown and discussed. Tenax performs better than Porapak at low temperature since the former desorbs the compounds at high temperature.

Neumoperitoneo por inyecciones subcutáneas. A propósito de un caso / Pneumoperitoneum by subcutaneous injections of GLP-1 analogues. A case report

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Implementación del protocolo hospitalario de insulinización subcutánea para pacientes no críticos en hospitales andaluces de tercer nivel / Implementation of subcutaneous insulin protocol for non-critically ill hospitalized patients in andalusian tertiary care hospitals

INTRODUCCIÓN: En 2009, la Sociedad Andaluza de Endocrinología y Nutrición diseñó un protocolo de insulinización subcutánea para pacientes hospitalizados no críticos («Protocolo de insulinización hospitalaria para el paciente no crítico» [PIH]), adoptado dentro del Sistema Sanitario Público Andaluz. OBJETIVOS: Analizar la implementación del PIH en hospitales de tercer nivel del Sistema Sanitario Público Andaluz. MÉTODO: Estudio multicéntrico descriptivo transversal en 8 hospitales andaluces de tercer nivel, mediante muestreo aleatorizado de pacientes ingresados ≥ 48 h, con DM (n = 306), en 5 servicios médicos (SM) y 2 quirúrgicos (SQ). La DM tipo 1, DM por trastornos específicos, soporte nutricional artificial, tratamiento esteroideo y gestación fueron criterios de exclusión. RESULTADOS: Se incluyeron 288 pacientes (varones 62,5%; 70,3 ± 10,3 años; 71,5% SM y 28,5% SQ). El régimen insulínico basal-bolus-corrección se instauró en el 55,9% (IC 95%: 50,5 - 61,2%); 63,1% SM vs. 37,8% SQ (p < 0,05). Las alternativas al régimen insulínico basal-bolus-corrección fueron: pautas móviles de insulina rápida (43,7%), dieta (31,3%), antidiabéticos orales (17,2%), premezclas (1,6%) y otras (6,2%). En pacientes tratados previamente con antidiabéticos orales, la dosis de insulina durante el ingreso fue 0,32 ± 0,1 UI/kg/día. En pacientes tratados previamente con insulina, la dosis de insulina durante el ingreso se incrementó en un 17% [-13-53] y en pacientes con terapia combinada, en 26,4% [-6-100]. Las pautas correctoras empleadas para < 40UI/día y 40-80UI/día fueron las recomendadas en el 72,2% y el 56,7%, respectivamente. Se solicitó HbA1c en el 23,6% (IC 95%: 18,8-28,8); 27,7% SM vs. 13,3% SQ (p < 0,05). CONCLUSIONES: Son recomendables estrategias para aumentar la implantación del PIH, especialmente en servicios quirúrgicos. Las pautas móviles de insulina rápida son la alternativa más frecuente al régimen insulínico basal-bolus-corrección. Es preciso fomentar la valoración del control metabólico al ingreso

INTRODUCTION: In 2009, the Andalusian Society of Endocrinology and Nutrition designed a protocol for subcutaneous insulin treatment in hospitalized non-critically ill patients (HIP). OBJECTIVE: To analyze implementation of HIP at tertiary care hospitals from the Andalusian Public Health System. Method A descriptive, multicenter study conducted in 8 tertiary care hospitals on a random sample of non-critically ill patients with diabetes/hyperglycemia (n = 306) hospitalized for ≥ 48 hours in 5 non-surgical (SM) and 2 surgical (SQ) departments. Type 1 and other specific types of diabetes, pregnancy and nutritional support were exclusion criteria. RESULTS: 288 patients were included for analysis (62.5% males; 70.3 ± 10.3 years; 71.5% SM, 28.5% SQ). A scheduled subcutaneous insulin regimen based on basal-bolus-correction protocol was started in 55.9% (95% CI: 50.5-61.2%) of patients, 63.1% SM vs. 37.8% SQ (P < .05). Alternatives to insulin regimen based on basal-bolus-correction included sliding scale insulin (43.7%), diet (31.3%), oral antidiabetic drugs (17.2%), premixed insulin (1.6%), and others (6.2%). For patients previously on oral antidiabetic drugs, in-hospital insulin dose was 0.32 ± 0.1 IU/kg/day. In patients previously on insulin, in-hospital insulin dose was increased by 17% [-13-53], and in those on insulin plus oral antidiabetic drugs, in-hospital insulin dose was increased by 26.4% [-6-100]. Supplemental insulin doses used for < 40IU/day and 40-80 IU/day were 72.2% and 56.7% respectively. HbA1c was measured in 23.6% of patients (95CI%: 18.8-28.8); 27.7% SM vs. 13.3% SQ (P < .05). CONCLUSIONS: Strategies are needed to improve implementation of the inpatient subcutaneous insulin protocol, particularly in surgical departments. Sliding scale insulin is still the most common alternative to insulin regimen based on basal-bolus-correction scheduled insulin. Metabolic control assessment during hospitalization should be encouraged

Asistencia a la gestante con diabetes. Guía de práctica clínica actualizada en 2014 / Care of pregnancies complicated by diabetes. Clinical practice guidelines: 2014 update

La diabetes es una de las complicaciones metabólicas más frecuentes de la gestación y se asocia a un incremento del riesgo de morbimortalidad maternal y fetal, que pueden evitarse y/o reducirse con un adecuado control. En la diabetes pregestacional, la preparación específica previa a la gestación es indispensable para intentar conseguir un control glucémico lo más próximo a la normalidad, evaluar complicaciones y revisar las pautas de tratamientos farmacológicos. En el caso de la diabetes gestacional, el tratamiento de esta entidad ha demostrado disminuir la tasa de complicaciones maternas y perinatales, por lo que su diagnóstico está justificado. En relación con la estrategia diagnóstica, ante la falta de consenso y la controversia desatada tras la aparición de los nuevos criterios IADPSG, el grupo ha decidido mantener la misma estrategia diagnóstica en 2 pasos y con los mismos puntos de corte hasta disponer de datos sólidos que avalen la introducción de nuevos criterios

Diabetes is one of the most common metabolic complications of pregnancy, and is associated with an increased risk of maternal and foetal morbidity and mortality that can be prevented and/or reduced with adequate glycaemic control. In pre-gestational diabetes, specific preparation prior to the pregnancy is essential in order to achieve glycaemic control near to normal as possible and to evaluate complications and review pharmacologic treatment prescription. The treatment of gestational diabetes has been shown to decrease the rate of maternal and perinatal complications, thus its diagnosis is justified. As regards the diagnostic strategy and due to the lack of consensus and the controversy arising after the publication of the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG), the group has decided to keep the same diagnostic strategy in two stages, and with the same cut-off points, until there are solid data available that support the introduction of new criteria

Influence of reduction in the elution times on HPLC glycohaemoglobin results.

OBJECTIVES: To compare HPLC methods with short and long elution times for HbA1c measurement in blood. METHODS: Comparison between G7-Tosoh (1.2 min); Bio-Rad-Variant-II-Turbo (1.3 min) and Arkray-HA-8160 (2.9 min). RESULTS: Passing-Bablok regression equations were: Y=0.17+0.96X; Y=-0.39+1.01X; Y=-0.40+1.0X and the means of the differences using Bland-Altman Plot were 0.02; -0.34; 0.32 for HA-8160/G7-Tosoh, HA-8160/Variant-II-Turbo and G7-Tosoh/Variant-II-Turbo, respectively. CONCLUSIONS: Faster elution methods had no problems on reproducibility of results obtained by slower elution methods.

Síndrome de Melkersson-Rosenthal: presentación de un caso / Melkerson-Rosenthal syndrome: presentación of a case

El síndrome de Melkersson-Rosenthal es una rara afección que cursa con parálisis facial recurrente, edema facial recurrente (fundamentalmente del labio) y lengua escrotal. Se presenta el caso de un paciente con este síndrome; se llega al diagnóstico del mismo por la triada clínica y se corrobora por el diagnóstico histopatológico de la queilitis